EyeWorld Asia-Pacific September 2021 Issue

REFRACTIVE EWAP SEPTEMBER 2021 29 Contact information Lahners: wjlahners@centerforsight.net Sobti: info@TECeyecare.com E nhanced monofocal and “ringless” EDOFs are a couple of the names yoating around for a newer type of IOL designed to extend depth of focus while maintaining, as much as possible, the quality of distance vision provided by a monofocal IOL. There are a few new non- diffractive IOLs available in the U.S., Vivity (Alcon), Eyhance (Johnson & Johnson Vision), and RayOne EMV (Rayner). “This is a whole new category of lenses that offer increased quality of vision in patients who want to try to achieve more spectacle independence at near and intermediate ranges,” said William Lahners, MD, who has experience with Vivity and Eyhance. With these lenses, Deepak Sobti, MD, put it, “we simply have more tools in our belt now to help patients achieve their goals.” Dr. Sobti, who has experience with Eyhance, described the lens as having a slight central steepening that adds additional plus power and, therefore, some intermediate vision. Dr. Lahners pointed out that Eyhance, a monofocal IOL with some additional intermediate vision A look at the latest ‘ringless’ IOLs that can extend depth of focus by Liz Hillman EyeWorld Editorial Co-Director and a little near vision, does not have presbyopia-correcting status from the FDA, whereas Vivity does, with more powerful near vision ranges, he said. “As a more powerful near lens, the Vivity does have more potential for mesopic and scotopic dysphotopsia than Eyhance,” Dr. Lahners said. When using a near card with patients, Dr. Lahners said he shows them what they can expect with J5 to J6 vision with a Vivity lens, compared to J6 to J7 with Eyhance or, on the other end of the EDOF spectrum, J4 to J5 with the Symfony OptiBlue (Johnson & Johnson Vision). “This near vision conversation is µuite a simplification of realityÆ some patients do a little better and some do a little worse, but at least it offers a way to compare the lenses,” he said. “We do have a conversation about intermediate vision, but it is a little harder to quantify in the clinic like we can with a near card.” As a non-diffractive lens, Dr. Lahners said Vivity has some advantages in terms of reduced night dysphotopsias that historically have been associated with diffractive EDOF lenses (though he noted that newer techniques have reduced these issues even in traditional diffractive lenses). While Vivity might have a better contrast sensitiÛity and glare profile at night, “there is no free lunch in optics,” Dr. Lahners said. “Because of our volumes, we have had several explantations of both Symfony and Vivity lenses for night dysphotopsias,” he said, noting that they haven’t explanted any Eyhance IOLs yet. The best patients for Eyhance and Vivity lenses, according to Dr. Lahners, are those who place primary importance on quality of vision (particularly night vision), even if it means wearing readers for fine print or heavy reading. While he wouldn’t consider a patient with corneal irregularities, epiretinal This article originally appeared in the July 2021 issue of EyeWorld . It has been slightly modified and appears here with permission from the ASCRS Ophthalmic Services Corp. • Vivity: This lens, FDA approved in 2020 and nationally launched in January 2021, is described by Alcon as a non-diffractive EDOF that delivers “monofocal-quality” distance vision, “excellent” intermediate vision, and “functional” near vision. • Eyhance: This lens, FDA approved and nationally launched in February 2021, is described by Johnson & Johnson Vision as a next-generation monofocal lens that slightly extends range of vision due to its shape. • RayOne EMV: This lens, FDA approved in March 2021, is a non-diffractive IOL that helps provide “enhanced” monovision, according to Rayner.