SVIOLs and Comorbidities?

Should a patient with comorbidities be considered for simultaneous vision intraocular lenses (SVIOLs)?

According to Joaquín Fernández MD, PhD, the answer to this question followed the global consensus on the new classification of intraocular lenses proposed by ESCRS’s Functional Vision Working Group.

“Patients should not be excluded from SVIOL implantation solely due to the presence of comorbidities,” he said. “Exclusion should instead be considered only in cases where the anticipated visual performance and level of spectacle independence reported in comparable populations are unlikely to align with patient expectations, or when the balance between risks and benefits is unfavourable in the long term.”

Citing “Navigating the Lens Labyrinth: A Practical Approach to Intraocular Lens Classification and Selection,” Professor Fernández noted that 52% of patients with and 12% of patients without comorbidities obtained spectacle independence, at intermediate and near respectively, with partial-depth-of-field-narrowed lenses (conventional monofocals). In the same analysis on rates of spectacle independence in eyes without comorbidities, patient rates were 77% at intermediate and 30% at near for the enhanced, 90% intermediate and 65% near for extended, 85% intermediate and 81% near for steep, 95% intermediate and 89% near for smooth, and 96% intermediate and 91% near for continuous.¹

Using the IOLEvidence app, Prof Fernández provided some examples of enhanced and narrowed partial depth of focus lenses in eyes with glaucoma.² In the moderate visual field loss group, outcomes with enhanced and narrowed lenses share similarities with some of the data available in literature regarding eyes with no comorbidities, he said. Patients with only a moderate affection of the visual field can be considered for the implantation of an enhanced lens.

Considering the balance between benefits and risks, Prof Fernández mentioned a study reporting that, among patients with postoperative complaints, 28.9% of cases were associated with ocular disease.³ Therefore, comorbidities should not always be considered an exclusion criterion; rather, they require careful review of the literature involving patients with similar characteristics to provide the best possible evidence-based information and expected long-term visual outcomes.

Another study also showed dissatisfaction can be predicted through patients’ preoperative issues.⁴ Dry eye and residual refractive errors can be avoided in this phase, Prof Fernández observed. For SVIOLs in patients with amblyopia, it is important to understand distant visual acuity expectations and ensure that visual acuity at the desired distance exceeds the threshold (generally the 0.2 logMAR or 0.3 logMAR cut-off point), as poorer visual acuities are unlikely to provide comfortable functional vision for patients without spectacles, Prof Fernández said.⁵

The findings related to SVIOLs and retinal disease are quite interesting, he observed. The lack of evidence in literature suggested these kind of lenses should be discouraged in patients with a retinal disease. However, Prof Fernandez noted a study published in 2020 examined whether these lenses should be discouraged in diabetic patients (considering the risk of diabetic macular oedema), if they should be discouraged only in patients with existing macular oedema, or even in all patients with diabetes.⁶

Prof Fernández spoke at the 2026 ESCRS Winter Meeting in Helsinki.

Joaquín Fernández Pérez MD, PhD is the CEO and Medical Director in the Ophthalmology Department at Qvisión in Vithas Virgen del Mar Hospital, Almería, Spain. He is the secretary of the ESCRS. joaquinfernandezoft@qvision.es

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