Should Fuchs’ Dystrophy Patients Get Premium Lenses?

Finding the right lens for triple procedures is tricky enough without patients weighing in, according to Pavel Studeny MD, PhD.

Professor Studeny highlighted how Fuchs’ dystrophy is the most common cause of corneal transplantation (at around 41% of all cases), with a global prevalence of 7.33%. As risk increases with age, and considering it is often undiagnosed, the demand for treatment is likely to rise.

During 2023 and 2024, Prof Studeny found that 2,804 patients at his clinic had Fuchs’ dystrophy, representing approximately 30% of all patients. Each was graded according to the severity of their disease, and 3% found to have grade 3 Fuchs’ dystrophy or above.

In these cases, he recommends a combined approach, especially towards patients with epithelial cell density of less than or equal to 1,000 cells/mm², pachymetry greater than 640 μm, significant guttae, and morning foggy vision. He emphasised applying this to patients with a hard nucleus and a shallow anterior chamber.

After opting for the combined approach, the next decision is which IOL to use as part of the triple procedure. In the age of Google, this can present issues.

“Normally, we use monofocal IOLs, but some patients know about premium IOLs and want them, but they are contraindicated [in severe Fuchs’ dystrophy],” Prof Studeny noted. “The main problems are calculation errors caused by corneal oedema and hyperopic shift between +0.5 and +1.0.”

In search of a way to mitigate patients’ concerns, Prof Studeny examined whether Vivity (Alcon) extended depth of focus (EDOF) lenses have a higher chance of achieving emmetropia in triple procedures than monofocal lenses. He also wanted to discover whether this lens could extend focus.

The study examined 48 eyes, all of which had cataract and Fuchs’ dystrophy at grade 3 or above. Twenty-six were given the Vivity IOL, and 22 received an IQ monofocal lens (Alcon), as both “have the same lens material and shape.” The Barrett formula target was -0.50 D to -0.75 D.

After six months, both uncorrected distance visual acuity was “a little bit higher in the Vivity group,” with 10 eyes achieving ≥ 0.8 and 24 eyes ≥ -0.5. This compares with 8 and 19 eyes achieving the same results with the IQ lens, he reported.

For close distance visual acuity, 25 eyes in the Vivity group achieved ≥ 0.8 and 26 eyes ≥ -0.5. In the IQ lens group, 20 eyes reached ≥ 0.8 and 22 eyes ≥ 0.5. Regarding the defocus curve, the findings were broadly similar, with the monofocal lens being “slightly flatter,” he said.

Concluding, Prof Studeny said the results highlight the safety of using the Vivity EDOF lens during triple procedures. However, he did add that the lens did not produce “statistically significant” results in the study.

Prof Studeny spoke at the 2025 EuCornea conference in Prague.

Pavel Studeny MD, PhD is the head of the department of ophthalmology at the Charles University in Prague, Czech Republic. studenypavel@seznam.cz