{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,3,27]],"date-time":"2026-03-27T14:53:12Z","timestamp":1774623192870,"version":"3.50.1"},"reference-count":37,"publisher":"Springer Science and Business Media LLC","issue":"1","license":[{"start":{"date-parts":[[2026,2,27]],"date-time":"2026-02-27T00:00:00Z","timestamp":1772150400000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"},{"start":{"date-parts":[[2026,2,27]],"date-time":"2026-02-27T00:00:00Z","timestamp":1772150400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"}],"content-domain":{"domain":["link.springer.com"],"crossmark-restriction":false},"short-container-title":["Ophthalmic Physiol. Opt."],"published-print":{"date-parts":[[2026,3]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Purpose<\/jats:title>\n                    <jats:p>Achieving good visual quality with a conventional spherocylindrical (CSC) lens requires precise alignment with the principal meridians of the astigmatism to be corrected. Despite advancements in stabilisation, current contact lens and intraocular lens designs face limitations on this regard. This study introduces different trizonal multi-toric (TMT) lens designs endowed with three concentric zones to provide 3.50\u2009D of astigmatic correction, with increased tolerance to rotational errors. Experimental results using low-contrast optotypes are also presented for the best purposed design.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>First, several variants of 3.50\u2009D astigmatic TMT designs were created and evaluated by means of retinal image simulation. The optical TMT design was then selected based on its Visual Strehl Ratio (VSR) performance and simulated image quality. Subsequently, a double-blind clinical study was conducted using an adaptive optics visual simulator and low-contrast optotypes. The study compared the maximum low-contrast visual acuity (LCVA) achieved with the best TMT design to that of a conventional spherocylindrical (CSC) design under varying degrees of rotational error.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>Numerical image simulations confirmed the superior rotational tolerance of the TMT designs, compared with CSC lenses, maintaining acceptable image quality up to \u00b17.50\u00b0, particularly with a 40% central zone. Clinical evaluation showed that the 3.50\u2009D astigmatic CSC design provided better LCVA than the best TMT design when properly aligned; however, this advantage decreased quickly with increasing rotational error. At \u00b17.50\u00b0, the CSC suffered a nearly two-line loss (+0.19 logMAR) compared with a one-line loss (+0.07 logMAR) achieved for the best TMT design tested here.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>Retinal image simulations have shown that TMT designs with a 40% central zone exhibit superior tolerance to rotational errors than CSC lenses. Moreover, the LCVA of the TMT design used in this study remained more stable under rotational errors than that of a CSC lens.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1007\/s44402-026-00025-3","type":"journal-article","created":{"date-parts":[[2026,2,27]],"date-time":"2026-02-27T07:44:55Z","timestamp":1772178295000},"page":"124-132","update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["An experimental study on the influence of low-contrast optotypes on the performance of multi-toric lenses for astigmatism compensation"],"prefix":"10.1007","volume":"46","author":[{"given":"Diana","family":"Gargallo","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Anabel","family":"Martinez-Espert","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Laura","family":"Rem\u00f3n","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Jorge","family":"Ares","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"297","published-online":{"date-parts":[[2026,2,27]]},"reference":[{"key":"25_CR1","doi-asserted-by":"publisher","first-page":"1793","DOI":"10.1364\/josaa.18.001793","volume":"18","author":"J