## 4 Discussion
This misalignment could result in an imbalance between the far and near zones within the pupil. In this line, [PERSON] et al. [6] reported a case of a Lentis MPIus lens that was upwardly decentered in an eye with a 3.6-mm pupil, leading to a measured refraction of \(-2.75\) D.  
The measurement of the radial power revealed clear differences associated with the asymmetric and symmetric designs. The three IOLs exhibit a reduction in power at the periphery, with this effect being more pronounced in the monofocal AN6 compared to the distance multifocal AN6V and AN6 VM, especially for higher powers. A possible explanation for this design can be associated with the control of the thickness of high-power IOLs to minimize the risks associated with IOLs implantation in hyperopic eyes [12]. Regarding the near zone of the multifocal AN6V and AN6 VM lenses, it is interesting to consider how the power of the addition reached +1.50 D for AN6V and +3.00 D for AN6 VM, exhibiting a \"two-step behavior\". In the first step, half of the addition was attained at approximately 1.00-mm optical zone, and the full addition was achieved at 1.50-mm optical zone. This \"two-step behavior\" in achieving the total addition of power in multifocal lenses could be related to facilitating a more efficient adaptation in brighter lighting conditions or situations where greater depth of field may not be necessary. Additionally, this smoother transition between different focal distances could potentially reduce side effects such as glare or dysphotopisa. However, this design may lead to patients with small pupils being unable to fully benefit from the addition if their pupillary diameter does not cover the area of greatest addition [13]. Regarding the aberrometric profiles, we have described the SA, primary vertical coma, and secondary vertical coma to provide clarity on the most relevant aberrometric values for understanding the visual performance of these lenses. Understanding the SA profile of the IOLs across their various optical zones could prove crucial in evaluating the SA balance between a patient's eye and the intraocular lens. Surgical decisions should consider the characteristics of both elements, along with other factors such as pupil size under photopic and mesopic conditions, as well as corneal regularity. The current study demonstrates that the SA in the monofocal AN6 remained neutral from the center up to a 1.75/2.00-mm optical zone diameter. Beyond that position, the SA increased in negative values towards the periphery, with higher values observed for lenses with greater power. According to the manufacturer, the monofocal AN6 has an aspherical posterior surface with spherical aberration correction of \(-0.13\)\(\upmu\)m [7]. This SA value was reached in our work at 4.00 mm, 4.6 mm, and more than 5 mm for IOL powers +30.00 D, +20.00 D, and +10.00 D, respectively. [PERSON] et al. [14] conducted an in vitro study where they measured SA and coma in monofocal AN6 +22.00 D using specific optical equipment. The measurements were taken for a 4.5-mm aperture using the WaveMaster IOL 2 (Trioptics, Wedel, Germany), on an optical bench, OptiSpheric IOL PRO 2, and adding eye model Cornea ISO2. In their in vitro conditions, combining the IOL with an in situ eye model, the researchers obtained a negative SA of \(-0.31\)\(\upmu\)m. However, our results at 4.5 mm in monofocal AN6V +20.00 D and AN6V +30.00 D showed values of \(-0.13\)\(\upmu\)m and \(-0.22\)\(\upmu\)m, respectively. This difference could be attributable to the variances in the in vitro conditions between the two studies. Regarding multifocal AN6V and AN6 VM, there are not available information about SA and the current results showed less dependency of SA with the IOL power than monofocal model, with the multifocal AN6 VM being the IOL showing lesser dependency. The multifocal AN6V and AN6 VM showed neutral SA in the center, increasing to positive values, and finally achieving negative values towards the periphery.