Evaluation of Quality of Vision and Visual Outcomes with Implantation of a Non-Diffractive Extended Vision IOL with Monovision

My name is Dr. Thomas Hunter Newsom. I’m in private practice at Newsom Eye & Laser Center in Tampa, Florida, where I specialize in advanced cataract and LASIK surgery. I recently reported the results of an investigator-initiated trial evaluating visual outcomes with the presbyopia-mitigating AcrySof® IQ VivityTM Extended Vision intraocular lens in cataract patients. Specifically, the trial examined VivityTM IOL performance after bilateral implantation using a monovision approach targeting a low level of myopia in the non-dominant eye. The VivityTM IOL has a non-diffractive design that creates an extended focal range by stretching and shifting incoming light without splitting it. VivityTM has performed very well in clinical trials, particularly at intermediate and distance. The lens’ unique design also suggests the potential to further expand the visual range and improve near vison with a mini-monovision approach. This prospective, single-arm study examined outcomes in 33 cataract patients who were candidates for bilateral IOL implantation and sought a reduction in spectacle dependence. Subjects were bilaterally implanted with the VivityTM IOL at a single surgical center, with a target of emmetropia in the dominant eye and a myopic refractive target of -0.75 D in the non-dominant eye. After completion of lens extraction and VivityTM IOL implantation, we followed up at 3 months and measured manifest refraction, uncorrected visual acuity, and distance-corrected visual acuity at near, intermediate, and distance. We also used questionnaires to understand subjects’ spectacle independence, satisfaction, and quality of vision. Three months after surgery, the mean inter-eye refractive difference was 0.8 D, reflecting the mini-monovision target, and monocular visual acuity was good in emmetropic and monovision target eyes. Binocular visual outcomes were excellent, with nearly 90% of subjects having an uncorrected near visual acuity of 0.2 logMAR or less, and over 75% having a distance-corrected acuity of 0.2 logMAR at all three distances tested. The data also showed that satisfaction with vision at near, intermediate, and distance was high. Overall, 84% of subjects indicated that they were completely or mostly satisfied with their vision without glasses. In parallel, the reported level of spectacle independence 3 months after surgery was high. This compared favorably with measures of spectacle independence after implantation of VivityTM without monovision, particularly at near. Questionnaire results also indicated that glare, halos, and starbursts were the most frequent visual disturbances experienced, and also tended to be those most frequently defined as severe. In general, visual disturbances were more prevalent than previously reported with VivityTM. Importantly, however, disturbances did not appear to be correlated with a subject’s degree of monovision. As patients’ near visual demands grow, so do their expectations for presbyopia correction. Our results with the VivityTM IOL support targeting -0.75 D of myopia in the non-dominant eye of bilaterally implanted cataract patients as a viable approach to improving near vision and spectacle independence. © 2022 Alcon Inc. US-VIV-2200040