Key Clinical Summary: Presbyopic IOLs: Latest Clinical Data to Empower Patient-Centered Selection

This is a micro-learning module summary of the session by Eric Donnenfeld, MD, FACS, which you can find here. Before participating, please read our CME and disclosure information which can be found here.

Acknowledgment: This program is supported through an independent educational grant from Johnson & Johnson. It is intended exclusively for healthcare professionals.

Introduction

Modern cataract surgery offers a wide range of presbyopia‑correcting solutions, each supported by clinical data demonstrating distinct advantages and trade‑offs. Across all categories, the evidence consistently shows that extended range of vision is achieved only by accepting some degree of optical compromise. Understanding these patterns is essential for aligning patient expectations with likely outcomes. This summary synthesizes current clinical evidence on presbyopia‑correcting intraocular lenses (PC-IOLs), highlighting trial outcomes, comparative performance data, dysphotopsia profiles, and tolerability. It emphasizes how these data support patient‑centered selection across monofocal‑plus, extended depth of focus (EDOF), multifocal, adjustable, and small aperture‑based technologies.

Adjustable IOLs: Evidence for Postoperative Precision

• The light‑adjustable lens (LAL) provides a unique evidence‑based advantage: postoperative modification of sphere and cylinder. Clinical experience and published outcomes show:
• High refractive accuracy, particularly in post‑LASIK eyes
• Ability to titrate monovision after surgery
• Reliable correction of residual refractive error before final lock‑in
• These data support the LAL as a strong option for patients with complex corneas or those who desire precise customization.

Monofocal‑Plus Lenses: Clinical Data on Intermediate Gains

Tecnis Eyhance: Large datasets, including analyses of approximately 1,500 eyes, demonstrate:

• Distance vision: Slightly reduced compared with monofocal controls
• 45% of monofocal patients achieved 20/16 vs. 33% with Eyhance
• Intermediate vision: Significantly improved
• 17% achieved 20/16 with Eyhance vs. 3% with monofocal controls
• Near vision: Better with Eyhance than with monofocal lenses
• Dysphotopsia: Eyhance comparable to standard monofocals
• These findings position Eyhance as a lens that preserves optical clarity while providing meaningful functional range.

Rainer EMV: FDA‑approved in 2021, this non‑diffractive design uses positive spherical aberration to extend depth of focus. Clinical evidence shows:

• A smooth, elongated defocus curve
• Strong intermediate performance
• High tolerance to small refractive errors
• Monofocal‑like dysphotopsia rates

EDOF Lenses: Data on Range and Tolerability

Symfony: Clinical trials demonstrate:

• Best‑corrected distance acuity equivalent to monofocals
• Extended intermediate range due to elongated focus
• Some reports of halos, though less than with multifocals
• Improved performance with chromatic aberration control

AcrySof IQ Vivity: Wavefront‑shaping technology produces:

• >0.50 D of additional reading ability over monofocal controls
• Very low dysphotopsia, similar to monofocals
• High patient satisfaction for mid‑range tasks
• Spectacle independence ~21%, higher than monofocals but lower than multifocals

Emerging EDOF Technologies

Tecnis Purity: Early clinical data indicate:

• EDOF superior to Eyhance
• Dysphotopsia profile similar to monofocals
• Exceptionally high patient satisfaction in trial settings

Invista Aspire: In ongoing trials, early findings show:

• A central zone of increased power
• Promising tolerance and extended range
• Potential to expand non‑diffractive EDOF options

Multifocal and Trifocal Lenses: Clinical Performance and Limitations

• Multifocal and trifocal lenses provide the broadest range of vision, supported by strong clinical data showing:
• Excellent near, intermediate, and distance acuity
• High rates of spectacle independence
• Predictable dysphotopsia, especially halos and reduced contrast in low light
• Dependence on precise centration for optimal performance

Next‑generation trifocal: Rainer Galaxy

• Trial data show:
• A continuous spiral optic without concentric rings
• Smooth, uninterrupted range of vision
• Minimal glare and halos compared with traditional trifocals
• High patient satisfaction and excellent quality of vision

Small Aperture Optics: Evidence in Irregular Corneas

• Small aperture-based IOLs demonstrate strong clinical utility in:
• Keratoconus
• Post‑RK
• Post‑LASIK ectasia
• Irregular astigmatism
• Clinical advantages include:
• Tolerance of up to 0.75 D of refractive error without loss of acuity
• Stable 20/20 distance vision despite corneal irregularity
• Improved near vision when the eye is targeted to slight myopia
• Effective performance in eyes with diurnal fluctuation

Conclusions

Across monofocal‑plus, EDOF, multifocal, adjustable, and small aperture designs, current clinical data reveal clear patterns in range of vision, dysphotopsia risk, contrast performance, and patient satisfaction. Applying these evidence‑based insights enables clinicians to match each lens category to the patient’s anatomy, visual priorities, and tolerance for optical trade‑offs - supporting truly patient‑centered selection in presbyopia‑correcting cataract surgery.

Content is accurate as of the date of release on 6 January 2026.