Visual outcomes and patient satisfaction after bilateral implantation of an enhanced monofocal intraocular lens: a single-masked prospective randomized study

Comparison of clinical outcomes of phacoemulsification with implantation of two new aspheric intraocular lenses: Real-world data

PURPOSE

This study aims to compare the visual and refractive outcomes of two new aspheric intraocular lenses (IOLs), that is, Clareon (Model CNA0T0) and Tecnis Eyhance (Model ICB00), in patients undergoing phacoemulsification cataract surgery.

METHODS

A retrospective comparative analysis was conducted at a tertiary referral institute in South India. A total of 132 eyes (91 patients) were included, with 66 eyes implanted with Clareon IOL (group 1) and 66 eyes with Tecnis Eyhance IOL (group 2). Preoperative and postoperative data were collected from January 2022 to April 2024. Primary outcomes included uncorrected distance visual acuity (UDVA), uncorrected near visual acuity (UNVA), spherical equivalent, and refractive cylinder, measured at 3 weeks postoperatively. Statistical analysis was performed using an independent sample t -test and Statistical Package for the Social Sciences software, with P values <0.05 considered significant.

RESULTS

The mean log of minimum angle of resolution (logMAR) UDVA in group 1 was 0.14 (95% confidence interval [CI] [0.11, 0.17]) and in group 2 was 0.16 (95% CI [0.13, 0.19]) ( P value 0.16). The mean logMAR UNVA in group 1 was M = 0.55 (95% CI [0.53, 0.58]) and in group 2 was M = 0.5 (95% CI [0.48, 0.52]) ( P value 0.0006). The mean add required for group 1 was + 1.76 (95% CI [1.66, 1.86]) and for group 2 was M = 1.56 (95% CI [1.49, 1.62]) ( P value 0.0005).

CONCLUSION

At 3 weeks postoperatively, both IOLs provided excellent visual outcomes. Tecnis Eyhance IOL offered enhanced near-vision performance.

Comparison of 3-month clinical outcomes between two enhanced monofocal intraocular lenses: A single-center prospective study

PurposeThis study aims to compare the 3-month clinical outcomes between two enhanced monofocal intraocular lenses (IOLs) following cataract surgery.Setting: Eye Clinic of Careggi University Hospital, Florence, Italy.DesignSingle-center prospective study.MethodsWe included patients with cataract and corneal astigmatism less than 0.75 D, with no ocular comorbidities, who underwent unilateral cataract surgery with implantation of either the Tecnis Eyhance ICB00 (N = 25) or Evolux (N = 25) IOLs. Standard cataract procedures were performed without complications. The main outcome measures included uncorrected and corrected visual acuity at distance (4 m), intermediate (60 cm) and near (40 cm) at 3-month follow-up. Additionally, monocular defocus curves, aberrometric profiles, and perceptions of halo and glare were evaluated.ResultsThe study involved 50 patients (26 male, 24 female) with a mean age of 68 ± 8 years. Preoperative characteristics were similar between the groups, and no intraoperative or postoperative complications were reported. Statistically significant differences were observed between the groups, with the Evolux IOL showing superior results (p < 0.05) in terms of uncorrected and corrected visual acuity at near, intermediate, and distance, as well as in aberrometric profiles (lower-order aberration root-mean-square [RMS], higher-order aberration RMS, spherical equivalent RMS, and point spread function) and defocus curves.ConclusionsBased on our experience, while both IOLs offer substantial visual performance for intermediate and distance vision, the Evolux IOL demonstrated superior mean visual outcomes and objective parameters at the 3-month follow-up compared to the Tecnis Eyhance IOL. This indicates a potential advantage of the Evolux IOL in providing better visual performance.

Comparison of visual acuity and optical quality between higher-order aspheric monofocal and standard introcular lenses

AIM

To compare the 12-month outcomes of visual performance and patient satisfaction of a higher-order aspheric monofocal intraocular lens (IOL) and a conventional monofocal IOL.

METHODS

Prospective, randomized, comparative, double-blinded study including 22 patients who underwent bilateral cataract surgery with implantation of the Tecnis Eyhance ICB00 IOL in one eye (ICB00 group) and the Tecnis ZCB00 IOL in the fellow eye (ZCB00 group). Uncorrected distance (UDVA), corrected distance (CDVA), uncorrected intermediate (UIVA), distance-corrected intermediate (DCIVA), uncorrected near (UNVA), and distance-corrected near visual acuities (DCNVA) were evaluated during a 12-month follow-up. Contrast sensitivity, defocus curves, and reading text size were also evaluated. Patient satisfaction was assessed with a questionnaire at the 6-month postoperative visit.

RESULTS

Mean postoperative logMAR UDVA was 0.01±0.12 and -0.02±0.10 in ICB00 and ZCB00 groups, respectively (P=0.37). Mean logMAR UIVA was 0.32±0.19 and 0.45±0.16 in ICB00 and ZCB00 groups, respectively (P=0.010). Differences between groups in UNVA did not reach statistical significance (P=0.16). The intermediate reading acuity at 66 cm (P=0.02) and 80 cm (P=0.04) was significantly better in the ICB00 group. Postoperative contrast sensitivity results did not differ significantly between groups (P>0.05). Patients reported high overall satisfaction, with 62% of patients using spectacles for reading in everyday life.

