Patient Reported Quality of Vision of a Non-Diffractive Extended Vision IOL and a Diffractive EDoF IOL After Bilateral Implantation

My name is Dr. Marius Scheepers. I am an ophthalmic surgeon in the West Kootenay Region of British Columbia, where I specialize in advanced cataract surgery procedures. I recently designed and conducted a prospective, randomized, investigator-initiated trial to evaluate and compare visual outcomes between the AcrySof® IQ Vivity Extended Vision intraocular lens and TECNIS^ Symfony IOL. Vivity is a presbyopia-mitigating IOL with a non-diffractive design that creates an extended focal range by stretching and shifting incoming light without splitting it. In contrast, TECNIS^ Symfony^ uses diffractive optics to split incoming light and create an extended range of focus. To understand the visual performance of these two IOLs, patients undergoing cataract surgery were randomized to receive bilateral implantation of either the Vivity or Symfony^ IOL. This was a single blinded study, and outcomes were evaluated three months following surgery. Visual disturbances were evaluated using a validated questionnaire. In addition, binocular distance-corrected visual acuity and low-contrast visual acuity were measured at different distances. Refractive outcomes, including manifest refraction spherical equivalent prediction accuracy and post-operative refractive astigmatism, were also examined at follow-up. Overall, 70 cataract patients were enrolled and randomized to receive either the Vivity or Symfony^ IOL, and 69 patients were included in the analysis. The reported incidences of visual severe disturbances were lower in the Vivity group, with 85.3 to 88.2% of recipients reporting starburst, halo, or glare severity as “none”. In contrast, 60 to 71.4% of patients who received Symfony^ IOLs reported the severity of the visual disturbances as “none”. The three-month data revealed similar mean binocular distance-corrected visual acuities at near, intermediate, and distance in both IOL groups. Mean low-contrast acuity, measured at 10% contrast, was also similar with Vivity and Symfony^. The manifest refraction spherical equivalent absolute prediction error was 0.5 D or less in 87% of eyes implanted with Vivity and 86% of eyes implanted with Symfony^. Similarly, 91% of Vivity-implanted eyes had post-operative refractive astigmatism of 0.50 D or less, and the same percentage of eyes in the Symfony^ group met this criterion. When selecting an IOL, it is important to consider lens design — and the implications of differences in design for visual performance. Presbyopia-mitigating IOLs employ a variety of approaches to increase focal ranges. Even within specific design categories, such as the extended depth of focus IOLs, design differences can impact the visual experience. In our study, the non-diffractive Vivity and diffractive Symfony^ IOLs provided comparable acuity and refractive outcomes, but Vivity was associated with lower rates of patient-reported visual disturbances. This profile can provide important benefits to patients and makes Vivity an exciting presbyopia-mitigating IOL option.

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