Refractive EDOF

IOL enhances intermediate vision, rivals monofocal at distance and quality. Howard Larkin reports from the 39th Congress of the ESCRS in Amsterdam. The TECNIS Eyhance (Johnson & Johnson Vision) refractive extended depth of focus lens (EDOF) provides similar distance vision and quality of vision to an aspheric monofocal lens while enhancing intermediate vision both monocularly and binocularly, according to a study presented by Dr Mayank A Nanavaty. Monofocals, he said, are the most commonly used intraocular lenses due to factors including low cost, excellent distance vision, fewer dysphotopsias than diffractive lenses, and their ability to be used in eyes with retinal and other pathologies. However, the Eyhance uses a refractive design that continuously changes power from the periphery to the centre of the lens. This means it doesn’t have any rings in it so there is no glare and halos. The result is similar distance vision and aberrations with enhanced intermediate vision at a price typically covered by national insurance plans, he reported. PROSPECTIVE, RANDOMISED STUDY In a prospective randomised study involving 47 patients, Dr Nanavaty and colleagues compared uniocular and binocular uncorrected and corrected distance and intermediate visual acuity, wavefront aberrations, and defocus curves of the Eyhance and the RayOne (Rayner) monofocal lens at one and three-to-nine months after surgery. They also interviewed patients regarding glare and halos and administered the Catquest-9SF questionnaire. The follow-up time was initially planned for three months but was extended up to nine months due to the COVID- 19 pandemic, Dr Nanavaty said. At follow-up conclusion, there was no significant difference in logMAR measures of corrected distance visual acuity. However, the Eyhance group showed significantly better distance corrected intermediate vision measured at 66 cm and a broader defocus curve (Figure 1). The Eyhance IOL also provided better mean uncorrected distance and intermediate VA, though slightly higher astigmatism in the RayOne IOL group may have accounted for the difference. There was some difference in spherical aberration, with the Eyhance more negative results, but this was not clinically significant, Dr Nanavaty said. Neither group had patients report glare or halos. Similarly, both groups saw improvement in Catquest-9SF Rasch scores from preoperative levels, ending with nearly identical scores of 2.91±0.81 for Eyhance and 2.97±0.16 for RayOne. “In my private practice, I changed my monofocal option to Eyhance because it is a monofocal-plus lens, and it works very well without any glare and halos,” Dr Nanavaty said. Mayank A Nanavaty MBBS, DO, FRCOphth, PhD is a Consultant Ophthalmic Surgeon at Brighton and Sussex University Hospitals, Brighton, UK. mayank_nanavaty@hotmail.com