Depression Improvement Correlates With Lower TMS Intensity in a Randomized Trial With Real-Time E-Field Modeling.

Keratoconus (KC) is a progressive, non-inflammatory corneal ectasia characterized by stromal thinning and irregular astigmatism, often resulting in significant high-order aberrations (HOAs) that impair visual quality. Due to these optical limitations, the use of premium intraocular lenses (pIOLs) has traditionally been considered contraindicated in these patients []. However, in early-stage KC, corneal shape and optical quality may remain acceptable, with HOAs within tolerable limits [–], making carefully selected pIOLs a potential option. Among pIOLs, extended-depth-of-focus (EDOF) pIOLs provide significantly fewer visual disturbances than multifocal lenses [–] and, as they are designed to maintain functional retinal image quality across an extended focal range [], can offer greater tolerance to minor defocus and wavefront aberrations, possibly mitigating HOAs and coma-like distortions characteristic of early KC. This is especially true for non-diffractive EDOF pIOLs, which preserve high level of contrast sensitivity (CS) by not splitting light energy into multiple focal points [], like the AcrySof IQ Vivity pIOL (Alcon, Fort Worth, TX, USA) which uses wavefront-shaping technology to elongate the focal range [, ] with reported favourable outcomes in patients with challenging ocular conditions such as glaucoma, macular degeneration and epiretinal membrane [–]. The present pilot study aims to evaluate the visual performance, tolerance, and optical quality outcomes after Vivity pIOL implantation in patients with cataract and stable, early-stage KC. This investigation explores the clinical feasibility of pIOLs in a population traditionally excluded from such refractive options.