Porter","year":"2001","unstructured":"Porter J, Guirao A, Cox IG, Williams DR. Monochromatic aberrations of the human eye in a large population. J Opt Soc Am A. 2001;18:1793\u2013803. https:\/\/doi.org\/10.1364\/josaa.18.001793.","journal-title":"J Opt Soc Am A"},{"key":"25_CR2","doi-asserted-by":"publisher","first-page":"599","DOI":"10.1097\/OPX.0b013e3181a6a211","volume":"86","author":"JM Miller","year":"2009","unstructured":"Miller JM. Clinical applications of power vectors. Optom Vis Sci. 2009;86:599\u2013602. https:\/\/doi.org\/10.1097\/OPX.0b013e3181a6a211.","journal-title":"Optom Vis Sci"},{"key":"25_CR3","doi-asserted-by":"publisher","first-page":"1208","DOI":"10.1097\/j.jcrs.0000000000000273","volume":"46","author":"JT Holladay","year":"2020","unstructured":"Holladay JT, Koch DD. Residual astigmatism with toric intraocular lens misalignment. J Cataract Refract Surg. 2020;46:1208\u20139. https:\/\/doi.org\/10.1097\/j.jcrs.0000000000000273.","journal-title":"J Cataract Refract Surg"},{"key":"25_CR4","doi-asserted-by":"publisher","first-page":"e0311566","DOI":"10.1371\/journal.pone.0311566","volume":"19","author":"D Gargallo","year":"2024","unstructured":"Gargallo D, Rem\u00f3n L, Ares J, Castro-Alonso FJ. The influence of rotational error and axial shift of toric intraocular lenses on residual astigmatism. PLoS ONE. 2024;19:e0311566 https:\/\/doi.org\/10.1371\/journal.pone.0311566.","journal-title":"PLoS ONE"},{"key":"25_CR5","doi-asserted-by":"publisher","first-page":"523","DOI":"10.1016\/s0886-3350(13)80232-5","volume":"20","author":"K Shimizu","year":"1994","unstructured":"Shimizu K, Misawa A, Suzuki Y. Toric intraocular lenses: correcting astigmatism while controlling axis shift. J Cataract Refract Surg. 1994;20:523\u20136. https:\/\/doi.org\/10.1016\/s0886-3350(13)80232-5.","journal-title":"J Cataract Refract Surg"},{"key":"25_CR6","doi-asserted-by":"publisher","first-page":"267","DOI":"10.1111\/opo.12128","volume":"34","author":"SA Read","year":"2014","unstructured":"Read SA, Vincent SJ, Collins MJ. The visual and functional impacts of astigmatism and its clinical management. Ophthalmic Physiol Opt. 2014;34:267\u201394. https:\/\/doi.org\/10.1111\/opo.12128.","journal-title":"Ophthalmic Physiol Opt"},{"key":"25_CR7","doi-asserted-by":"publisher","first-page":"1340","DOI":"10.1016\/j.jcrs.2019.03.030","volume":"45","author":"F Zhou","year":"2019","unstructured":"Zhou F, Jiang W, Lin Z, Li X, Li J, Lin H, et al. Comparative meta-analysis of toric intraocular lens alignment accuracy in cataract patients: image-guided system versus manual marking. J Cataract Refract Surg. 2019;45:1340\u20135. https:\/\/doi.org\/10.1016\/j.jcrs.2019.03.030.","journal-title":"J Cataract Refract Surg"},{"key":"25_CR8","doi-asserted-by":"publisher","first-page":"1654","DOI":"10.1016\/j.jcrs.2014.01.044","volume":"40","author":"T Miyake","year":"2014","unstructured":"Miyake T, Kamiya K, Amano R, Iida Y, Tsunehiro S, Shimizu K. Long-term clinical outcomes of toric intraocular lens implantation in cataract cases with preexisting astigmatism. J Cataract Refract Surg. 2014;40:1654\u201360. https:\/\/doi.org\/10.1016\/j.jcrs.2014.01.044.","journal-title":"J Cataract Refract Surg"},{"key":"25_CR9","doi-asserted-by":"publisher","first-page":"2289","DOI":"10.1364\/OL.518973","volume":"49","author":"D Gargallo","year":"2024","unstructured":"Gargallo D, Martinez-Espert A, Perches S, Collados MV, Rem\u00f3n Mart\u00edn L, Ares J. Multi-toric optical element to compensate ocular astigmatism with increased tolerance under rotation. Opt Lett. 2024;49:2289\u201392. https:\/\/doi.org\/10.1364\/OL.518973.","journal-title":"Opt Lett"},{"key":"25_CR10","unstructured":"De Carle JT. Bifocal contact lenses. US Patent 4704016 A, United States; 1987."