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Evaluation of Visual, Refractive, and Functional Outcomes after Implantation of an Extended Depth of Focus Intraocular Lens in Patients with Stable and Mild Glaucoma
The aim of this study is to describe the visual, refractive, functional, and patients’ satisfaction outcomes of the AcrySof™ IQ Vivity™ extended depth-of-focus intraocular lens (EDOF IOL) in patients with mild primary open-angle glaucoma (POAG).
Methods
This is an ambispective, multicenter, and descriptive study. Patients with mild and stable POAG for at least 6 months, as well as patients who had the AcrySof™ IQ Vivity™ EDOF IOL implanted were included. Humphrey Field Analyzer III (Carl Zeiss Meditec, Dublin, CA, USA) and Triton optical coherence tomography (Topcon, Japan) were used to evaluate the inclusion criteria. In all cases, the formula used to calculate IOL power was Barrett Universal II. Refractive outcomes and visual acuity at distance, intermediate, and near were evaluated from 3 months postoperatively onward. In addition, monocular and binocular defocus curve and contrast sensitivity (CSV-1000, VectorVision, Greenvile, OH, USA) were assessed. Patient satisfaction was assessed through the Intraocular Lens Satisfaction (IOLSAT) and Questionnaire for Visual Disturbances (QUVID) questionnaires .
Results
In total, 72 AcrySof™ IQ Vivity™ lenses from 36 patients were enrolled, of which 28 were women. The mean age was 71.61 ± 7.68 years, the mean thickness of the retinal nerve fiber layer (RNFL) was 79.24 ± 14.96 µm, the mean intraocular pressure (IOP) was 16.88 ± 3.09 mmHg, and the mean number of topical anti-glaucoma medication was 0.89 ± 0.95. Binocular corrected distance visual acuity (CDVA), binocular corrected intermediate visual acuity (CIVA), and binocular corrected near visual acuity (CNVA) were 0.00 ± 0.12, 0.16 ± 0.14, and 0.24 ± 0.11 LogMAR, respectively. Spherical equivalent was −0.27 ± 0.33 diopters (D). In addition, 86.11% of eyes were within ± 0.5 D and 95.83% were within ± 1.0 D. The binocular defocus curve shows a peak of maximum visual acuity (VA) at 0 D (0.00 ± 0.11 LogMAR) and smooth curve at intermediate (66 cm/−1.5 D) 0.11 ± 0.09 LogMAR and near distance (40 cm/−2.5 D) 0.36 ± 0.18 LogMAR. Binocular contrast sensitivity showed a decrease in high spatial frequencies compared with low spatial frequencies. The IOLSAT revealed that in bright light conditions, 88.89%, 91.67%, and 63.89% of patients “never” or “rarely” need glasses at far, arm’s length, and near distances, respectively. In addition, according to the QUVID, 97.06% of patients “never” report shadow areas.
Conclusions
The new AcrySof™ IQ Vivity™ EDOF IOL seems to provide good visual outcomes at distance, intermediate, and near vision, with an adequate contrast sensitivity, defocus curve, a low rate of visual disturbances and high visual satisfaction in patients with mild and stable POAG.
Prior presentation: This study was presented in Barcelona at the 2025 ESCRS congress as a presented poster by the corresponding author in the session “IOLs—EDOF” on 8 September 2024.
Key Summary Points
Why carry out this study?
Glaucoma, a leading cause of irreversible blindness, often coexists with cataracts in aging populations, creating a need for intraocular lens (IOL) options that enhance visual performance without compromising contrast sensitivity.
Extended depth-of-focus (EDOF) intraocular lenses are designed to improve intermediate and near vision while minimizing photic disturbances, making them a potential solution for patients with mild primary open-angle glaucoma (POAG).
What was learned from the study?
The study demonstrated that the AcrySof™ IQ Vivity™ EDOF IOL provides good visual outcomes across distance, intermediate, and near vision, with 86.1% of eyes achieving refractive accuracy within ± 0.5 D and high patient satisfaction.
