We all want to be young again, at least when it comes to vision: visual quality, range of vision, and freedom from glasses is best when we are in our 20s (or even younger). With age comes presbyopia and then cataracts — and while our current range of IOLs is excellent, nothing beats being young again.
When we speak of extended depth of field (EDOF) IOLs, it is helpful to review the difference between depth of field and depth of focus. Though ophthalmologists use these terms interchangeably, there is a difference between the two:
The patients desire the widest depth of field so that they can see everything from far away to up close, all without glasses. In terms of optics, we are looking at the depth of focus within the eye. Either way, our goal is a wider depth of field and a wider depth of focus, so that our patients can have greater freedom from glasses.
We do have IOLs which can restore much of the vision at the time of cataract surgery. The monofocal IOLs give the best visual quality but also have the narrowest range of focus. The trifocal IOLs (like the Alcon PanOptix) give the widest range of vision without glasses but they compromise image quality with reduced contrast and nighttime glare/halos/rings. There are extended depth of focus (EDOF) IOLs which aim to mitigate that situation by elongating the depth of focus. The commonly used designs are the small aperture IOLs (Acufocus), the diffractive EDOF (Tecnis Symfony), and now the wavefront beam-shaping EDOF (Alcon Vivity).
The Alcon Vivity uses a central optical zone that is beam-shaping: it changes the wavefront of these central light beams to elongate the depth of focus. This gives a wider range of good vision without glasses, with patients seeing at least 1 line better for intermediate and near when compare to a monofocal IOL.
If we want to give our patients the widest range of vision without glasses, then using a trifocal IOL like the Alcon PanOptix would be the best choice. However this IOL will give less contrast as well as nighttime glare/halos/rings. The monofocal IOL will give the best image quality but also the most limited range of vision without glasses. The Alcon Vivity EDOF IOL splits the difference, giving about 50% more visual range than the monofocal while avoiding the nighttime glare/halo/rings of the diffractive PanOptix.
The increased depth of focus is seen clearly in the MTF and Defocus curves above. The MTF is modulation transfer function and it shows that while there is an increased depth of focus with the Alcon Vivity IOL, it comes with a decrease in the MTF at the 0.00 (plano) focal point which we see as a decrease in the contrast.
We are now ramping up the use of the Alcon Vivity IOL in our practice and we anticipate that it will complement the other IOL options that are available to our patients. Our goal is to individualize the treatment and the surgery to each individual patient and each specific eye. We always welcome additional tools in the toolbox and this IOL will play a role in the spectrum of options for our patients.
Click below to learn more about EFOD IOLs and how they can be used to help your patients:
Can you comment pls on binocular MTF loss in Vivity?
Is the contrast sensitivity loss with Vivity something patients are noticing in real life? If so how is it manifested? Only in dim light or night driving?
What is the diameter of the central zone of Vivity?
about 2 mm. I would have to look up exact dimensions.
I have a pseudo macular. Would I be better off with the eyhance??? (Than the vivity) . Is there that much difference between these two products. ? Intermediate vision at 60 ct or 66ct.?
there is a huge difference — the visual range is about 3x better with Vivity over Eyhance. a video explaining this is coming
Thank you. I have a pseudo macular. At the end of your video you said “healthy macular.”and dry eye Do not want to put in lens that is not good for me. One doctor did not recommend and one did. Confused. Hope the eight thousand plus for the Vivity vs o dollars for the Eyhance is not a factor
No IOP spikes since the triamcinolone is washed out of the AC within a day or two. Very small dose, 0.5mg to 1.0mg. Remember that the aqueous turns over every 90 minutes which is 18x per day.
Hello Doctor Uday, I’m a 28 years old man that had a traumatic cataract replacement a year ago with a monofocal IOL in my dominant right eye and since then I have a lot of glare and halos at night plus poor intermediate vision and a miserable near vision. My doctor stated that I’m facing that because the IOL wasn’t perfectly centered during the surgery. Now I’m at exactly 12 months from the surgery and I’m not planning to live my whole life like that so I’m considering to have a lens exchange with the new VIVITY IOL. Please let me know what do you think about this.
Regards
Are you able to explain how you use Angle Alpha and Angle Kappa in your clinical practice, and what your cutoffs are that would allow or disallow premium IOLs?
Thank you!
yes, I will make a future video of this in 2022
Look forward to it! Thank you!
Have vivity toric lens in non dominant eye and still waiting for dominant eye lens. My non dominant eye gets hazy and loss of much distance as day goes on. What lens should I have in dominant eye? Should I have YAG on toric lens for late day haziness?
Please compare Alcon Vivity versus Rayner Rayone EMV
Yes please Vivity V Rayner EMV as I’m trying to chose for Op very shortly