The features, proposed mechanisms of actions, and early outcomes of the latest IOL offerings

Using published research, this article briefly outlines the features, proposed mechanisms of actions, and early outcomes of the most recently FDA-approved IOLs.

TECNIS Eyhance

FDA-approved in February 2021, the TECNIS Eyhance (model DIB00), from Johnson & Johnson Vision, affords enhanced distance-corrected intermediate visual acuity (DCIVA) when implanted bilaterally, while not significantly compromising distance visual acuity in either eye.¹

It is designated as a monofocal IOL with a design that may extend depth of focus through its higher-order polynomial, aspheric anterior surface.¹

Additionally, it has negative fourth-order spherical aberration nearly identical to the TECNIS Monofocal 1-Piece, model ZCB00. Both IOLs are biconvex with anterior aspheric surfaces, and spherical posterior surfaces.

Optical bench testing using a model eye compared the TECNIS Eyhance to the TECNIS Monofocal 1-Piece IOL regarding their spherical aberration and modular transfer function (MTF) across different pupil sizes.² TECNIS Eyhance had positive sixth-order and negative eighth-order spherical aberration and a central add power.² Also, it had increased negative fourth-order spherical aberration (>3.7 increased negative spherical aberration than the TECNIS Monofocal 1-Piece at 2.0 mm pupil diameter) and reduced MTF at smaller pupil sizes.² Results were similar between the IOL models at pupil sizes > 3.50 mm.² Further, in TECNIS Eyhance eyes, the net corneal-IOL spherical aberration had a greater negative value in small-pupil conditions when compared to the TECNIS Monofocal 1-Piece, which may allow the paraxial rays focusing in front of the retina to provide useful intermediate vision.²

In summary, the central curvature of the TECNIS Eyhance is steeper, providing a local increase in power.

Finally, in a prospective, multi-center, bilateral, randomized, control study, patients implanted bilaterally with the TECNIS Eyhance had 1.1 lines logMAR better monocular and binocular DCIVA and uncorrected intermediate visual acuity (UIVA) compared to the TECNIS Monofocal 1-Piece.¹ Both groups had similar contrast sensitivity in photopic and mesopic lighting conditions.

Adverse events and photic phenomena (ie., glare, halos, or starbursts) were comparable between the two groups.¹

AcrySof IQ Vivity

FDA-approved in February 2020, this beam-shaping extended depth-of-focus IOL, from Alcon, is available in 8 models, that employ a central optical apparatus that extends depth of focus.³

The DFT and DAT models (i.e., AcrySof IQ Vivity Toric Extended Vision IOLs, AcrySof IQ Vivity Extended Vision UV Absorbing IOL, and AcrySof IQ Vivity Toric Extended Vision UV Absorbing IOLs) allow for distance and intermediate visual acuity, and adequate near visual acuity.³

The AcrySof IQ Vivity Extended Vision UV Absorbing IOL consists of a 6.0 mm optic that has a central 2.2 mm diameter, and dual transition element that affords depth of focus, which translates to improved intermediate vision. Its central optical element stretches the focal point and shifts the stretched area of focus anteriorly.

In a preliminary study of 106 eyes implanted with the AcrySof IQ Vivity models, 61.3% had bilateral uncorrected distance visual acuity of 20/20-2 or better, 55.7% had bilateral UIVA of 20/20-2 or better, and 2.8% had bilateral uncorrected near visual acuity (UNVA) of 20/20-2 or better.³ Also, 90.6% implanted with the Acrysof IQ Vivity models in both eyes achieved bilateral UNVA of 20/40-2 or better, while 55.9% of patients implanted with the monofocal control achieved bilateral UNVA of 20/40-2 or better.³

Visual disturbances such as glare, halos, and starbursts were similar between the two groups. In preliminary studies using a model eye, the peak MTF at +0.00 D of defocus was significantly reduced in the EDOF IOL compared to the monofocal IOL. This pattern was reversed at defocus ranges from -0.50 D to -2.50 D. Therefore, surgeons should be aware of possible reduction in contrast sensitivity in vivo. CP

References

1. Auffarth GU, Gerl M, Tsai L, Janakiraman P, Jackson B, Alarcon A. Clinical evaluation of a new monofocal intraocular lens with enhanced intermediate function in cataract patients. J Cataract Refract Surg. 2021 Feb 1;47(2):184-191.
2. Vega F, Millán MS, Gil MA, Garzón N. Optical Performance of a Monofocal Intraocular Lens Designed to Extend Depth of Focus. J Refract Surg. 2020;36(9):625-632.
3. Alcon Laboratories Inc. Product Information: AcrySofTM IQ VivityTM Extended Vision Intraocular Lenses (IOLs) Models: DFT015, DFT315, DFT415, DFT515. https://ifu.alcon.com/iol/927409848?prefix=iol&code=927409848&tab=1&value=DFT015 . Accessed June 3, 2021.

DR. MERCER is an instructor at the Medical University of South Carolina College of Medicine.

DR. ROCHA is the director of the Cornea & Refractive surgery division at the Medical University of South Carolina. She has received several awards, including the International Society of Refractive Surgery Waring Memorial Award in 2016, has published over 140 scientific works, and serves on the program committee for the American Academy of Ophthalmology Refractive Surgery Basic and Clinical Science Course (BCSC). Disclosures: Johnson & Johnson Vision, Alcon, Bauch + Lomb, Allergan, and Dompé.