EDOF Lenses Show Promise for Irregular Astigmatism

Low to moderate irregular asymmetric astigmatism does not affect the visual performance of an extended depth of focus (EDOF) IOL, according to a study presented by Daniel Schartmüller MD.

“Modern IOLs aim for the best possible visual acuity and presbyopia correction, and the current opinion is that presbyopic IOLs depend on the regularity of the cornea,” Dr Schartmüller said. For this study, AcrySof Vivity IOL (Alcon) was considered to determine how well it performs in eyes with low to moderate anterior surface irregularities or asymmetries. The overall diameter of the Vivity IOL is 13 mm, and the optic diameter is 6 mm.

The study involved 28 patients with bilateral age-related cataract and irregular astigmatism exhibiting an anterior root mean square (RMS/a) greater than or equal to 0.3 μm/mm² in the central 3 mm zone measured at the OCT. Eyes with astigmatism more than 75.0 D received a toric IOL. As Dr Schartmüller reminded the audience, both eyes were implanted with the Vivity EDOF lens, as advised by the manufacturer.

At the six-month postoperative follow-up, the researchers performed binocular best-corrected distance visual acuity (BCDVA), binocular distance-corrected intermediate visual acuity at 66 cm, and monocular defocus curves, as well as IOL tilt and decentration. Preoperative mean RMS/a was 0.0037. Dr Schartmüller reported that the defocus curve resembled those seen in the Vivity IOL. The monocular defocus curves of the Vivity IOL showed an enhanced depth of focus of 0.16 logMAR at -1.5 D defocus in eyes with corneal irregularities.

Binocular distance visual acuity showed very good results with a mean of -0.08 logMAR. Only minimal deviations of decentration and tilt compared to preoperative values were observed at the anterior segment OCT measurement.

The study revealed that low to moderate irregular astigmatism is not an exclusion criterion for binocular implantation of EDOF IOLs. “We wanted to prove that—even though you have an irregular eye—you could have binocular, functional, good vision and a mean below zero, meaning we had a very good distance visual acuity, and the distance corrected intermediate visual acuity for both eyes was below 0.1,” Dr Schartmüller concluded.

The Clareon Vivity IOL has received CE approval and is commercially available in Europe. Other Clareon IOLs include the monofocal, toric, and PanOptix versions.

Dr Schartmüller presented the results of this study at the 2025 ESCRS Annual Congress in Copenhagen.

Daniel Schartmüller MD is an ophthalmologist and researcher at the Medical University of Vienna, Austria. daniel.schartmueller@meduniwien.ac.at