These findings suggest that EDOF IOLs are a viable option for patients with mild glaucoma, offering improved visual functionality without significant impact on contrast sensitivity, although further research is required to confirm their long-term effects on glaucoma progression.
Introduction
Glaucoma is a progressive optic neuropathy characterized by the death of retinal ganglion cells and their axons, producing thinning of the retinal nerve fiber layer (RNFL) and an increase in papillary excavation, and finally affecting the visual field [1]. It is currently the leading cause of irreversible blindness worldwide [2, 3], affecting approximately 70–80 million people worldwide in 2020 [4] and is expected to affect 111.8 million people in 2040 [5]. The diagnosis of glaucoma is not always simple because it is a silent disease that does not show easily recognizable symptoms until the advanced stages. In addition, glaucomatous patients, owing to their age (> 60 years), usually present with cataracts in a physiological manner.
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The definitive treatment for cataract is phacoemulsification surgery with intraocular lens (IOL) implantation. It has been shown that the use of multifocal IOLs can improve uncorrected near vision and uncorrected distance visual acuity and therefore reduce dependence on glasses [6] in patients without ophthalmological pathologies. Many designs have been developed on the basis of different physical principles, such as refractive, diffractive, refractive–diffractive, and accommodative principles [7]. Although they can improve visual acuity at different distances, there are side effects that should be avoided, such as halos, glare, and loss of contrast sensitivity [8‐12].
To avoid these side effects due to the design of IOLs, there are extended depth-of-focus IOLs (EDOF) on the market that have similar performance to monofocal IOLs and provide a certain multifocality [13]. Furthermore, these IOLs have notable advantages over multifocal diffractive IOLs in terms of contrast sensitivity [14]. Specifically, the EDOF IOL contrast sensitivity is less affected in medium and low illumination conditions compared with a pure diffractive IOL [15]. Even so, the use of this type of EDOF IOL in patients with glaucoma is controversial because these patients already have decreased contrast sensitivity [16] and quality of vision due to their pathology [17] in intermediate vision, which affects mobility and could lead to falls [18, 19].
This study aims to provide valuable insights into the visual, refractive, and functional outcomes of the AcrySof™ IQ Vivity™ EDOF IOL in patients with mild and stable primary open-angle glaucoma (POAG), an area with limited existing research. Unlike previous studies that primarily focus on visual acuity, we also assess contrast sensitivity function (CSF), the defocus curve, and patient-reported outcomes through a questionnaire, offering a comprehensive evaluation of visual performance over an average follow-up of 1 year.
Methods
Study Design
We performed an ambispective, multicenter, cross-sectional, and descriptive study. The ophthalmologic centers that participated in the study were Miranza Begitek (Donostia – San Sebastián, Spain), Miranza Ókular (Vitoria – Gasteiz, Spain), and Miranza IOA (Madrid, Spain). All the procedures complied with the ethical standards described in the 1975 Declaration of Helsinki that were revised in 1983. Research Ethics Committee approval was obtained from the IMO Miranza Group Barcelona (GlauVivity no. 230119-222). In addition, the purpose of the study and the policy on the protection of personal data were explained in detail to all participants, and informed consent was obtained from all participants.
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Patient Population
The inclusion criterion was pseudophakic patients who had the AcrySof™ IQ Vivity™ (Alcon Laboratories Inc., Fort Worth, TX, USA) EDOF IOL implanted binocularly. Furthermore, these patients had to have mild (according to Hodapp–Parrish–Anderson classification) and stable POAG. POAG was classified using the Humphrey Field Analyzer III campimeter (Carl Zeiss Meditec, Dublin, CA, USA) through the visual field index (VFI) and mean deviation (MD) and was considered stable when the thickness of the global RNFL remained the same or changed to less than 10 µm or when there was no progression in the trend over 6 months preoperatively or in the events of the glaucoma progression analysis (GPA). While these parameters are widely used to assess glaucoma progression, we acknowledge that stability at a given time does not guarantee future stability, as glaucoma is a progressive disease. However, our inclusion criteria aimed to ensure that patients had no significant glaucomatous progression before study enrollment, making them suitable candidates for evaluating visual performance with the Vivity IOL. The RNFL assessment was performed using Triton optical coherence tomography (DRI OCT Triton, Topcon Corp, Tokyo, Japan). Exclusion criteria were as follows: patients who had prior refractive surgery, hazy eye, or strabismus; patients who were diabetic; or those with retinal or neuro-ophthalmological pathology, corneal astigmatisms greater than 1 diopters (D), or systemic pathologies.
