Surgeon Dr David Gunn was impressed with the RayOne EMV IOL as soon as he used it. Now he has the data to back up those first impressions, and the excellent feedback from his patients.
Brisbane ophthalmologist Dr David Gunn knew he was on to a good thing pretty quickly with the RayOne EMV intraocular lens (IOL).
The cornea, cataract and refractive surgeon at the Queensland Eye Institute and Focus Vision private practice has included lots of data and interesting numbers in a research paper published in the Journal of Ophthalmology Research Reviews & Reports.
He and his team conducted a retrospective, single-centre analysis of 147 eyes of 74 patients implanted with RayOne EMV or EMV Toric IOLs, the lens designed in collaboration with Western Australia ophthalmologist Professor Graham Barrett
That study, published on May 14, 2025, merely confirmed the initial enthusiasm Dr Gunn felt for the product years earlier, when he performed his first implants.
“In that first approximately 20 patients, I probably had about four or five who were completely spectacle independent, and I really didn’t expect that,” he says.
“I had some patients that were coming in at 6/4.5 and N5 – I can read my phone, I can read everything, I can read the computer. And they had zero halos, zero night-time aberrations.
“And that was quite a positive, because sometimes you start a lens and it’s all bad for the first 10 or 20 cases.
“My first cases with the EMV, right at the start, I was quite impressed by the amount of reading vision they got from what effectively looks like a monofocal lens.”
Dr Gunn sees a wide variety of patients, including those with irregular corneas, people needing post-refractive surgery, patients with high expectations about spectacle independence, as well as Fuchs endothelial dystrophy and other anterior segment comorbidities that come with a corneal practice.
He reckons his work is roughly 50/50 for refractive and cataract surgery.
In his practice, about 80% of the IOLs he uses are presbyopia correcting, half of those being multifocal and half EDOF lenses.
Dr Gunn has been using the Rayner EMV since the toric version was released in Australia in 2022.
He was impressed with the technology developed by Prof Barrett and the company, and particularly the spherical aberration of the lens.
He had noticed that patients with other EDOF IOL products implanted were not entirely happy with the resulting distance vision.
“They’d go, my reading is great but my distance isn’t kind of what I was expecting,” he says.
“It seemed there was a tradeoff to be made, and EDOF wasn’t working out for everyone.
“So I started with the Rayner EMV when it came out, and then I started to get some really good results.”
When those first 20 patients became 200, he decided it was time to review his data to see if the results and outcomes matched the positive feedback from his patients.
Dr Gunn and his team reviewed results from 74 patients implanted with RayOne EMV and EMV Toric IOLs between November 2022 and November 2023.
All were assessed during a one-month follow-up.
Patients were categorised into four refractive target groups: bilateral emmetropia; mini-monovision; modest monovision; and full monovision. And it evaluated the impact of pre-operative parameters — corneal spherical aberration (SA), higher-order aberrations (HOAs), and Chang Waring chord (CW-chord) – on monocular and binocular vision.
They found that mini-monovision patients achieved high levels of uncorrected distance visual acuity (UDVA, 80.4% at 6/6 or better) and uncorrected near visual acuity (UNVA, 84% at N8 or better).
Dr Gunn and his team concluded that the findings “support the effectiveness of increased range of focus IOLs”.
“The RayOne EMV or EMV Toric IOLs, with their innovative design incorporating positive spherical aberration, demonstrate promising outcomes, particularly for patients seeking a balance between distance and intermediate vision,” the study says.
“A mini-monovision approach delivers a useful range of distance and intermediate vision in most patients, even with variation of pre-operative aberration profile.”
He says those outcomes can be enhanced if practitioners follow Prof Barrett’s guidance for monovision implantations, with a few minor tweaks here and there.
“Professor Barrett, he often aims for minus one in the non-dominant eye.
“The issue that I have with that approach is that some patients don’t accept that cross blur.
“With those larger amounts of anismetropia, one in 50 patients come back at a year saying, I haven’t adapted, there’s something wrong with this eye. It feels weird, it feels fuzzy.
“So you need to really do a lot of consenting beforehand, or maybe do a contact lens trial to simulate that cross blur.
“If patients have been doing contact lens monovision for 15 years, and they love it, I do exactly what Graham does – RayOne EMV aiming for distance in the dominant eye and -1.25 D or -1.50 D in the non-dominant eye and they’re extremely happy with that.
“But for patients coming with cataracts who haven’t ever tried monovision, for general surgeons who don’t do a lot of monovision and have moved away from it, I think going much beyond 0.50 D or 0.75 D of anisometropia can probably increase the chance of ending up in situations where you have to do enhancements.”
He says one of the greatest attributes of the RayOne EMV is that it is a very “forgiving” lens with a wide range of intermediate and distance vision.
“When we looked at our data set, we found that it actually made no difference in terms of the lens performance if they had an abnormal angle kappa or increased higher order aberration profile.
“So if the lens was a bit de-centred from the visual axis or if the natural eye’s optics were a bit abnormal, it made no difference to the visual outcomes with the EMV.”
That is unlike many of the more complex lenses that can come with compromises.
Using those lenses can be a bit “overwhelming”, he says, even for experienced surgeons.
“And you can be worried about using lenses that ask you to go check this and this and this parameter; you need to have a Pentacam and aberrometry, you need to have all this equipment,” Dr Gunn says.
“You can kind of ignore that with the RayOne EMV. You can just put it in patients. Even if you have basic biometry equipment and for most relatively normal cataract patients it’s going to be completely fine.”
That simple, broad appeal, and the forgiving design of the Rayner IOL make it ideal for surgeons in general ophthalmology practices who might want to try an extended depth of focus lens.
“The EMV is a great choice for getting started with EDOF and using just the smallest amount of monovision in the other eye, -0.25 D or -0.50 D to start.
“They can put a little bit more if they would like and it really increases the quality of intermediate reading vision they get. I think it’s a great platform for that.”
Dr Gunn’s patients agree.
Beyond the data, he has plenty of great anecdotal evidence and feedback about the quality of the RayOne EMV, his work, and the outcomes for the patients.
“In terms of the clarity of the distance and the quality of that distance vision, they’ve been very happy with it,” he says. “In terms of the reading vision, it’s variable.
“Around a quarter to a third of patients I’ve talked to – I didn’t say they were going to be getting reading vision – they find that they’re pretty much spectacle independent, no glasses at all, and no halos.
“The other three-quarters will often say, ‘oh, I can hold my phone away a bit, and I can read things, and I’m happy enough with that’, but they are happy with the quality of the distance vision.”
Dr Gunn acknowledges concerns remain that the RayOne EMV is a hydrophilic lens.
“There’s always the concern of gas exposure to the lens, and that lens platform . . . that discussion has been going on for a while now. Potentially that argument is a bit overblown and perhaps it is less of an issue with the current generation of lenses. For some surgeons though, hydrophilic materials are an issue.”
Due to this he feels the lens is not the ideal choice for a patient potentially needing a vitrectomy or endothelial keratoplasty.
But he is happy to recommend the RayOne EMV in most situations.
It is great for patients “lifestyle-wise, you know, going to the shops, picking up a bottle, reading the shampoo and conditioner, seeing your dinner while you’re eating – those sort of things that make life a lot more comfortable.
“And yeah, reading glasses still come on for the computer for two hours or reading the small print on their phone. But just day-to-day, for your standard cataract patients, they walk away happier than a standard monofocal.”
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