CONCLUSION

The eyes of patients implanted with the enhanced monofocal IOL evaluated have significantly better visual acuity for intermediate distances with the same contrast sensitivity as a conventional monofocal IOL.

Visual and patient-reported outcomes of an enhanced versus monofocal intraocular lenses in cataract surgery: a systematic review and meta-analysis

Understanding the functional outcomes achieved with new enhanced monofocal intraocular lenses (IOLs) is crucial for adequately managing patient expectations. This study evaluated visual and patient-reported outcomes of an enhanced range of field IOL versus other monofocal IOLs in cataract patients. A systematic review and meta-analysis, pre-registered on PROSPERO (CRD42024561611), included studies from Medline (PubMed), Embase (Ovid), and trial registries (2019-2024) focused on binocular cataract surgeries with various IOL models. Primary outcomes assessed were monocular distance-corrected visual acuities (CDVA, DCIVA, DCNVA), defocus curves, and contrast sensitivity; secondary measures included binocular visual acuities and patient-reported outcomes such as spectacle independence and photic phenomena. Out of 31 studies (8 randomized clinical trials, 23 case series), high-certainty evidence indicated no significant difference in CDVA between enhanced and conventional IOLs. However, enhanced IOLs demonstrated better intermediate (DCIVA: -0.11 logMAR, CI 95%: -0.13 to -0.10) and near (DCNVA: -0.12 logMAR, CI 95%: -0.17 to -0.07) visual acuities, supported by defocus curves, though with lower-certainty evidence. No significant differences were observed in contrast sensitivity or photic phenomena, and evidence for positive dysphotopsia was moderate to low. Enhanced IOLs significantly favored intermediate-distance spectacle independence, with an odds ratio of 7.85 (CI 95%: 4.08-15.09), though no differences were observed for distance spectacle independence. Near-distance spectacle independence also favored enhanced IOLs, though with low-certainty evidence. In summary, enhanced IOLs provide improved intermediate and near visual acuities compared to conventional monofocal IOLs, though further studies are needed to confirm outcomes in contrast sensitivity and patient-reported outcomes across various enhanced monofocal IOLs.

Comparison of Visual Acuity Outcomes of Enhanced Monofocal Versus Standard Monofocal Intraocular Lenses from a Randomized, Multicenter, Active-Controlled Trial

PURPOSE

To compare visual performance of the Vivinex Impress enhanced monofocal intraocular lens (IOL) (HOYA Surgical Optics) with the Acrysof IQ monofocal IOL (Alcon Laboratories, Inc).

METHODS

In this multicenter, active-controlled trial, participants were randomized 2:1 to bilateral implantation with the enhanced monofocal (test) or standard monofocal (control) IOL and examined through 12 months postoperatively for visual acuities, refractive outcomes, defocus curves, and pupil diameters.

RESULTS

Ninety-eight test and 46 control participants completed testing for the first implanted eye. The test arm demonstrated a statistically significant benefit in monocular distance-corrected intermediate visual acuity (DCIVA) (photopic: 1.2 lines, P < .001; mesopic: 0.7 lines, P = .01) and uncorrected intermediate visual acuity (0.8 lines; P < .001) but no significant difference in monocular corrected distance visual acuity (P = .07). Using a stepwise regression analysis for DCIVA, the final model (adjusted R-square, 0.31) identified three significant predictor variables (age, pupil diameter, and treatment arm). Photopic defocus curves showed the test arm produced better monocular visual acuity from -1.00 through -2.50 D than the control arm. The intermediate vision benefit of the test IOL is independent of pupil size and axial length. Cumulative and persistent adverse events for the test IOL did not exceed the Safety and Performance Endpoint rates per International Organization for Standardization 11979-7.

CONCLUSIONS

Compared to a standard monofocal IOL, the Vivinex Impress enhanced monofocal IOL offers an extended range of vision, with significant improvements in intermediate vision and a DCIVA benefit unaffected by pupil size and axial length. This IOL is safe and effective for patients seeking improved intermediate vision following cataract surgery. [J Refract Surg. 2025;41(4):e300-e309.].

Efficacy and safety of the enhanced monofocal intraocular lens in glaucoma of varying severity

This study evaluates the safety and visual outcomes of enhanced monofocal intraocular lenses compared to standard monofocal intraocular lenses in patients with varying severities of glaucoma. Utilizing data from surgeries performed in 2021, the study involved patients aged 40 and older with visually significant cataracts and diagnosed glaucoma or glaucoma suspects. The findings indicate that both enhanced and standard monofocal lenses lead to significant improvements in best-corrected visual acuity, visual field index, mean deviation, and retinal nerve fiber layer thickness postoperatively. No significant differences were observed between the two groups in the extent of these improvements, suggesting that enhanced monofocal lenses may offer a viable alternative for patients with glaucoma, providing significant visual benefits and potentially better intermediate vision while preserving overall visual function.