We retrospectively identified patients who had previously undergone bilateral Vivity IOL implantation and met the stability criteria at the time of selection. Since this was a retrospective study with a single-visit evaluation, the preoperative follow-up period varied among participants. Thus, all patients who met all the inclusion criteria and none of the exclusion criteria were identified (retrospectively). Subsequently, they were called by telephone to inform them of the purpose of the study. Finally, patients who decided to participate in the study were scheduled for consultation to measure the study variables.
IOL power calculations were performed with Barrett II Universal formula. The IOLs were implanted and targeted for emmetropia. In all cases, the IOL power chosen was the one yielding myopic value closer to zero.
Study Variables
All study variables were measured by an experienced optometrist from each ophthalmologic center and were performed in photopic conditions (85 cd/m2). All data were collected during a single visit, including corrected visual acuities, contrast sensitivity function (CSF), and questionnaire responses. We did not perform serial follow-up visits, and no additional visual field tests were conducted beyond the preoperative assessment. We measured the monocular and binocular corrected visual acuity at far (6 m), intermediate (66 cm), and near (40 cm) distances as well as the subjective refraction. The monocular and binocular defocus curves (DC) were performed starting at −4.00 D in 0.50 D steps until +1.50 D defocus. Binocular and monocular CSF was measured for spatial frequencies of 3, 6, 12, and 18 cycles per degree (cpd) using the CSV-1000 (Vector Vision, Greenvile, OH, USA) device. The DC and CSF were assessed using the subjective distance refraction setting. Besides the evaluation of the clinical outcomes, the patient satisfaction was assessed through two validated tests: IOL Satisfaction (IOLSAT) and Questionnaire for Visual Disturbance (QUVID) [20, 21]. The IOLSAT questionnaire is divided into four sections: section 1 assesses how frequently the wearer is required to use glasses under various lighting and distance conditions; section 2 assesses how well the wearer can see without using glasses under various conditions; section 3 asks what the wearer expected from their cataract surgery; and section 4 asks about their satisfaction with their vision following cataract surgery. The QUVID questionnaire evaluates the frequency, severity, and bothersomeness of different photopic phenomenon rates such as starburst, halos, glare, hazy vision, blur vision, diplopia, and shadow area.
After carrying out the study measurements, a glaucoma specialist ophthalmologist conducted a thorough ophthalmological examination that included slit lamp biomicroscopy, Goldmann applanation tonometry (CT-80; Topcon, Tokyo, Japan), and fundoscopy.
Statistical Analysis
The data were collected using a Microsoft Excel spreadsheet. Baseline characteristics were summarized using frequencies and percentages for categorical variables and means with standard deviations for continuous variables. Descriptive statistics (mean ± standard deviation and range) were used to analyze all measured parameters, including the IOP, RNFL, VFI, MD, corrected distance visual acuity (CDVA), corrected intermediate visual acuity (CIVA), corrected near visual acuity (CNVA), CSF, and defocus curve. The IOLSAT and QUVID questionnaires were analyzed using percentage-based distributions. The proportion of patients within the target spherical equivalent (SE) was calculated using percentages. A line graph was used to represent the defocus curve and CSF.
Results
In total, 72 AcrySof™ IQ Vivity™ lenses from 36 patients were enrolled, of which 28 (77.77%) were women. The mean age was 71.61 ± 7.68 years, the global RNFL mean thickness was 79.24 ± 14.96 µm, the mean IOP was 16.88 ± 3.09 mmHg, and the mean number of topical anti-glaucoma medication was 0.89 ± 0.95. Out of all the patients who met the inclusion and exclusion criteria of the study, three had iridotomies before cataract surgery and three more had combined surgery involving iStent and cataract. None of the patients had adverse events after cataract surgery. The remaining demographic data are presented in Table 1.
