Next-Generation Extended Depth Of Focus (Edof) Iol: Advancing Visual Performance And Higher-Order Aberrations Analysis

The TECNIS PureSee™ Extended Depth of Focus (EDOF) intraocular lens (IOL) (Johnson & Johnson Vision, USA) represents a new generation of refractive extended depth of focus lenses. This study evaluates the clinical and functional outcomes of bilateral TECNIS PureSee™ implantation. 

A prospective, interventional, non-randomized study conducted at SPKSO Ophthalmic University Hospital in Warsaw, Poland, with all surgeries performed by experienced cataract surgeons. Follow-up examinations were planned at 1, 3, and 6 months postoperatively. The study adhered to the principles of the Helsinki Declaration and received approval from the bioethics committee.

Thirty five patients with bilateral cataracts and no other significant ocular pathology underwent sequential phacoemulsification with TECNIS PureSee™ EDOF IOL implantation, with a 4-week interval between surgeries. Target refraction was planned using the Barrett Universal II formula, incorporating a micro-monovision strategy. All patients underwent a full ophthalmological examination preoperatively and postoperatively, along with additional tests. Assessments included visual acuity, subjective refraction, contrast sensitivity, dysphotopsia profile, HOAs, spectacle independence, visual function, defocus curve analysis for depth of focus. Refractive outcomes were analyzed to evaluate tolerance to residual refractive errors.

In total, 35 patients (70 eyes) were included. Mean UDVA was -0.008 ± 0.07 logMAR, UIVA 0.14 ± 0.11 logMAR, UNVA 0.08 ± 0.15 logMAR. Near vision was better than intermediate vision (t = -2.45, p = 0.031, paired t-test) Binocular contrast sensitivity was 1.79 ± 0.09 logCS (40 cm) and 1.82 ± 0.08 logCS (100 cm). Initially, 8.33% of patients reported mild dysphotopsia, which did not affect daily activities. Defocus curve analysis confirmed a stable depth of focus. Corneal HOAs measured in 30 eyes remained stable. Pearson’s analysis showed UNVA correlated with oblique trefoil (r=0.669, p=0.024), while UDVA correlated with oblique astigmatism (r=0.602, p=0.048), spherical aberration (r=-0.685, p=0.021), and vertical coma (r=-0.604, p=0.049).

The new-generation refractive TECNIS PureSee™ EDOF IOL provided superior UNVA compared to UIVA that also retained high quality. Despite the implementation of a micro-monovision strategy, distance vision acuity and quality achieved a very high level. Refractive design improved tolerance to postoperative refractive errors and delivered a dysphotopsia profile similar to monofocal IOLs. Defocus curve analysis confirmed a stable depth of focus over a broad vergence range. Preliminary data indicate that phacoemulsification with TECNIS PureSee™ implantation remains neutral to corneal HOAs. Patients with higher total and anterior oblique trefoil values achieved better postoperative near visual acuity (UNVA).