Vivity® Versus Isopure® Versus Eyhance®: A Prospective, Double-Blind, Randomised Comparison Between Three Enhanced Depth-Of-Focus Intraocular Lenses

The study aims to evaluate visual acuity, binocular defocus curves, contrast sensitivity, and patient-reported outcomes in patients undergoing bilateral same-day cataract surgery with either Vivity® (V), Isopure® (I) or Eyhance® (E) lenses, adopting a mini-monovision approach. This is a double-blind, randomized, prospective study with a follow-up period of 4 to 6 months.

Single-center study at Vista Alpina Eye Clinic, Visp, Switzerland.
In a double-blind, randomized, prospective design, 280 eyes of 140 patients were implanted bilaterally with Vivity®, Isopure® or Eyhance®, targeting mini-monovision (-0.5D).

A full set of visual acuities, including monocular corrected distance visual acuity (CDVA) and binocular uncorrected distance, intermediate (66cm) and near (40cm) visual acuities (bUDVA, bUIVA and bUNVA), were measured over 4-6 months. Binocular distance-corrected defocus curves were assessed at 1-2 months, spectacle independence (PRSIQ) and contrast sensitivity (CSV-100) at 4-6 months, and photic phenomena and patient satisfaction at 1-2 and 4-6 months. We here present 1-2 months visual acuities and defocus curves, and spectacle independence at 4-6 months.

V demonstrated the broadest defocus curve (1.85D near defocus at 0.2 logMAR), shortly followed by E (1.75D) and I (1.60D).

CDVA was worse for V (0.00±0.11 logMAR) than for I (-0.05±0.06, p<0.001) and E (-0.04±0.07, p=0.004).

Photopic bUDVA was worse for V (0.03±0.07) than for I (-0.03±0.08, p=0.001) and E (-0.03±0.07, p<0.001). Mesopic bUDVA showed larger differences, and E performed also significantly better than I: 0.28±0.12, 0.17±0.10, and 0.13±0.08 for V, I, E. 

bUIVA was comparable: V 0.09±0.09, I 0.11±0.11 and E 0.08±0.09 (ns).

bUNVA was better for V (0.26±0.09) than I (0.33±0.15, p=0.01), but not E (0.30±0.13, ns).

In this study comparing three enhanced depth of focus intraocular lenses — Vivity®, Isopure®, and Eyhance® — distinct optical performance profiles were observed.

Vivity® offered the broadest defocus curve and superior near visual acuity, but had compromised distance vision, especially in low light. Eyhance® and Isopure® offered better distance vision, with Eyhance® excelling in low light. Intermediate vision was comparable across all lenses, and there was similar spectacle independence for intermediate and near tasks among the lenses. These outcomes highlight the importance of considering individual visual needs and preferences when selecting the appropriate lens for patients undergoing cataract surgery.