},{"key":"25_CR11","doi-asserted-by":"publisher","first-page":"1071","DOI":"10.1097\/01.opx.0000192347.57764.4c","volume":"82","author":"J Ares","year":"2005","unstructured":"Ares J, Flores R, Bara S, et al. Presbyopia compensation with a quartic axicon. Optom Vis Sci. 2005;82:1071 https:\/\/doi.org\/10.1097\/01.opx.0000192347.57764.4c.","journal-title":"Optom Vis Sci"},{"key":"25_CR12","doi-asserted-by":"publisher","first-page":"175","DOI":"10.1097\/OPX.0000000000000476","volume":"92","author":"J Woods","year":"2015","unstructured":"Woods J, Woods C, Fonn D. Visual performance of a multifocal contact lens versus monovision in established presbyopes. Optom Vis Sci. 2015;92:175\u201382. https:\/\/doi.org\/10.1097\/OPX.0000000000000476.","journal-title":"Optom Vis Sci"},{"key":"25_CR13","doi-asserted-by":"publisher","first-page":"e43","DOI":"10.1111\/aos.13173","volume":"95","author":"P Kang","year":"2017","unstructured":"Kang P, McAlinden C, Wildsoet CF. Effects of multifocal soft contact lenses used to slow myopia progression on quality of vision in young adults. Acta Ophthalmol. 2017;95:e43\u2013e53. https:\/\/doi.org\/10.1111\/aos.13173.","journal-title":"Acta Ophthalmol"},{"key":"25_CR14","doi-asserted-by":"publisher","first-page":"393","DOI":"10.1016\/j.clae.2018.03.006","volume":"41","author":"P Fernandes","year":"2018","unstructured":"Fernandes P, Amorim-de-Sousa A, Queir\u00f3s A, Escand\u00f3n-Garcia S, McAlinden C, Gonz\u00e1lez-M\u00e9ijome JM. Light disturbance with multifocal contact lens and monovision for presbyopia. Cont Lens Anterior Eye. 2018;41:393\u20139. https:\/\/doi.org\/10.1016\/j.clae.2018.03.006.","journal-title":"Cont Lens Anterior Eye"},{"key":"25_CR15","doi-asserted-by":"publisher","first-page":"21","DOI":"10.1111\/cxo.12987","volume":"103","author":"PS Kollbaum","year":"2020","unstructured":"Kollbaum PS, Bradley A. Correction of presbyopia: old problems with old (and new) solutions. Clin Exp Optom. 2020;103:21\u201330. https:\/\/doi.org\/10.1111\/cxo.12987.","journal-title":"Clin Exp Optom"},{"key":"25_CR16","unstructured":"American National Standards Institute. ANSI Z8028-2022: ophthalmics-methods of reporting optical aberrations of eyes. Washington, DC: ANSI; 2022."},{"key":"25_CR17","unstructured":"Jalie M. The principles of ophthalmic lenses. 4th ed. London: The Association of British Dispensing Opticians; 1994. p. 41\u201342."},{"key":"25_CR18","unstructured":"Emsley HH. Visual optics. London: Hatton; 1952."},{"key":"25_CR19","doi-asserted-by":"publisher","first-page":"e0150204","DOI":"10.1371\/journal.pone.0150204","volume":"11","author":"S Perches","year":"2016","unstructured":"Perches S, Collados MV, Ares J. Visual Strehl ratio as a measure of image quality in optical systems. PLoS ONE. 2016;11:e0150204 https:\/\/doi.org\/10.1371\/journal.pone.0150204.","journal-title":"PLoS ONE"},{"key":"25_CR20","doi-asserted-by":"publisher","first-page":"57","DOI":"10.1097\/01.opx.0000195563.82891.3b","volume":"83","author":"DR Iskander","year":"2006","unstructured":"Iskander DR. Computational aspects of the visual Strehl ratio. Optom Vis Sci. 2006;83:57\u201359. https:\/\/doi.org\/10.1097\/01.opx.0000195563.82891.3b.","journal-title":"Optom Vis Sci"},{"key":"25_CR21","doi-asserted-by":"publisher","first-page":"322","DOI":"10.1167\/4.4.8","volume":"4","author":"JD Marsack","year":"2004","unstructured":"Marsack JD, Thibos LN, Applegate RA. Metrics of optical quality derived from wave aberrations predict visual performance. J Vis. 2004;4:322\u20138. https:\/\/doi.org\/10.1167\/4.4.8.","journal-title":"J Vis"},{"key":"25_CR22","doi-asserted-by":"publisher","first-page":"S579","DOI":"10.3928\/1081-597X20030901-14","volume":"19","author":"X Cheng","year":"2003","unstructured":"Cheng X, Thibos LN, Bradley A. Estimating visual quality from wavefront aberration measurements. J Refract Surg. 2003;19:S579\u2013S584. https:\/\/doi.org\/10.3928\/1081-597X20030901-14.","journal-title":"J Refract Surg"},{"key":"25_CR23","doi-asserted-by":"publisher","first-page":"4601","DOI":"10.3928\/1081-597X-20020901-27","volume":"45","author":"PA