A non-diffractive extended depth of focus (EDOF) intraocular lens (IOL) has demonstrated favourable visual outcomes and high patient satisfaction in cataract patients with prior myopic laser in situ keratomileusis (LASIK) or photorefractive keratectomy (PRK) and elevated corneal spherical aberration, according to a newly published study in Clinical Ophthalmology.
The ambispective, observational study by Dr J Micheletti and Dr Brad Hall in the United States evaluated bilateral implantation of the AcrySof IQ or Clareon Vivity IOL in post-refractive surgery patients traditionally considered challenging candidates for presbyopia-correcting lenses. The authors note that high corneal spherical aberration is often viewed as a relative contraindication due to concerns around reduced image quality and increased dysphotopsias.
A total of 20 subjects (40 eyes) with prior myopic LASIK or PRK and corneal spherical aberration between 0.30 microns (µ) and 1.20 µ were included. All eyes were targeted for emmetropia and implanted with either Vivity or Vivity toric IOLs following uncomplicated phacoemulsification.
At three months postoperatively, binocular uncorrected visual acuity outcomes were strong across distances. Mean binocular uncorrected distance visual acuity (UDVA), uncorrected intermediate visual acuity (UIVA) and uncorrected near visual acuity (UNVA) were 0.02 ± 0.16 logMAR, 0.14 ± 0.13 logMAR and 0.24 ± 0.14 logMAR, respectively. Eighty-five per cent of subjects achieved 20/25 or better at distance, while 90% achieved 20/32 or better at intermediate and 75% achieved 20/40 or better at near.
Refractive accuracy was high, with 95% of eyes within ±0.50 diopters (D) of the target spherical equivalent and 98% within ±0.50 D of residual astigmatism. The binocular defocus curve demonstrated excellent distance and intermediate vision with a gradual decline beyond −1.50 D, consistent with the functional near performance expected from a non-diffractive EDOF design.
Patient-reported outcomes supported the objective findings. On the questionnaire for visual disturbances (QUVID), no patients reported being “bothered quite a bit” or “very much” by glare or halos, and only one patient (5%) reported this level of bother from starbursts. While some subjects reported moderate or severe dysphotopsias, overall bothersomeness remained low.
Spectacle independence, measured using the intraocular lens satisfaction questionnaire (IOLSAT), was highest at distance and intermediate. Ninety per cent of patients reported “never” or “rarely” using spectacles for distance, 75% for intermediate, and 30% for near. Overall, 80% of subjects reported being satisfied or very satisfied with their vision, 65% said they would choose the same lens again, and 70% would recommend the lens to friends or family.
The authors noted that many participants initially preferred a trifocal IOL but opted for a non-diffractive EDOF lens due to concerns about dysphotopsias following refractive surgery. Despite these expectations, satisfaction remained high.
Exploratory analysis showed weak correlations between preoperative spherical aberration (SA) and postoperative dysphotopsias. Moderate negative correlations were observed between SA and monocular UDVA and distance corrected near visual acuity (DCNVA), though only the association with DCNVA reached significance prior to statistical adjustment.
According to the authors, this is the first study to specifically examine outcomes with the Vivity IOL in post-myopic LASIK and PRK patients with high corneal spherical aberration. Visual outcomes and satisfaction were reported to be comparable to published results in eyes without prior refractive surgery.
The study was supported by an investigator-initiated grant from Alcon Vision and was presented at the 2024 and 2025 American Society of Cataract and Refractive Surgery (ASCRS) Annual Meetings.
