Optical quality in decentration of intraocular lenses: updated systematic review

Topic: To evaluate the impact of intraocular lens (IOL) decentration on optical quality and performance using optical bench studies and ray-tracing numerical simulations, and to analyze how different IOL designs (monofocal, extended depth-of-focus [EDOF], multifocal, and toric) respond to decentration. Clinical Relevance: IOL decentration may adversely affect visual outcomes, particularly with newer IOL designs. Despite advances in surgical techniques, optimal centration cannot always be guaranteed because of anatomical variability and other factors. Understanding how different IOL designs tolerate decentration is therefore essential for appropriate lens selection and optimized postoperative visual quality. Methods: A systematic review of the literature was conducted following PRISMA guidelines. Searches were performed in PubMed, Scopus, and Google Scholar using Boolean operators and truncated terms. Inclusion criteria focused on indexed optical bench studies published in English over the past 20 years. Data were extracted on optical metrics such as modulation transfer function, Strehl ratio, wavefront aberrations, and point spread function, in relation to various degrees of IOL decentration and lens types. Results: A total of 74 studies were included. Aspheric monofocal IOLs with negative spherical aberration showed greater optical degradation with decentration compared with spherical models. Multifocal and EDOF IOLs were more sensitive to decentration, with notable reductions in image quality and contrast sensitivity, especially at higher decentration levels. Toric IOLs were particularly affected when decentration was combined with rotational misalignment. Optical quality loss was directly related to each lens's design and optical profile. Conclusions: IOL decentration has a measurable and clinically relevant impact on optical quality, especially in aspheric and multifocal designs. Understanding IOL behavior under decentration conditions is essential for optimizing lens selection and postoperative visual outcomes.