Non-Diffractive Wavefront-Shaping Intraocular Lens with Extended Depth of Focus: First Implantation Experience

Purpose. Analysis of short-term clinical and functional results of implantation of a new non-diffractive IOL with expanded depth of focus.

Patients and methods. The study included 27 patients (35 eyes) after bilateral (8 patients) or monolateral (19 patients) AcrySof IQ Vivity IOL implantation (Alcon, USA) with mean follow-up of 3.8 ± 0.3 (3–5) months. In all cases, IOL implantation was preceded by cataract phacoemulsification or refractive lensectomy. Women accounted for 63 % (n = 17) and men for 37 % (n = 10). AcrySof IQ Vivity DFT015 IOLs were implanted in 24 eyes and toric AcrySof IQ Vivity DFT315, DFT415 and DFT515 IOLs in 11 eyes with clinically significant (more than 1.0 D) astigmatism.

Results. There was a significant (p < 0.05) increase in distance and intermediate uncorrected and best corrected visual acuity starting from the 1st day after surgery. An increase from 0.31 ± 0.09 to 0.58 ± 0.12 at the 1st day after the operation, and further up to 0.63 ± 0.13 at the follow-up period of 3 months (p < 0.05) was also registered while assessing near uncorrected visual acuity. In spite of some increase of best corrected near visual acuity in the follow-up period of 3 months in comparison with preoperative period (0.68 ± 0.19 and 0.57 ± 0.16, respectively), these differences were not statistically
significant (p > 0.05). After IOL implantation, the spherical refractive index was shown to decrease from –2.75 ± 1.4 in the preoperative period to –0.10 ± 0.73 in the follow-up period of 3 months. Permanent or periodic optical phenomena were detected in 4 patients out of 27 (14.8 %), of them 2 patients (7.4 %) had glare and 2 (7.4 %) — halo. Patients did not complain of difficulties in driving in the dark. In 11 oof 27 cases (40.7 %), patients required spectacle correction for reading. In spite of the need for spectacle correction for near vision in 40 % cases, the vast majority of patients (n = 24; 88.9 %) rated the result of surgery as “excellent” and three (11.1 %) as good.

Conclusion. This work presents the first experience in Russia of implantation of a new non-diffractive intraocular lens with an expanded depth of focus forming a wavefront in 35 eyes. The presented data testify to the high efficacy of this IOL for medium distance and far distance vision correction and to the possibility of providing functional near vision. Implantation of the investigated IOL was associated with a low incidence of adverse optical phenomena, such as halo, glare, and discomfort when driving in the dark. The use of this IOL in clinical practice may be an option to achieve the desired outcome in cataract surgery.

1. Pershin K.B., Pashinova N.F., Konovalova M.M., Tsygankov A.Yu., Konovalov M.E. Multifocal intraocular lenses implantation in presbyopia correction. Literature review. Acta biomedica scientifica. 2019;4(4):41–55 (In Russ.). DOI: 10.29413/ABS.2019-4.4.6

2. Rodov L., Reitblat O., Levy A., Assia E.I., Kleinmann G. Visual outcomes and patient satisfaction for trifocal, extended depth of focus and monofocal intraocular lenses. J Refract Surg. 2019;35(7):434–440. DOI: 10.3928/1081597X-20190618-01

3. Pedrotti E., Carones F., Talli P., Bonacci E., Selvi F., Galzignato A., Besutti A., De Gregorio A., Marchini G. Comparative analysis of objective and subjective outcomes of two different intraocular lenses: trifocal and extended range of vision. BMJ Open Ophthalmol. 2020;5:e000497. DOI: 10.1136/bmjophth-2020-000497

4. Hovanesian J.A., Jones M., Allen Q. The PanOptix trifocal IOL vs the ReSTOR 2.5 active focus and ReSTOR 3.0 add multifocal lenses: a study of patient satisfaction, visual disturbances, and uncorrected visual performance. Clin Ophthalmol. 2021;15:983–990. DOI: 10.2147/OPTH.S285628

5. Monaco G., Gari M., Di Censo F., Poscia A., Ruggi G., Scialdone A. Visual performance after bilateral implantation of 2 new presbyopia correcting intraocular lenses: trifocal versus extended range of vision. J Cataract Refract Surg. 2017;43(6):737–747. DOI: 10.1016/j.jcrs.2017.03.037

6. Cochener B., Boutillier G., Lamard M., Auberger Zagnoli C. A comparative evaluation of a new generation of diffractive trifocal and extended depth of focus intraocular lenses. J Refract Surg. 2018;34(8):507–514. DOI: 10.3928/1081597X-20180530-02

7. Pershin К.B., Pashinova N.F., Tsygankov А.Yu., Antonov E.A. First Experience of Multifocal and Toric Extended Depth of Focus Intraocular Lenses Implantation (Short Term Analysis). Ophthalmology in Russia = Oftal’mologiya. 2021;18(3):408–414 (In Russ.). DOI: 10.18008/1816-5095-2021-3-408-414

8. Singh B., Sharma S., Dadia S., Bharti N., Bharti S. Comparative Evaluation of Visual Outcomes After Bilateral Implantation of a Diffractive Trifocal Intraocular Lens and an Extended Depth of Focus Intraocular Lens. Eye Contact Lens. 2020;46(5):314–318. DOI: 10.1097/ICL.0000000000000637