Piers","year":"2004","unstructured":"Piers PA, Fernandez EJ, Manzanera S, Norrby S, Artal P. Adaptive optics visual simulator: a clinical tool to study visual performance. Invest Ophthalmol Vis Sci. 2004;45:4601 https:\/\/doi.org\/10.3928\/1081-597X-20020901-27.","journal-title":"Invest Ophthalmol Vis Sci"},{"key":"25_CR24","doi-asserted-by":"publisher","first-page":"20","DOI":"10.1097\/ICL.0b013e3182048fb9","volume":"37","author":"G Young","year":"2011","unstructured":"Young G, Sulley A, Hunt C. Prevalence of astigmatism in relation to soft contact lens fitting. Eye Contact Lens. 2011;37:20\u20135. https:\/\/doi.org\/10.1097\/ICL.0b013e3182048fb9.","journal-title":"Eye Contact Lens"},{"key":"25_CR25","doi-asserted-by":"publisher","first-page":"1479","DOI":"10.1016\/j.jcrs.2010.03.035","volume":"36","author":"PC Hoffmann","year":"2010","unstructured":"Hoffmann PC, H\u00fctz WW. Analysis of biometry and prevalence data for corneal astigmatism in 23,239 eyes. J Cataract Refract Surg. 2010;36:1479\u201385. https:\/\/doi.org\/10.1016\/j.jcrs.2010.03.035.","journal-title":"J Cataract Refract Surg"},{"key":"25_CR26","doi-asserted-by":"publisher","first-page":"104","DOI":"10.1016\/j.clae","volume":"34","author":"TB Edrington","year":"2011","unstructured":"Edrington TB. A literature review: the impact of rotational stabilization methods on toric soft contact lens performance. Cont Lens Anterior Eye. 2011;34:104\u201310. https:\/\/doi.org\/10.1016\/j.clae.","journal-title":"Cont Lens Anterior Eye"},{"key":"25_CR27","doi-asserted-by":"publisher","first-page":"11","DOI":"10.1097\/00006324-200201000-00008","volume":"79","author":"G Young","year":"2002","unstructured":"Young G, Hunt C, Covey M. Clinical evaluation of factors influencing toric soft contact lens fit. Optom Vis Sci. 2002;79:11\u201319. https:\/\/doi.org\/10.1097\/00006324-200201000-00008.","journal-title":"Optom Vis Sci"},{"key":"25_CR28","doi-asserted-by":"publisher","first-page":"65","DOI":"10.1097\/01.ICL.0000436269.00879.4b","volume":"40","author":"W Jin","year":"2014","unstructured":"Jin W, Jin N, Chen Y, Mao X, Xu S, Chen Y, et al. The impact of eyelid and eye contour factors on a toric soft contact lens fitting in Chinese subjects. Eye Contact Lens. 2014;40:65\u201370. https:\/\/doi.org\/10.1097\/01.ICL.0000436269.00879.4b.","journal-title":"Eye Contact Lens"},{"key":"25_CR29","doi-asserted-by":"publisher","first-page":"412","DOI":"10.1016\/j.clae.2018.04.006","volume":"41","author":"D Luensmann","year":"2018","unstructured":"Luensmann D, Schaeffer JL, Rumney NJ, Stanberry A, Walsh K, Jones L. Spectacle prescriptions review to determine prevalence of ametropia and coverage of frequent replacement soft toric contact lenses. Cont Lens Anterior Eye. 2018;41:412\u201320. https:\/\/doi.org\/10.1016\/j.clae.2018.04.006.","journal-title":"Cont Lens Anterior Eye"},{"key":"25_CR30","doi-asserted-by":"publisher","first-page":"1845","DOI":"10.18240\/ijo.2023.11.17","volume":"16","author":"GY Chino-Zhang","year":"2023","unstructured":"Chino-Zhang GY, Ye L, Wang WJ, Guo YM, Wei JH, Ren MX. Effectiveness of toric soft contact lenses for vision correction in patients with different degrees of astigmatism: a real-world study. Int J Ophthalmol. 2023;16:1845\u201353. https:\/\/doi.org\/10.18240\/ijo.2023.11.17.","journal-title":"Int J Ophthalmol"},{"key":"25_CR31","doi-asserted-by":"publisher","first-page":"3721","DOI":"10.2147\/OPTH.S370151","volume":"16","author":"B Gustafson","year":"2022","unstructured":"Gustafson B, Whaley S, Giedd B, Montaquila S, Edwards B, Subbaraman LN. Short-term fit assessment of a novel daily disposable, toric, silicone hydrogel contact lens. Clin Ophthalmol. 