Monofocal lenses continue to be the most common type of IOL used in cataract surgery because of the consistent visual outcomes they produce and their relative affordability compared to premium alternatives. Monofocal lenses, however, offer functional uncorrected vision at fewer ranges than premium IOLs. In order to bridge this gap, new-technology monofocal IOLs have been designed to offer focusing power at intermediate distance, and these products are becoming increasingly popular. This article provides an overview of the latest monofocal IOL technologies available.
AcrySof IQ Vivity Extended Vision
The AcrySof IQ Vivity Extended Vision (Alcon) has a nondiffractive design that offers a continuous extended range of vision while maintaining a low incidence of visual disturbances.1 Alcon’s proprietary nondiffractive technology, XWave, creates an extended focal range by stretching and shifting the wavefront, as opposed to splitting the wavefront into multiple focal points as diffractive multifocal lenses do.2 The AcrySof IQ Vivity Extended Vision IOL is available in the United States and Europe.
The Aspira IOL (HumanOptics) is a hydrophilic, glistening-free, acrylic, UV-absorbing, foldable posterior chamber IOL with optional blue-light protection. It is available in one- and three-piece designs.
The one-piece Aspira IOL features an aspheric anterior surface, a 360º lens epithelial cell barrier, and a high-definition optic within the standard diopter range. The lens is also available in an XL delivery range of -20.00 to 60.00 D in 1.00 D steps and 10.00 to 30.00 D in 0.50 D steps.
The three-piece Aspira features an extended optic diameter of 13.0 mm and highly flexible polyethersulfone C-loop haptics that reportedly optimize axial stability and radial flexibility and are suitable for placement on sensitive sulcus tissue. It is designed with an aspheric posterior surface, a 360º sharp posterior edge, and high-definition optics manufactured using subnano-resolution technology, which, according to the company, can more precisely reproduce the calculated curvature for the optic than conventional manufacturing processes.
The Aspira IOLs are available in Europe.3
According to VSY Biotechnology, the Enova is a dry-packed, 100% glistening-free hydrophobic acrylic IOL that does not require prehydration and storage in saline solution. The lens’ unique material reportedly allows uniform hydration of specific sites to have controlled water uptake and resistance to glistening formation. Because of its low glass transition temperature (−2 °C) and optimized modulus of elasticity, the lens unfolds gently and in a well-controlled fashion, requiring no warming or special conditioning, according to the company. The Enova IOL is available in Europe.4
According to Alsanza, the Alsee is a dry-packed, glistening-free hydrophobic acrylic IOL with 24-hour aspherical correction. It features Alsanza’s Arms2Fit haptic design, which consists of a narrow junction angle, stress dimmer curves on the inner arms, and a flexible yet strong design, according to the company. The Alsee IOL is available in Europe.5
According to Bausch + Lomb, the EnVista is an aspheric aberration- and glistening-free one-piece hydrophobic acrylic monofocal IOL. The lens features a continuous 360º posterior square edge that reportedly provides excellent contrast sensitivity and vision quality and uses a uniform power from center to edge, which allows it to compensate for common levels of decentration, per the company. The EnVista monofocal is available in the United States and Europe.6
The LuxGood preloaded IOL (Bausch + Lomb) features Pure Refractive Optics technology, meaning it is based only on refractive profiles and has no diffractive areas. This monofocal lens is available both with and without a proprietary acrylic hydrophobic cross-linked copolymer material with a UV absorber to protect the eye against damaging UV light. The platform has a four-point fixation haptic design to achieve lens centration and rotational stability, resist posterior capsular opacification, and improve refractive predictability. The LuxGood IOL is available in Europe.7
RayOne EMV (Rayner) was developed in collaboration with world-renowned surgeon Professor Graham Barrett specifically to enhance patient outcomes achieved with monovision. The lens extends a patient’s range of vision with a patented nondiffractive optic profile, reportedly enabling a depth of field similar to with many presbyopia-correcting IOLs but with reduced dysphotopsia and a shorter period of neural adaptation. RayOne EMV is offered on a hydrophilic optic platform through the RayOne fully preloaded two-step injector and is available in countries that accept the CE Mark.8
Tecnis Eyhance ICB00
A continuous change in power from the periphery to the center of the Tecnis Eyhance ICB00 monofocal IOL (Johnson & Johnson Vision) reportedly improves intermediate vision while maintaining distance image quality. According to the manufacturer, unlike other monofocal lenses, this IOL’s continuous power profile is based on a higher-order asphere, resulting in a highly favorable contrast profile. The Tecnis Eyhance monofocal IOL is available in Europe and Canada.9
Made of a hydrophobic acrylic material, the Xact Mono-EDOF (Santen) is a monofocal lens with four diffractive rings and a broad single peak of focus. According to the manufacturer, this lens offers patients exceptional uncorrected intermediate and distance vision and contrast sensitivity equivalent to that with a monofocal IOL. The Xact Mono-EDOF IOL also reportedly has a higher tolerance of decentration and tilt than a conventional extended depth of focus IOL. The Xact Mono-EDOF IOL is available throughout Europe.10
1. Alcon announces European launch of Vivity, the only presbyopia-correcting intraocular lens with x-wave technology [news release]. Alcon. March 12, 2020. Accessed December 10, 2020. https://www.alcon.com/media-release/alcon-announces-european-launch-vivity-only-presbyopia-correcting-intraocular-lens-x
2. Ligabue E, Ang RE, Dick HB, et al. In the pipeline. Cataract & Refractive Surgery Today. April 2020. Accessed December 10, 2020. https://crstoday.com/articles/2020-apr/in-the-pipeline/
3. Premium is the new standard. Humanoptics. 2020. Accessed December 14, 2020. https://www.humanoptics.com/en/physicians/intraocular-lenses/monofocal-1p-aspira/#z1
4. Enovation technology. VSY Biotechonology. 2020. Accessed December 14, 2020. https://www.vsybiotechnology.com/enova
5. Allsee. Alsanza. 2020. Accessed December 14, 2020. https://alsanza.com/ophthalmology/monofocal-iols/alsee
6. enVista IOL. Bausch + Lomb. 2020. Accessed December 14, 2020. https://www.bausch.com/ecp/our-products/cataract-surgery/lens-systems/envista-iol
7. Bausch + Lomb Announces European launch of a new platform of preloaded IOLs, LuxSmart and LuxGood. Eyewire News. May 27, 2020. Accessed December 10, 2020. https://eyewire.news/articles/bausch-lomb-announces-the-launch-of-a-new-platform-of-preloaded-iols-luxsmart-and-luxgood
8. RayOne EMV product. Rayner. Accessed December 10, 2020. https://rayner.com/en/iol/monofocal/rayone-emv
9. Johnson & Johnson Vision launches TECNIS synergy and TECNIS Eyhance intraocular lenses (IOLs) for the treatment of cataracts in Canada [news release]. Johnson & Johnson Vision. August 11, 2020. Accessed December 10, 2020. https://www.jjvision.com/press-release/johnson-johnson-vision-launches-tecnis-synergy-and-tecnis-eyhance-intraocular-lenses
10. Santen introduces the xact Mono-EDoF in Europe – the monofocal IOL with true extended depth of focus [news release]. Santen. September 16, 2019. Accessed December 10, 2020. https://www.santen.eu/our-vision/emea-news/santen-introduces-xacttm-mono-edoftm-europe-monofocal-iol-true-extended-depth