One of the most exciting aspects of cataract surgery is the continuous innovation in intraocular lens (IOL) technology. There are numerous companies working on the next generation of IOL platforms to improve both quality of vision and quality of life.

About a year ago, the first trifocal IOL—Alcon’s PanOptix—hit the market, and largely exceeded expectations. More recently, Alcon introduced the AcrySof IQ Vivity Extended Vision IOL, which also offers a toric version. These IOLs are indicated for aphakic presbyopia correction in patients with up to 2.50D of corneal astigmatism. The manufacturer says this new platform provides high-quality distance vision, improved intermediate vision and functional near vision.

Lens Details

Vivity’s two surface transitions centrally work to alter the wavefront of light, extending the range of vision. Image courtesy of Alcon. Click image to enlarge.

The Vivity is a UV-absorbing, blue light-filtering foldable IOL. Compared with a monofocal IOL, this lens is said to provide an extended range of vision from distance to intermediate (66cm) to near (44cm), potentially without increasing the incidence of visual disturbances. Unlike traditional refractive multifocal IOLs that use rings to split light energy, the Vivity IOL uses a non-diffractive design that stretches and shifts the wavefront to provide a continuous range of focus with minimal halos and glare, according to Alcon. 

Company literature describes how two transition zones in the center optic accomplish this. First, a slightly elevated (by about 1µm) smooth plateau helps stretch the focal range; next, a slight curvature change across the central 2.2mm region shifts the wavefront to use all available light energy. Alcon calls this optic design “X-Wave.”

Clinical Outcomes

Vivity is pupil-independent, allowing for enhanced visual performance in both bright and dim environments. Patients reported similar difficulties with glare, starbursts and halos with this IOL compared with a monofocal lens; only 2% of patients were bothered by starburst, 1% by halos and 0% by glare.¹ In the FDA clinical studies, 89% of patients had 20/25-2 or better uncorrected vision at distance, 86% had 20/25-2 or better uncorrected vision at the intermediate distance (26”) and 91% had 20/40-2 or better uncorrected vision at near (16”).¹

Candidate Selection

The Vivity IOL is a good option for motivated premium IOL candidates who want to be less dependent on visual correction but don’t mind using readers for very small print. It can also be considered for those who may not be good candidates for traditional multifocal IOLs due to halo or starburst sensitivities. In our experience, it provides sharp vision with minimal complications, making it viable for those who require crisp, clear vision, especially at distance or at night.

It may also be a good choice for patients who don’t want to sacrifice distance visual quality for near acuity. Patients with a history of maculopathy, glaucoma or mild ocular surface disease may be suitable candidates due to the optic design and its reduced side effects.

Takeaways

Innovation has become the norm in the world of IOLs, with novel technologies providing greater options for our patients, including Alcon’s Vivity and PanOptix IOLs and soon Johnson & Johnson Vision’s new Tecnis Eyhance and Synergy IOLs.

As optometrists, we can help our patients understand the differences between traditional monofocal IOLs, multifocal IOLs, extended depth-of focus-IOLs and the latest extended vision IOLs to advise them on the pros and cons of each technology and find the best fit for their lifestyle. 

Dr. Colmenares practices at Virginia Eye Consultants in Norfolk, VA. She has no financial interests to disclose.

Dr. Cunningham is the director of optometry at Dell Laser Consultants in Austin, TX. He has no financial interests to disclose. Dr. Whitley is the director of professional relations and residency program supervisor at Virginia Eye Consultants in Norfolk, VA. He is a consultant for Alcon.