Benchmarking Visual Performance with Monofocal Intraocular Lenses with and without Enhanced Optical Properties in a Nighttime Driving Simulator Environment: A Proof-of-Concept Study.

Background: The purpose of this study is to introduce a method for benchmarking intraocular lenses during driving activities under highly standardized conditions, specifically with regard to visual acuity (VA) and contrast sensitivity (CS). Therefore, patients with intraocular lens (IOL) implants ICB00 (Tecnis Eyhance, Johnson & Johnson, Santa Ana, CA, USA) vs. CNA0T0 (Clareon, Alcon Laboratories Inc., Fort Worth, TX, USA) were examined clinically and in a nighttime driving simulator.

Patients And Methods: Clinical tests for high (HCVA), low contrast (LCVA) distant VA, and mesopic CS were conducted in subjects at least 2 months after binocular IOL surgery (inclusion criteria: VA > 20/25, ophthalmologically normal, except cataract surgery). All patients completed a straight driving simulator route. VA, CS, and halo size were assessed binocularly during nighttime driving using eight-position Landolt Cs in four different locations and two (far and intermediate) distances.

Results: Results are presented as median/interquartile range: ICB00 data (corresponding CNA0T0 data are shown in brackets): 5 (6) subjects, aged 69.6/8.3 (71.1/13.0) years were enrolled. Clinical tests: logMAR HCVA 0.11/0.39 (0.00/0.51), logMAR LCVA 0.78/0.52 (0.80/0.54); logCS without glare 0.50/0.31 (0.30/0.65), logCS with glare 0.20/0.15 (0.20/0.5). Nighttime driving simulator: logMAR VA thresholds for right roadside, dashboard, navigation screen, and interior rear-view mirror were 0.50/0.06 (0.57/0.22), 0.81/0.07 (0.91/0.14), 0.80/0.17 (0.92/0.27), 0.50/0.11 (0.63/0.26); logCS thresholds were1.53/0.67 (1.00/0.81), 0.82/0.11 (0.61/0.19), 0.71/0.14 (0.50/0.15), 0.87/0.07 (0.81/0.11). Halo size: 5.40°/0.89° (5.88°/2.00°).

Conclusions: Within a nighttime driving simulator environment, ICB00 exceeded CNA0T0 in median logMAR (VA) and logCS by 0.1 log unit at intermediate distances (dashboard, navigation screen). The clinical test for far and remote distances did not show a difference. These results confirm benefits of monofocal IOLs with enhanced optical properties for intermediate distances compared to conventional monofocal lenses within the target medium distance ranges.