Aims To evaluate the visual performance of an aberration-free intraocular lens (IOL) in patients with different corneal profiles using adaptive optics visual simulation.

Methods A crx1 adaptive optics visual simulator was used to simulate the aberration pattern of an aberration-free IOL combined with five corneal profiles: virgin corneas and corneas with low and high myopic ablations and low and high hyperopic ablations. Ten eyes of 10 subjects were evaluated, and monocular distance visual acuity (VA) at 100%, 50% and 10% of contrast was measured.

Results At 100% of contrast, no differences were found in VA values among virgin corneas, low and high myopic ablations and low hyperopic ablation groups (p=0.06). All these groups achieved better results than the high hyperopic ablation group (p<0.001). At 50% and 10%, the best values of VA were obtained for the virgin corneas and for the low myopic and low hyperopic ablation groups (p>0.1, for both levels of contrast). Significant differences were found between these three corneal profiles and the other two corneal profiles (p<0.002 for high myopic and p<0.001 for high hyperopic, for both levels of contrasts).

Conclusions The results suggest that the aberration-free IOL design gives an excellent visual performance for a range of corneal spherical aberrations that could correspond to patients with virgin corneas and patients in which the corneal spherical aberration has been slightly modified by a hyperopic or myopic laser ablation.