Table 1
Descriptive data of the sample before surgery of both eyes
Mean ± SD
Range
Max/min
Age (years)
71.61 ± 7.68
88/60
RNFL (µm)
79.24 ± 14.96
125/57
IOP GAT (mmHg)
16.88 ± 3.09
25/12
Number of drugs
0.89 ± 0.95
2/0
VFI (%)
96.02 ± 4.52
100/80
MD (dB)
−1.90 ± 2.10
1.67/−6.00
Axial length (mm)
23.84 ± 1.25
26.56/21.13
IOL power (D)
20.38 ± 3.90
29.50/11.50
D diopters, IOP GAT intraocular pressure measured with Goldman applanation tonometer, MD mean deviation, RNFL retinal nerve fiber layer, VFI visual field index
The mean time between surgery and study measurements was 13.50 ± 7.24 months (range: 1.26–20.13 months). After cataract surgery, patients achieved the following refractive outcomes: a sphere of −0.00 ± 0.35 D (+ 1.00/−1.25), a cylinder of −0.52 ± 0.47 D (0.00/−1.50), and a spherical equivalent (SE) of −0.27 ± 0.33 D (+ 0.50/−1.25). In addition, 86.11% of eyes (62 out of 72) were within ± 0.5 D of the target SE and 95.83% (69 out of 72) were within ± 1.0 D. Table 2 shows postop visual acuity data.
Table 2
Visual acuity after Vivity IOL implantation
Visual acuity
Monocular (72 eyes)
Binocular (36 patients)
CDVA (LogMAR)
0.03 ± 0.10
−0.15 / 0.34
0.08 ± 0.12
−0.20 / 0.28
CIVA (LogMAR)
0.18 ± 0.15
−0.14 / 0.50
0.16 ± 0.14
−0.06 / 0.42
CNVA (LogMAR)
0.31 ± 0.15
−0.10 / 0.64
0.24 ± 0.11
0.10 / 0.46
Data are expressed as mean ± standard deviation (SD) and range (max/min)
Figures 1 and 2 show the defocus curve and contrast sensitivity function. In Fig. 1, the binocular defocus curve shows a peak of maximum VA at 0 D (0.00 ± 0.11 LogMAR) that corresponds to distance vision (6 m) and a more elongated and smoother peak of VA at the intermediate (66 cm or −1.50 D) and near (40 cm or −2.50 D) distances (0.11 ± 0.09 LogMAR and 0.36 ± 0.18 LogMAR, respectively). Regarding the binocular contrast sensitivity curve (Fig. 2), at short spatial frequencies (3 and 6 cpd) a high and expected performance is evident (1.67 ± 0.22 Log and 1.84 ± 0.17 Log, respectively); however, at high spatial frequencies (12 and 18 cpd) a decrease (1.44 ± 0.29 Log and 0.93 ± 0.29 Log, respectively) compared with low spatial frequencies was observed.
Fig. 1
Monocular and binocular defocus curve given in LogMAR after Vivity IOL implantation IOL intraocular lens
Table 3 provides a summary of the IOLSAT outcomes for sections 1 and 2. In section 3, patients were asked how often they anticipated needing glasses for near (question 18), intermediate (question 19), or far (question 20) vision after cataract surgery. The percentage of subjects who reported “never or rarely needing glasses” was 19.44% for near vision, 72.22% for intermediate vision, and 83.33% for far vision. Conversely, the percentage of subjects who reported needing glasses “every time or most of the time” was 38.89% for near vision, and 2.78% for both intermediate and far vision. In section 4 (question 21), when asked about their satisfaction with their vision after cataract surgery, 86.11% of patients responded as being “satisfied or very satisfied.”