9. Pershin K.B., Pashinova N.F., Tsygankov A.I., Korneeva E.A. Efficacy and Safety Analysis of the New Aspheric Hydrophobic Acrylic Monofocal IOL Implantation at Short Term Follow Up. Ophthalmology in Russia. = Oftal’mologiya. 2021;18(4):845–851 (In Russ.). DOI: 10.18008/1816-5095-2021-4-845-851

10. Kohnen T., Suryakumar R. Extended depth of focus technology in intraocular lenses. J Cataract Refract Surg. 2020;46(2):298–304. DOI: 10.1097/j.jcrs.0000000000000109

11. Ruiz Mesa R., Blanch Ruiz J., Ruiz Santos M., Montés Micó R. Optical and visual quality assessment of an extended depth of focus intraocular lens based on spherical aberration of different sign. Int Ophthalmol. 2021;41(3):1019–1032. DOI: 10.1007/s10792-020-01659-z

12. Savini G., Balducci N., Carbonara C., Rossi S., Altieri M., Frugis N., Zappulla E., Bellucci R., Alessio G. Functional assessment of a new extended depth of focus intraocular lens. Eye (Lond). 2019;33(3):404–410. DOI: 10.1038/s41433-018-0221-1

13. Hooshmand J., Allen P., Huynh T., Chan C., Singh R., Moshegov C., Agarwal S., Thornell E., Vote B.J. Small aperture IC 8 intraocular lens in cataract patients: achieving extended depth of focus through small aperture optics. Eye (Lond). 2019;33(7):1096–1103. DOI: 10.1038/s41433-019-0363-9

14. Tognetto D., Giglio R., De Giacinto C., Pastore M.R., Cirigliano G., Piñero D.P, Turco G. Profile of a new extended range of vision IOL: a laboratory study. Graefes Arch Clin Exp Ophthalmol. 2022;260(3):913–916. DOI: 10.1007/s00417-021-05426-3

15. Bala C., Athanasiov P., Holland J., Dhariwal M., Gupta A., Rathi H. A Cost Effectiveness Analysis of AcrySof IQ Vivity Intraocular Lens (IOL) from Private Health Fund Perspective in Australia. Clin Ophthalmol. 2022;16:2403–2412. DOI: 10.2147/OPTH.S370420.

16. Pershin K.B., Pashinova N.F., Konovalova M.M., Tsygankov A.Yu., Konovalov M.E., Temirov N.E. Short Term Analysis of New Single Piece Aspheric Diffractive Trifocal Intraocular Lens Implantation. Ophthalmology in Russia = Oftal’mologija. 2019;16(1):19–25 (In Russ.). DOI: 10.18008/1816-5095-2019-1-19-25

17. Temirov N.E., Temirov N.N. Subjective complaints following implantation of various multifocal intraocular lenses. Cataractal and refractive surgery = Kataraktal’naja i refrakcionnaja hirurgija. 2015;15(1):43–48 (In Russ.).

18. Gundersen K.G., Potvin R. Clinical Outcomes and Quality of Vision Associated with Bilateral Implantation of a Wavefront Shaping Presbyopia Correcting Intraocular Lens. Clin Ophthalmol. 2021;15:4723–4730. DOI: 10.2147/OPTH.S342947

19. Arrigo A., Gambaro G., Fasce F., Aragona E., Figini I., Bandello F. Extended depthof focus (EDOF) AcrySof® IQ Vivity® intraocular lens implant: a real life experience. Graefes Arch Clin Exp Ophthalmol. 2021;259(9):2717–2722. DOI: 10.1007/s00417-021-05245-6

20. van Amelsfort T., Webers V.S.C., Bauer N.J.C., Clement L.H.H., van den Biggelaar F.J.H.M., Nuijts R.M.M.A. Visual outcomes of a new nondiffractive extended depth of focus intraocular lens targeted for minimonovision: 3 month results of a prospective cohort study. J Cataract Refract Surg. 2022;48(2):151–156. DOI: 10.1097/j.jcrs.0000000000000825

21. Kohnen T., Petermann K., Böhm M., Hemkeppler E., Ahmad W., Hinzelmann L., Pawlowicz K., Jandewerth T., Lwowski C. Nondiffractive wavefront shaping extended depth of focus intraocular lens: visual performance and patient reported outcomes. J Cataract Refract Surg. 2022;48(2):144–150. DOI: 10.1097/j.jcrs.0000000000000826

22. Fernández Vega Cueto L., Madrid Costa D., Alfonso Bartolozzi B., Vega F., Millán M.S., Alfonso J.F. Optical and Clinical Outcomes of an Extended Range of Vision Intraocular Lens. J Refract Surg. 2022;38(3):168–176. DOI: 10.3928/1081597X-20220104-01

23. Rementería Capelo L.A., Lorente P., Carrillo V., Sánchez Pina J.M., Ruiz Alcocer J., Contreras I. Patient Satisfaction and Visual Performance in Patients with Ocular Pathology after Bilateral Implantation of a New Extended Depth of Focus Intraocular Lens. J Ophthalmol. 2022 Apr 28;2022:4659309. DOI: 10.1155/2022/4659309

24. Jeon S., Choi A., Kwon H. Clinical outcomes after implantation of extended depthof focus AcrySof® Vivity® intraocular lens in eyes with low grade epiretinal membrane. Graefes Arch Clin Exp Ophthalmol. 2022 Jul 7. DOI: 10.1007/s00417-022-05751-1.