Multifocal intraocular lenses and glare.

In a previous paper, we reported finding deficits in the contrast sensitivity functions of patients with diffractive multifocal intraocular lenses (IOL's). The results were consistent with optical measurements of the modulation transfer function (MTF) of the IOL. When this MTF is treated as a linear spatial frequency filter, it predicts the existence of a glare effect; contrast threshold for the recognition of target letters should be elevated by a bright, adjacent stimulus. We tested this prediction by measuring contrast thresholds for recognizing 0.2 degrees Sloan letters on a background luminance of 11.2 cd/m2. The letters were presented inside bright (300 cd/m2) annular rings with inner diameters ranging from 0.42 to 1.22 degrees. Thresholds were measured for seven multifocal subjects, age-matched groups of monofocal subjects and phakic-control subjects, and a young group. Multifocal subjects exhibited a greater glare effect than monofocal subjects, and they in turn exhibited a greater effect than phakic-control subjects. The observed glare effect for multifocal subjects was about twice that expected from the spatial filtering property of the multifocal IOL.