Table 3
IOLSAT questionnaire
Condition
Section 1: percentage of subjects that “never” or “rarely” need glasses
Section 2: percentage reporting “good” or “very good” vision without glasses
Overall
47.22
–
General
Distance (“far away”)
88.89
–
Intermediate (“arm’s length”)
83.33
–
Near (“up close”)
47.22
–
Bright light
Distance (“far away”)
88.89
88.89
Intermediate (“arm’s length”)
91.67
77.78
Near (“up close”)
63.89
69.44
Dim light
Distance (“far away”)
83.33
77.78
Intermediate (“arm’s length”)
80.56
61.11
Near (“up close”)
33.33
30.56
Data are expressed in %; IOLSAT, intraocular lens satisfaction
Table 4 summarizes the QUVID questionnaire outcomes for various vision problems and qualitative measures. Owing to time constraints during the study, 34 of the 36 patients completed the questionnaire. Of these, 82.35% reported no concerns about the frequency of hazy vision and 85.29% reported no issues with its severity or associated discomfort. In addition, 97.06% of the patients reported having no shadows in terms of frequency, severity, or bothersome effect.
Table 4
QUVID questionnaire
Starbursts
Halos
Glare
Hazy vision
Blur vision
Diplopia
Shadow area
FREQUENCY (how often they occur?)
Never
82.35
79.41
55.88
82.35
82.35
91.18
97.06
Rarely
0.00
2.94
11.76
2.94
2.94
2.94
0.00
Sometimes
11.76
14.71
17.65
11.76
11.76
2.94
2.94
Most of the time
2.94
2.94
14.71
0.00
0.00
2.94
0.00
Always
2.94
0.00
0.00
2.94
2.94
0.00
0.00
SEVERITY (how severe are they at their worst?)
None
82.35
79.41
55.88
85.29
82.35
91.18
97.06
A little
0.00
8.82
5.88
2.94
2.94
2.94
0.00
Mild
11.76
11.76
11.76
8.82
11.76
2.94
0.00
Moderate
5.88
0.00
23.53
2.94
2.94
2.94
2.94
Severe
0.00
0.00
2.94
0.00
0.00
0.00
0.00
BOTHERSOME (how much do they bother you?)
Not at all
85.29
91.18
64.71
85.29
85.29
91.18
97.06
A little bit
2.94
8.82
8.82
11.76
5.88
2.94
0.00
Somewhat
8.82
0.00
2.94
0.00
5.88
2.94
0.00
Quite a bit
2.94
0.00
11.76
2.94
2.94
2.94
2.94
Very much
0.00
0.00
11.76
0.00
0.00
0.00
0.00
Data are expressed in %; QUVID Questionnaire for Visual Disturbances
Discussion
This study assessed the visual performance and patient satisfaction with the Vivity IOL in patients with mild POAG. Results showed satisfactory visual outcomes, aligning with previous research findings [22‐24]. Both monocular and binocular visual performance were favorable across distance, intermediate, and near visual acuities, with minimal reliance on spectacles, high predictability, and a low incidence of visual disturbances in eyes with mild glaucoma. The mean monocular corrected distance, intermediate, and near visual acuities (CDVA, CIVA, CNVA) were 0.03 ± 0.10, 0.18 ± 0.15, and 0.31 ± 0.15 LogMAR, respectively. For binocular measurements, CDVA, CIVA, and CNVA were 0.00 ± 0.12, 0.16 ± 0.14, and 0.24 ± 0.11 LogMAR, respectively. Furthermore, 86.11% of eyes were within ± 0.5 D of the spherical equivalent target, and 95.83% were within ± 1.0 D.
