Alcon has officially ushered in what some Australian ophthalmologists are calling a new class in presbyopia-correcting intraocular lens (IOL) technology due to its ability to negate visual disturbances – the bane of many EDOF and multifocal IOL designs.
Australian surgeons got their first glimpse of the AcrySof IQ Vivity IOL at a virtual launch out of Sydney on 17 September hosted by media personality Tracey Spicer. They were presented with findings of clinical trials and heard from leading ophthalmologists and patients who have had early access to the lens.
The launch of Vivity, an extended range of vision IOL that uses non-diffractive design called X-Wave technology, has been highly anticipated after some early adopters stated it could become their default lens for cataract surgery.
Last week’s virtual event featured presentations and a panel discussion with Associate Professor Chandra Bala, managing director at personalEYES, Associate Professor Michael Lawless from the Vision Eye Institute in Sydney, and Clinical Associate Professor Paul McCartney from Hobart Eye Surgeons.
Bala, who took part in a trial comparing Vivity with the Alcon Acrysof IQ monofocal, presented key findings from two US and global studies, which demonstrated how Vivity enables high-quality vision at far and intermediate ranges as well as functional up-close vision.
While patients may require spectacles for some near activities, a monofocal visual disturbance profile is said to be a key advantage for Vivity over other presbyopia-correcting designs. These include multifocals which may offer spectacle independence with some visual disturbances, or some EDOF designs that may require spectacles while also producing visual disturbances.
In his presentation, Bala showed that in bright light 94% of Vivity patients reported good or very good vision without spectacles for distance, which was comparable to Acrysof IQ patients (92%).
For intermediate, Vivity was superior with 92% reporting good vision compared with 63% for Acrysof IQ, and for up close those numbers were 57% for Vivity and 25% for Acrysof IQ. In dim light, Vivity also performed better over all distances.
“So you are not only getting good distance vision, but the patient actually feels the quality of vision for intermediate is as good, and I think that’s an important take home message because the next question is what about visual disturbance, the one thing that plagues most presbyopia-correcting IOLs?” Bala said.
In another slide, Bala showed how Vivity offered a visual disturbance profile equivalent to a monofocal lens (Acrysof IQ).
Overall, 74% of Vivity and 72% of Acrysof IQ patients were ‘not bothered’ by starbursts; 83% of Vivity and 89% of Acrysof IQ weren’t bothered by haloes; and for glare those numbers were 78% for Vivity and 70% for Acrysof IQ.
Bala said Vivity had similar architecture to a monofocal, with a key difference being an added on component in the form of the X-Wave technology. It’s essentially a small shift in the lens in about one micron in thickness, affecting a 2.2mm-wide section in the centre of the lens.
“So for all practical intents and purposes, it’s overall designed as a monofocal lens but gives you an extended range of vision,” he said.
Lawless, who has implanted 112 Vivity IOLs since December, said he was initially cautious. However, he was now convinced of the technology and labelled it “a new class of lens”.
“This is an evolution, if by evolution you mean that this does things that I can’t do with other lenses,” he said. “I have been stung by many lenses over the years, but I’m pleased to say this lens does exactly what it is meant to do.”
He said the mechanism of action is a process called trapezoidal phase shift. This alters the waveform by stretching and then shifting the wave of light so that it increases the depth of focus so the image is in focus over a wider area. It does this without losing light at any range which is why the quality of vision is better than other EDOF or multifocal lenses. These, he said, lose around 12-15% of the light energy at any given point.
Lawless said until Vivity, the Zeiss At Lara was his ‘go-to’ EDOF lens, but there was still gaps in vision between intermediate and distance.
“The thing about the Vivity is its seamless quality, there is no hunting for the right focal lengths. It just seems normal to patients; they have described it to me as the vision they felt like they had when they were 35,” he said.
“It’s effectively taken the monofocal part of the practice, but it’s wrong to call it my default lens. The way I think about it is that I have to think of a reason why I would not use the Vivity lens in this particular patient, and it’s actually pretty hard to find a patient these days in my practice who I wouldn’t put a Vivity in.”