Extending IOL Options for Monofocality

Enhanced monofocal IOLs provide improved vision for day-to-day activities compared to standard monofocal IOLs. Roibeárd O’hÉineacháin reports. An array of new enhanced monofocal intraocular lenses (IOLs) and monofocal extended depth of focus (mono- EDOF) IOLs are becoming available. The new options appear to provide patients with the same distance visual acuity as standard monofocal IOLs but with better intermediate visual acuity and without the photic phenomena of EDOF and multifocal IOLs. “Enhanced IOLs are a very fluid field of lenses, using different strategies, different technologies, different materials, and different designs. This is leading to a sort of Tower of Babel effect in which everyone speaks his own language and there is confusion when comparing IOLs and results,” notes Rita Mencucci MD. The new IOLs include the TECNISR Eyhance ICB00 (Johnson & Johnson), the xact™ Mono-EDoF™ IOL (Santen), the ISOPURER (PhysIOL/BVI), and the RayOneR EMV (Rayner). The Eyhance IOL’s optics are based on a purely refractive technology with a modified anterior aspheric optic with a continuous power profile that increases from the periphery to the centre of the lens. The xact has four diffractive rings on the anterior surface that direct the light mainly towards far and intermediate focus. The ISOPURE’s optic design is based on unique polynomial technology developed to improve intermediate vision without inducing photic phenomena. The RayOne EMV increases depth of focus by inducing a small amount of extra positive spherical aberration, Dr Mencucci explained. Studies published to date indicate the new lenses deliver on their promise. As an illustration, she reviewed the results of a study she and her associates conducted comparing visual outcomes, spectacle independence, and quality of vision achieved in 40 patients, split into two groups of 20. Half of the patients underwent bilateral implantation of the new TECNIS Eyhance IOL, and the other 20 patients underwent standard aspheric TECNIS ZCB00 IOL implantation. She noted at the six-month follow-up, there were no significant differences between the two groups in terms of uncorrected distance visual acuity (UDVA), uncorrected near visual acuity (UNVA), and distance-corrected near visual acuity (DCNVA). Furthermore, the Eyhance IOL provided significantly better results at a defocus of -1.0 D and -1.5 D. No patients reported the use of spectacles to correct distance visual acuity in either group, but only 20% in the Eyhance group needed intermediate correction in their everyday life compared to 90% in the TECNIS group. There were no significant differences between the two groups in terms of contrast sensitivity at any spatial frequency as measured with the OptecR 6500 Vision Tester or optical quality as measured with the OQAS system. Similar results have been reported with the Eyhance IOL at other centres and with the xact and ISOPURE IOLs in visual acuity, contrast sensitivity, and photic phenomena. “And although enhanced monofocal IOLs are not suitable for patients seeking spectacle independence for near vision, they can offer improved functional performance in daily life and may therefore represent a premium option for monofocality,” Dr Mencucci said. This presentation was made at the 39th Congress of the ESCRS in Amsterdam. Rita Mencucci MD is a Professor of Ophthalmology at the University of Florence, Italy. rita.mencucci@unifi.it