The Visual Impact of Induced Astigmatism of a Violet Light-Filtering Diffractive Extended Depth of Focus Intraocular Lens

Purpose To evaluate tolerance to simulated astigmatism on distance visual acuity in pseudophakic eyes implanted with an extended depth of focus (EDOF) diffractive intraocular lens (IOL) with violet light filter. Methods This prospective observational study enrolled consecutive patients who underwent cataract surgery with violet light-filtering diffractive EDOF IOL implantation. Cylinder defocus was induced with plus cylinder lenses from +0.50 to +2.00 diopters (D) in 0.50-D steps for each astigmatic orientation (against-the-rule [ATR], oblique, and with-the-rule [WTR]). The monocular distance visual acuity was measured after induced astigmatism was added to the patient's corrected distance manifest refraction. The magnitude of astigmatic tolerance was assessed by taking the difference between distance visual acuity at each defocus relative to corrected distance visual acuity without defocus. Quality of vision was evaluated using the National Eye Institute Visual Function Questionnaire (VFQ-25). Results Most patients maintained 20/40 or better distance visual acuity with up to 1.00 D WTR astigmatism and 0.50 D ATR and oblique astigmatism. The median astigmatic defocus to maintain distance visual acuity within one-line reduction was 1.00 D with WTR and 0.50 D with ATR and oblique astigmatism. Within a two-line reduction, it was 1.50 D for WTR and 1.00 D for oblique and ATR. All patients reported excellent outcomes on the VFQ-25 questionnaire. Conclusions The diffractive EDOF IOL with violet light filter demonstrated satisfactory distance vision tolerance to induced astigmatism. WTR astigmatism was better tolerated for distance vision than oblique and ATR astigmatism. [ J Refract Surg . 2025;41(5):e421–e426.]