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Our study found good intermediate and functional near vision outcomes, which are becoming more important as the use of screens, including computers, laptops, tablets, and smartphones, continues to rise in everyday life. The Vivity IOL achieves this through a non-diffractive, wavefront-shaping design that extends the focal range without splitting light into multiple foci, unlike multifocal IOLs. Kerr et al. similarly found that the Vivity IOL offered an extended range of vision in patients with early glaucoma, with enhanced intermediate and near vision and minimal visual disturbances, comparable to monofocal IOLs [24]. In addition, Ferguson reported favorable outcomes for patients with mild glaucoma implanted with the Vivity IOL, with 85% achieving uncorrected distance vision (UDVA) of ≥ 20/25 and 77% attaining uncorrected intermediate vision (UIVA) of ≥ 20/32 at 4 months [22]. A recent prospective study by Liu et al. assessing the Vivity IOL in patients with well-controlled glaucoma and ocular hypertension demonstrated that the Vivity IOL significantly improved distance and intermediate visual acuity at the 3-month follow-up. Uncorrected distance vision improved from 0.84 LogMAR preoperatively to 0.02 LogMAR at 3 months (p < 0.001), and uncorrected intermediate visual acuity improved from 0.30 LogMAR preoperatively to 0.03 LogMAR at 3 months (p = 0.002), while uncorrected near visual acuity remained the same (p = 0.379) [25].
The good intermediate and functional near vision observed in our study was reflected in the binocular defocus curve results. We reported binocular visual acuities of 0.11 ± 0.10 LogMAR for intermediate vision at −1.50 D and 0.36 ± 0.21 LogMAR for near vision at −2.50 D. These findings align with previous studies, which reported visual acuities between 0.05 and 0.10 at −1.50 D and between 0.35 and 0.38 at −2.50 D in healthy participants [26, 27]. This demonstrates that the Vivity IOL offers reliable performance across intermediate and near distances, supporting its effectiveness in patients with mild and stable POAG.
Concerning CSF, our study observed a reduction at higher spatial frequencies (0.93 ± 0.29 Log at 18 cpd), which aligns with previous reports showing lower contrast sensitivity in glaucomatous eyes at higher frequencies [16, 28, 29]. Bissen-Miyajima et al. also reported decreased contrast sensitivity in glaucomatous eyes at similar frequencies using a diffractive EDOF IOL [23], as opposed to the non-diffractive IOL used in our research. Some studies reported that the reduction in the contrast sensitivity may not only be due to glaucoma but also to the diffractive IOL optical design; decreased contrast sensitivity at higher frequency was reported in diffractive IOLs. [23, 29, 30] Moreover, it is widely known that contrast sensitivity declines with age, particularly at higher spatial frequencies [28], a trend that is also evident in our study group, whose average age was 71.61 ± 7.68 years.
Hong’s systematic review [31] found that postoperative CSF in glaucomatous eyes remained comparable to that in healthy eyes after EDOF IOL implantation. However, discrepancies between our findings and Hong’s may reflect differences in patient populations and methodologies. Our study specifically targeted patients with mild, stable glaucoma (mean preoperative MD of −1.90 ± 2.10 dB), characterized by good RNFL, MD, and VFI metrics. In contrast, the studies reviewed by Hong included heterogeneous patient groups and varied testing methods. For instance, Ferguson et al. [22] evaluated CSF in mild POAG using the Pelli–Robson chart, while Rementeria-Capelo et al. [32] included a diverse patient cohort with multiple ocular pathologies, including glaucoma, ocular hypertension, and macular degeneration, among others. Such diversity, along with variations in testing equipment and calibration, complicates direct comparisons. Reduced contrast sensitivity at higher spatial frequencies may have functional implications, particularly in low-light conditions such as night driving. Patients may experience a decreased ability to detect fine details and contrast in dim environments, which could impact their ability to perceive road signs, pedestrians, and other objects at night. Despite this reduction, overall contrast sensitivity remained within functional limits, and patients reported satisfactory visual performance.
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Our findings may indirectly support Dessouky et al. [33], who demonstrated a significant correlation between preoperative MD and postoperative CSF (p < 0.001), indicating that better preoperative MD predicts improved postoperative CSF. Although we did not specifically assess this correlation, the fact is that our cohort’s relatively preserved CSF at lower spatial frequencies (3–6 cpd) could be attributed to the mild nature of glaucomatous damage (mean MD of −1.90 ± 2.10 dB). This reinforces the importance of preoperative MD as a predictor of visual outcomes and its utility in clinical decision-making for EDOF IOL implantation in patients with mild glaucoma and cataracts.
In our study, we used the IOLSAT and QUVID questionnaires, finding that 86.11% of patients were satisfied or very satisfied with their vision. In addition, 47% of patients reported never needing spectacles, with 88.9% rarely or never requiring them for distance tasks and 83.3% for intermediate tasks. These findings align with McCabe’s study [21], which reported 21.6% of Vivity IOL patients never needed spectacles overall and 80–90% rarely or never needed them for distance and intermediate vision. Notably, 21% of our patients experienced halos and 44% reported glare, but only 8.82% and 11.76%, respectively, found these symptoms bothersome. However, the lack of studies using the same questionnaires as ours limits direct comparisons.
Both healthy individuals and patients with glaucoma may experience reduced contrast sensitivity following cataract surgery. However, patients with glaucoma are particularly vulnerable owing to optic nerve damage, visual field changes, and impaired visual function, which can worsen difficulties with night driving [34]. To optimize outcomes and improve the quality of life for patients with glaucoma, selecting an IOL that prioritizes optical quality is essential. While multifocal IOLs can provide excellent vision at extended ranges, they come with the trade-off of reduced contrast sensitivity and increased visual disturbances. As a result, multifocal IOLs are not considered ideal for patients with glaucoma [24, 35], while EDOF IOLs, such as Vivity, enhance intermediate vision and offer better contrast sensitivity and fewer visual disturbances compared with multifocal IOLs [14, 27, 28, 35]. Key factors in optimizing outcomes for patients with glaucoma include thorough preoperative assessment of optic nerve health and disease stability, selecting IOLs that minimize glare and visual disturbances to preserve contrast sensitivity, tailoring postoperative intraocular pressure (IOP) management, and setting realistic patient expectations regarding visual outcomes. By addressing these factors, we can improve visual function and overall quality of life for patients with glaucoma.
This study has some limitations. Firstly, the absence of a control group limits direct comparisons with monofocal or other EDOF IOLs, which would have strengthened the interpretation of outcomes. Secondly, the relatively short follow-up period may not fully capture neuroadaptation effects, as this process can take between 3 months and 1 year. Neuroadaptation, which refers to the brain’s ability to adjust its neurophysiology to changes in retinal image quality caused by light dispersion, is particularly relevant for multifocal and EDOF IOLs [36‐38]. Longer follow-up studies would provide stronger evidence regarding the stability of visual performance over time and the role of neuroadaptation in optimizing visual outcomes [36, 37]. Another limitation is the lack of pupil size measurements, which are known to correlate strongly with CSF [39, 40]. This omission could explain the observed CSF values at high spatial frequencies, as small pupil size may affect light transmission and induce optical aberrations. In addition, this study assessed contrast sensitivity only under photopic conditions and it is important to note that glaucomatous eyes are at higher risk of reduced contrast sensitivity in mesopic conditions [41]. Finally, our study focused solely on patients with mild POAG, which limits the generalizability of the findings to patients with more advanced disease. Further studies are warranted to evaluate the long-term visual outcomes of EDOF IOLs in patients with varying levels of glaucoma severity.
Although we included patients with stable POAG, postoperative visual field testing to evaluate the impact of the Vivity IOL on glaucoma progression was not included in our study. Previous studies have noted decreased values of mean deviation (MD) on visual field examinations using the Humphrey perimeter in healthy patients who received multifocal IOLs [42, 43]. Aychoua et al. observed a decrease of 2.4 dB in MD in patients with multifocal IOLs compared with phakic and monofocal IOL groups, attributing this decline to the IOL’s optical design rather than pseudophakia itself. Farid further noted that these MD reductions did not improve over time or with neuroadaptation. However, a study involving another type of EDOF IOL—not Vivity™—found that eyes implanted with this EDOF IOL generally exhibited MD values comparable to those of eyes with monofocal IOL and superior to those with multifocal IOL [44]. This suggests that EDOF designs may have a lesser impact on visual field metrics compared with multifocal designs. Since our study specifically examined the Vivity IOL, further research is needed to fully understand its unique impact on visual fields, particularly in patients with glaucoma. Future research should focus on tracking long-term changes in visual function, contrast sensitivity, and quality of life in patients with glaucoma implanted with the Vivity IOL. Including control groups with monofocal and alternative EDOF IOLs will provide a more robust comparative analysis. In addition, investigations into the interaction between neuroadaptation, contrast sensitivity, and glaucoma stability over extended periods will be essential for optimizing patient outcomes.