2022;16:3721\u201330. https:\/\/doi.org\/10.2147\/OPTH.S370151.","journal-title":"Clin Ophthalmol"},{"key":"25_CR32","doi-asserted-by":"publisher","first-page":"23","DOI":"10.1016\/j.clae.2009.08.003","volume":"33","author":"R McIlraith","year":"2010","unstructured":"McIlraith R, Young G, Hunt C. Toric lens orientation and visual acuity in non-standard conditions. Cont Lens Anterior Eye. 2010;33:23\u201326. https:\/\/doi.org\/10.1016\/j.clae.2009.08.003.","journal-title":"Cont Lens Anterior Eye"},{"key":"25_CR33","doi-asserted-by":"publisher","first-page":"859","DOI":"10.1016\/j.jcrs.2010.11.032","volume":"37","author":"NE de Vries","year":"2011","unstructured":"de Vries NE, Webers CA, Touwslager WR, Bauer NJ, de Brabander J, Berendschot TT, et al. Dissatisfaction after implantation of multifocal intraocular lenses. J Cataract Refract Surg. 2011;37:859\u201365. https:\/\/doi.org\/10.1016\/j.jcrs.2010.11.032.","journal-title":"J Cataract Refract Surg"},{"key":"25_CR34","doi-asserted-by":"publisher","first-page":"4097","DOI":"10.2147\/OPTH.S388462","volume":"16","author":"FA Bucci Jr","year":"2022","unstructured":"Bucci FA Jr. Patient preference, visual quality, and multivariate regression analysis with contralateral bifocal and trifocal intraocular lenses. Clin Ophthalmol. 2022;16:4097\u2013107. https:\/\/doi.org\/10.2147\/OPTH.S388462.","journal-title":"Clin Ophthalmol"},{"key":"25_CR35","doi-asserted-by":"publisher","first-page":"839","DOI":"10.1038\/nn906","volume":"5","author":"MA Webster","year":"2002","unstructured":"Webster MA, Georgeson MA, Webster SM. Neural adjustments to image blur. Nat Neurosci. 2002;5:839\u201340. https:\/\/doi.org\/10.1038\/nn906.","journal-title":"Nat Neurosci"},{"key":"25_CR36","doi-asserted-by":"publisher","first-page":"346","DOI":"10.1016\/j.clae.2014.05.003","volume":"37","author":"H Momeni-Moghaddam","year":"2014","unstructured":"Momeni-Moghaddam H, Naroo SA, Askarizadeh F, Tahmasebi F. Comparison of fitting stability of the different soft toric contact lenses. Cont Lens Anterior Eye. 2014;37:346\u201350. https:\/\/doi.org\/10.1016\/j.clae.2014.05.003.","journal-title":"Cont Lens Anterior Eye"},{"key":"25_CR37","doi-asserted-by":"publisher","first-page":"322","DOI":"10.1016\/j.clae.2016.05.002","volume":"39","author":"A Sivardeen","year":"2016","unstructured":"Sivardeen A, Laughton D, Wolffsohn JS. Investigating the utility of clinical assessments to predict success with presbyopic contact lens correction. Cont Lens Anterior Eye. 2016;39:322\u201330. https:\/\/doi.org\/10.1016\/j.clae.2016.05.002.","journal-title":"Cont Lens Anterior Eye"}],"container-title":["Ophthalmic and Physiological Optics"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1007\/s44402-026-00025-3.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/article\/10.1007\/s44402-026-00025-3","content-type":"text\/html","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1007\/s44402-026-00025-3.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,3,27]],"date-time":"2026-03-27T13:56:53Z","timestamp":1774619813000},"score":1,"resource":{"primary":{"URL":"https:\/\/link.springer.com\/10.1007\/s44402-026-00025-3"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,2,27]]},"references-count":37,"journal-issue":{"issue":"1","published-print":{"date-parts":[[2026,3]]}},"alternative-id":["25"],"URL":"https:\/\/doi.org\/10.1007\/s44402-026-00025-3","relation":{},"ISSN":["0275-5408","1475-1313"],"issn-type":[{"value":"0275-5408","type":"print"},{"value":"1475-1313","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,2,27]]},"assertion":[{"value":"4 November 2025","order":1,"name":"received","label":"Received","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"8 November 2025","order":2,"name":"revised","label":"Revised","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"13 November 2025","order":3,"name":"accepted","label":"Accepted","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"27 February 2026","order":4,"name":"first_online","label":"First Online","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"The authors declare no competing interests.","order":1,"name":"Ethics","group":{"name":"EthicsHeading","label":"Competing interests"}}]}}