title: The clinical depth of field achievable with trifocal and monofocal intraocular lenses: theoretical considerations and proof of concept clinical results.
abstract: BACKGROUND
  To estimate the depth of field (DOF) achievable with multi-and monofocal intraocular lenses (IOLs) and compare with actual measurements of DOF in cases implanted with a trifocal IOL and biconvex monofocal IOL METHODS: I) Computer simulations were produced to describe the relationship between DOF, pupil size, preoperative ametropia, and retinal blur tolerance limit for a model eye implanted with either multi- or monofocal IOLs. II) Monocular DOF and pupil size were measured under distance viewing conditions between 3 and 6 months postoperative following uneventful cataract surgery. Cases were implanted with either i) trifocal aspheric IOL (n = 36), or ii) biconvex aspheric monofocal IOL (n = 26). DOF was also measured at 0.33 m in cases implanted with i).
  
  
  RESULTS
  Simulations revealed significant associations between DOF, pupil size, and retinal blur tolerance limit. The mean (±SD) DOF & pupil sizes were at distance for i)  above 2.59D (0.68) & 3.54 mm (0.377), and for ii) above 1.67D (0.51) & 2.90 mm (0.351), and for i) above 3.16D (0.46) at near. The difference between groups were significant for DOF and pupil size at distance (p < 0.001). DOF was significantly greater at near compared with distance in i) above (p < 0.001). For a pupil size of 3 mm, the simulations produce similar DOF values when the tolerance limit of retinal blur is 10 μ.
  
  
  CONCLUSIONS
  The DOF was significantly better after implanting the trifocal IOL compared with the monofocal IOL, and DOF is increased under near viewing conditions. The clinical results are similar to calculated DOF values when the tolerance limit of retinal blur is 10 μ.
authors.affiliation: Special Eye Hospital Svjetlost, Heinzelova 39, 10000, Zagreb, Croatia. ante.barisic@svjetlost.hr.
authors.forename: Ante
authors.initials: A
authors.lastname: Barišić
authors.affiliation: Special Eye Hospital Svjetlost, Heinzelova 39, 10000, Zagreb, Croatia.|NHS National Services Scotland, Edinburgh, UK.
authors.forename: Sudi
authors.initials: S
authors.lastname: Patel
authors.affiliation: Special Eye Hospital Svjetlost, Heinzelova 39, 10000, Zagreb, Croatia.
authors.forename: Nikica
authors.initials: N
authors.lastname: Gabric
authors.affiliation: Barzilai Hospital, BenGurion University of the Negev, BerSheeba, Israel.
authors.forename: Claes G
authors.initials: CG
authors.lastname: Feinbaum
mesh_terms: D002387:Cataract Extraction; D003198:Computer Simulation; D015350:Contrast Sensitivity; D006801:Humans; D007910:Lenses, Intraocular / Q000592:standards*; D008954:Models, Biological; D011446:Prospective Studies; D011474:Prosthesis Design; D014792:Visual Acuity
keywords: Depth of field; Intraocular lenses; Pupil; Retinal blur