1218: J&J Eyhance versus Alcon Vivity

Many surgeons have asked me to make a video comparing the J&J Eyhance to the Alcon Vivity IOL. I have already posted individual videos about each of these IOLs here:

The J&J Tecnis Eyhance is a monofocal IOL which slightly extends the intermediate range (67 cm) as compared to the J&J Tecnis ZCB00. There is a shift of some of the distance focused light energy (plano refraction, far distance) to the intermediate range which is centered at about -1 diopters of defocus (about 1 meter). This is accomplished by a central 1 mm zone of increased curvature. Studies have shown an increase of about 0.5 diopters at 67 cm for the J&J Tecnis Eyhance when compared to the J&J Tecnis ZCB00. The Tecnis Eyhance is not classified as an extended depth of focus IOL.

The Alcon Vivity is an extended depth of focus IOL (EDOF) which provides more intermediate range and even some near vision. It takes more of the light energy from the distance vision (plano defocus) and uses a beam-shaping element to elongate the focal range to include about -2 diopters of defocus (about 50 cm). The cost in terms of optical quality is a loss of some contrast which may be noticed more at night.

A monofocal IOL has a defocus of about 0.5 diopters, the Eyhance is about 1.0 diopters, and the Vivity is about 2.0 diopters. This means that the Eyhance is about 0.5 diopters more range than the monofocal IOL and the Vivity is 1.5 diopters more range than the monofocal IOL. That is a very significant difference of about 3x as much with the Vivity (1.5 D extra) over the Eyhance (0.5 D extra).

The key to remember is that for all of these IOLs, the area under each curve is about the same. The total number of light photons (light energy) entering the eye is the same and the IOL designs simply redistribute that energy to change the defocus curve. No IOL will magically increase the total amount of light energy being distrubted!

To maximize the true reading range using the J&J Eyhance monofocal IOL, a significant degree of monovision must be planned. For many patients a goal of about -1.25 diopters for the reading eye would be most helpful.
For the Alcon Vivity IOL, only a slight difference of about 0.5 diopters between the eyes will give good performance in the true reading range of 40 to 50 cm (16 to 20 inches).
For patients with cataracts, note that all of these IOL options provide a much better visual range and quality than what they are starting with pre-operatively. This is because the cataract limits much of the light energy entering the eye.
While we can use an IOL like the Alcon Vivity to give reasonable computer and reading vision to our presbyopic patients, but patients must accept that we may take away some of the image quality from distance vision to achieve this.
All of our patients including those with cataracts and those who are just presbyopic, must understand that no IOL is as good as being young. The same way that a plastic surgeon cannot give a 60 year old the face of a teenager, we cannot give a 60 year old patient youthful eyes again. Well, not until we have a commercially available truly accommodating IOL on the market (LensGen Juvene!)

click below to compare the J&J Tecnis Eyhance to the Alcon Vivity IOL:

disclosures: I have no current financial disclosures in relation to the Tecnis Eyhance IOL or the Alcon Vivity IOL. I do have a financial interest in LensGen, CataractCoach.com, and also in performing cataract surgery.

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