Conclusions
The AcrySof™ IQ Vivity™ EDOF IOL demonstrates favorable visual outcomes in patients with mild POAG, providing good distance and intermediate vision, high patient satisfaction, and minimal spectacle dependence. This lens maintains contrast sensitivity close to that of monofocal IOLs while reducing photic phenomena commonly associated with multifocal IOLs. With an average follow-up of 1 year post-implantation, our findings suggest that the Vivity IOL preserves good visual function in this patient population, making it a viable option for patients with glaucoma requiring cataract surgery. Further studies with longer follow-up and a broader range of glaucoma severities are needed to confirm these findings and assess the IOL’s long-term impact on disease progression.
Acknowledgements
The authors would like to thank the participants of the study and everyone at Miranza Begitek, Miranza Ókular, and Miranza IOA who helped with data collection.
Medical writing/editorial assistance
The manuscript was drafted by the corresponding author and reviewed by the first author—partial medical writing support was provided by Giorgio Pirazzini (GP Communications). No funding was provided from a third party for support in medical writing.
Declarations
Conflicts of Interest
Aritz Urcola: consultant (A) for Alcon. Gorka Lauzirika, Igor Illarramendi, Andrea Soto-Velasco, Ronald Sánchez-Ávila, Carlota Fuente-García, and Aitor Fernández-García have no competing interests in the medical devices/products that are involved in this manuscript. The authors have no proprietary or commercial interest in the medical devices/products that are involved in this manuscript.
Ethical Approval
All the procedures complied with the ethical standards described in the 1975 Declaration of Helsinki that were revised in 1983. Research Ethics Committee approval was obtained from the IMO Miranza Group Barcelona (GlauVivity no. 230,119–222). In addition, the purpose of the study and the policy on the protection of personal data were explained in detail to all participants, and informed consent was obtained from all participants.
Open Access This article is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License, which permits any non-commercial use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by-nc/4.0/.
Evaluation of Visual, Refractive, and Functional Outcomes after Implantation of an Extended Depth of Focus Intraocular Lens in Patients with Stable and Mild Glaucoma
Verfasst von
Aritz Urcola
Gorka Lauzirika
Igor Illarramendi
Andrea Soto-Velasco
Ronald Sánchez-Avila
Carlota Fuente-García
Aitor Fernández-García
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Je höher der BMI, umso höher ist das Risiko, bei einer Infektion zu sterben. Das gilt nicht nur für Covid-19, sondern für Infektionen allgemein. Bei einer Grad-III-Adipositas ist die Mortalität während einer Infektion sogar verdreifacht. Darauf deuten Daten aus Finnland und Großbritannien.
Periphere Fazialisparesen sollten nicht vorschnell als idiopathisch klassifiziert werden. Vor allem bei atypischen Manifestationen gilt es, auf dem Quivive zu sein. Der Fall einer 73-Jährigen zeigt, warum.
Bei der Festlegung der Intervalle für Kontrollkoloskopien nach einer Polypektomie sollten nicht ausschließlich polypenbezogene Merkmale berücksichtigt werden. Wie eine internationale Studie zeigt, beeinflussen auch individuelle demografische Faktoren, wie Geschlecht, Body-Mass-Index und Ethnie, das Rezidivrisiko.
In einer Kohortenstudie wurde ein Zusammenhang zwischen oralen Bakterien und Pilzen und dem Auftreten von Pankreaskarzinomen gesehen. Diese Assoziation könnte helfen, Patientinnen und Patienten für gezielte Vorsorgeuntersuchungen ausfindig zu machen.
