Purpose: To evaluate the effect of decentration of a monofocal intraocular lens (IOL) and a refractive multifocal IOL on retinal image quality using a new visual simulation system. Methods: Using a new visual simulation system, we performed visual simulation of a monofocal and a multifocal IOL at 5, 4, 3, 2, 1, and 0.4 m with several decentered IOL positions from 0 to 1.0 mm through a 3- or 4-mm aperture using Landolt visual acuity (VA) charts. The VA was estimated under each condition from the simulated retinal image. Results: With a monofocal IOL, the image was affected minimally by decentration at 4 and 5 m; at 2 and 3 m, the image contrast decreased slightly with increased decentration. With the multifocal IOL, some loss of image contrast developed at all distances compared with the monofocal IOL; however, the images of the Landolt's rings were still recognizable under all conditions. Conclusions: Our results suggest that up to 1.0 mm of decentration of a monofocal and multifocal IOL would not greatly affect the retinal image quality.
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