IOL with high patient satisfaction – Tips & Results

A study evaluating a new nondiffractive extended-depth-of-focus (EDOF) IOL, the Vivity IOL (Alcon), showed high patient satisfaction rates with the lens and high glasses independence when patients were using a computer, driving, and watching TV , said John A. Hovanesian, MD, who has private practice in Laguna Hills, California.

Hovanesian explained that currently available EDOF diffractive lenses contain two adjacent zones of uncorrected vision (ie, far and intermediate or intermediate and near), but patients often report dissatisfaction due to visual side effects (AEs) such as cobwebs or halos.

“The Vivity implant is different because it is a zonal refractive EDOF lens that offers the same field of view with contrast sensitivity similar to monofocal lenses; that is, with fewer AEs,” he said.

Rating of the Vivity lens
Hovanesian, along with Michael Jones, MD, and Quentin Allen, MD, conducted a study to evaluate the postoperative experience of patients who underwent uncomplicated cataract surgery. Patients completed a questionnaire one month after bilateral cataract surgery.

This questionnaire is a validated tool previously used to evaluate other multifocal IOLs; specifically, a study pairing the ReSTOR 3.0 IOL (Alcon) with the ActiveFocus 2.5 D add lens in contralateral eyes, a study on mini-monovision targeting 0.5 spheres in the non-dominant eye, and a study on bilateral Implantation of the PanOptix IOL (Alkon). These studies were compared for similar results.

The primary outcome of the study discussed was the percentage of the 60 study patients with very little or no postoperative complaints of glare or halos around lights in low light. The secondary outcome was the percentage of patients who required glasses for various activities, particularly computer use.

“The Vivity lens performed better than any previously evaluated multifocal or trifocal lens,” said Hovanesian. “The lens was associated with significantly less glare and halos, as reported by all patients implanted with the Vivity lens bilaterally.”

Regarding the need for glasses when using a computer, the results obtained with the Vivity were similar to those previously obtained with other IOLs, including the PanOptix IOL and Mini-Monovision with the 2.5D lens. According to Hovanesian, most patients (ie, 90%) implanted with the Vivity lens reported that they never needed glasses when using a computer. When the need for glasses was assessed based on other activities, the researchers found that the percentage of patients requiring glasses with the Vivity IOL was similar to the percentage achieved with other multifocal diffractive IOLs.

“Assessing the need for glasses across all activities showed that the highest level of glasses independence was achieved with the PanOptix IOL compared to all other lens combinations studied – 83%,” said Hovanesian. “The Vivity lens is similar to previous multifocal IOLs in terms of glasses independence, but not quite as good as the PanOptix IOL.” However, the Vivity IOL achieved the best results for glare and halos among the combinations tested.

Take Home Points
“This is a unique IOL that we typically offer to patients who are averse to unwanted visual AEs, or to patients with less than perfect eyes [who] may not be optimal candidates for a diffractive multifocal IOL,” said Hovanesian.

The results showed a very high level of glasses independence, comparable to the values ​​achieved with IOLs introduced before the PanOptix IOL for computer use, reading and other visual tasks. Patient satisfaction with the Vivity IOL was high and the low glare and halo index makes this IOL a place in the refractive arsenal of future cataract surgery patients.

Another consideration is that the Vivity is often used with mini-monovision, which was not evaluated in the present study. “We have found that for patients who want better near vision without correction, aiming at approximately -0.5D or higher in the nondominant eye can achieve good range of vision and avoid glare and halos for patients who can tolerate mini-monovision and have the best of both worlds,” concluded Hovanesian.

John A. Hovanesian, MD
This article is an adaptation of Hovanesian’s presentation at the 2021 American Academy of Ophthalmology Annual Meeting. He is an advisor to Alcon. The study was supported by a grant from Alcon.

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