Depth of focus of four novel extended range of vision intraocular lenses

Abstract

Purpose To assess the depth of focus of four latest non-diffractive extended range of vision IOLs on the optical bench. Such comparison had not been done before. Methods We assessed and compared the through focus modulation transfer function (MTF) of the following novel IOLs with a nominal power of 22 D: Acrysof Vivity, LuxSmart Crystal, RayOne EMV and Tecnis Eyhance. An ISO-2 model eye was applied with apertures of 3 and 4.5 mm with monochromatic light of 546 nm. Measurements were done on OptiSpheric IOL PRO 2 optical bench. Results For the aperture of 3 mm, Eyhance and RayOne EMV showed the most pronounced peak in MTF with only little enlarged depth of power. Vivity and LuxSmart showed two peaks of about 1.7 D respectively 1.3 D depth of focus, yet reduced MTF and with maxima differently located. For 4.5 mm, MTF values for Eyhance and particularly for RayOne EMV dropped. For Vivity and LuxSmart, only the peak for the secondary focus decreased. Conclusion Vivity and LuxSmart showed a larger depth of focus for our measuring conditions than Eyhance and RayOne EMV. Correspondingly, the peak MTF was best for Eyhance and RayOne ERV with small aperture. With the larger aperture, RayOne EMV considerably lost performance.

Positioning of enhanced monofocal intraocular lenses between conventional monofocal and extended depth of focus lenses: a scoping review

“…The major loss of energy at far distance was related to the increase of DoF in the following order: EDoF, Vivinex Impress, Xact, Tecnis Eyhance, and IsoPure [27]. These results were on agreement with other metrics such as the through focus MTF at 50 lp/mm which showed half MTF at far distance of the EDoF IOLs but a higher increase of the DoF in comparison to the RayOne EMV and the Tecnis Eyhance [25]. Only one study reported the chromatic performance of an enhanced monofocal, particularly the Xact [26].…”

“…The systematic reviews only included evidence for the Tecnis Eyhance IOL, which was for both laboratory and clinical studies, the enhanced monofocal IOL with the highest volume of evidence to date. Laboratory studies have reported optical quality of other enhanced monofocal IOLs such as RayOne EMV [20,[23][24][25], IsoPure [20,27], Zoe [20], Acunex Quantum [21], Lentis Quantum [22], and Vivinex Impress [27], but optical profiles have been only documented for Tecnis Eyhance [31,32]. However, laboratory or clinical studies have not been conducted for other announced enhanced monofocal IOLs such as Evolux and Extend HP.…”

“…Regarding the laboratory evidence, the elevation changes for refractive EDoF lenses were not achieved for Table 5 Criteria accomplished by the enhanced monofocals according to the ANSI standard definition of EDOF lenses and additional points RCT Randomized clinical trial, CS Case series ANSI-1: Statistical significance versus control for mean monocular visual acuity, with distance correction, at an intermediate distance of 66 cm ANSI-2: An increase in depth of field is achieved in the monocular defocus curve with distance correction equal to or greater than 0.5 D for a visual acuity level of 0.2 logMAR ANSI-3: The median monocular visual acuity, with distance correction, at an intermediate distance of 66 cm, is at least 0.2 logMAR ANSI-4: Monocular acuity at distance, with correction at this distance, is statistically non-inferior to control using a non-inferiority margin of 0.1 logMAR Add-1: Statistical significance versus control for mean binocular visual acuity, with distance correction, at an intermediate distance of 66 cm Add-2: An increase in depth of field is achieved in the binocular defocus curve with distance correction equal to or greater than 0.5 D for a visual acuity level of 0.2 logMAR Add-3: The mean monocular visual acuity, with distance correction, at an intermediate distance of 66 cm, is at least 0.2 logMAR Add-4: Starting with CDVA, the monocular defocus range at 0.2 logMAR is ≥ 1.5 and < 2. Bova et al [44], Nanavaty et al [39], Corbelli et al [49], Lopes et al [40], Steinmüller et al [17], Auffarth et al [45], Ucar et al [37], Kang et al [41], Unsal et al [38], Cinar et al [42], Huh et al [28], Yangzes et al [36], Eguileor et al [43], Mencucci et al [3], Garzón et al [46] the Tecnis Eyhance [31,32], and the optical quality studies that included both, enhanced monofocals and EDoF lenses, showed a higher depth of focus range with poorer distance optical quality for EDoF lenses in comparison to enhanced monofocals [25,27]. These laboratory results were in agreement with clinical evidence of studies including enhanced monofocals and EDoF lenses, demonstrating a higher range of focus and better DCNVA for the latter [33][34][35]49].…”

“…Three papers showed the influence of the IOL centration on the modulation transfer function (MTF) at 50 lp/mm (Table 2) [21][22][23]. The wavefront spherical aberration was also reported in 3 studies (Table 3), [14,19,24] and the data provided by four manuscripts was not able to be compared since the MTF was normalized, single indices were not used or the data was presented for specific wavelengths or no common metrics [25][26][27][28]. Thus the findings of these studies are reported directly in the text as follows.…”

Clinical outcomes of a new four-haptic hydrophobic presbyopia-correcting intraocular lens

“…However, they may cause a reduction in contrast sensitivity and an increase in glare, which can affect the quality of vision 19 , 20 . In contrast, EDOF IOLs are designed to enhance visual range, especially at intermediate distances while maintaining a high level of continuous VA 21 .…”