I am frequently asked if the new class of EDOF (extended depth of focus) IOLs can be used in eyes with corneal disease, retinal disease, and even glaucoma. The two types of EDOF IOLs which are commonly used in the USA are the diffractive EDOF IOL (J&J Tecnis Symfony) and the beam-shaping EDOF IOL (Alcon AcrySof Vivity) and both of these designs provide good visual performance and a wider range of vision without glasses when compared to monofocal IOLs.
For both of these EDOF IOLs, there is a loss of contrast sensitivity as measured by MTF (modulation transfer function) along with a corresponding increase in depth of focus as seen on the defocus curve. For a normal, healthy eye, this is a reasonable trade-off and it is worth it for patients who want to have more spectacle freedom.
However, if we have an eye with pre-existing ocular co-morbidities such as ocular surface disease, an irregular cornea, macular lesions, or optic neuropathies like glaucoma, it may not be the best decision to implant an IOL that will sacrifice some visual quality. In eyes with significant pre-existing disease, my preference is to stick with a monofocal IOL to maximize the image quality and tell the patients to expect to use spectacles to extended their range of visual focus.
Remember that even though the Alcon Vivity does not produce significant nighttime glare like diffractive iOLs, there is still a manufacturer’s warning that comes with the IOL:
I am happy to have more and more IOL options available because it allows us to truly tailor the surgery to suit the patient’s anatomy and desires. I welcome all new IOL designs with the understanding that it is my job as the surgeon to choose what is best for each patient. So can you use the EDOF IOL in your patient with pre-existing ocular disease? You tell me — you are the boss in that situation!
click to watch this video and learn the logic behind patient selection for the EDOF IOLs: