New IOL designs seek to overcome postop visual disturbances

New IOL designs seek to overcome postop visual disturbances

December 19, 2022

2 min read

Johnston is the clinical and residency director at Georgia Eye Partners in Atlanta.

Disclosures: Johnston reports consulting for Aldeyra, Avellino, Azura, Bruder, Dompe, Horizon Therapeutics, Orasis, Quidel, SeaGen, Thea, Visus and Zeiss; consulting and speaking for BioTissue, Glaukos, Kala, Oyster Point and Sun; being a shareholder of LacriSciences; consulting and researching for Tarsus; and consulting, speaking and researching for Allergan and Sight Sciences. Johnston also reports that his spouse is employed by Johnson & Johnson.

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Undesirable subjective optical patterns known as dysphotopsias are one of the most common complaints following cataract surgery.

First described by Masket in the 1990s, patients can present with positive or negative dysphotopsia (PD or ND). The former refers to a bright artifact of light seen as arcs, streaks, starbursts, rings or halos in the central or mid-periphery, and the latter is a dark, temporal arcing shadow or line artifact. PD may be related to IOL material, design and location, while the potential causes of ND are less well understood.


New IOL designs are intended to overcome dysphotopsias. Source: Adobe Stock

Josh Johnston

Changes manufacturers have incorporated to address PD include rounding the anterior portion of the square edge, reducing the thickness of the square edge, leaving the edge unpolished and moving the IOL optical power more anterior than posterior.

The most recent generation of Johnson & Johnson Vision’s extended depth of focus (EDOF) IOLs — the Tecnis Symfony OptiBlue and Tecnis Synergy — feature InteliLight technology meant to provide improved contrast and low-light performance. According to the manufacturer, InteliLight’s three key features are a violet-light filter that serves to mitigate halo, glare and starburst; an echelette design to reduce light scatter and halo intensity; and achromatic technology that corrects chromatic aberration to allow for better contrast day and night.

It has been shown that violet-light wavelengths can increase halos, especially at night. IOLs with violet-light filtration allow healthy blue light to pass through while filtering out the violet light for improved contrast and reduced dysphotopsia (Mainster, Mainster). Patients’ perception of daytime and nighttime driving is statistically significantly better with violet-light filtration IOLs compared with clear IOLs.

The IC-8 Apthera IOL is the first small aperture implant to receive FDA approval, the first lens indicated for implantation with a monofocal or monofocal toric IOL in the fellow eye, the first EDOF lens indicated for monovision and the first nontoric IOL indicated for cataract patients with low amounts — up to 1.5 D — of corneal astigmatism.

According to the company, Apthera’s embedded FilterRing component mitigates presbyopia by filtering out peripheral defocused and aberrated light that degrades image quality, allowing central focused light to be delivered to the retina. Compared with multifocal IOLs, patients experienced low levels of visual symptoms, with the severity of visual effects of glare, halos and starburst rated as 3.0%, 3.6% and 3.6%, respectively, according to data from the U.S. investigational device exemption clinical study.

AcrySof IQ Vivity is the first nondiffractive EDOF lens available in the U.S. Traditional diffractive presbyopia-correcting lenses split light into multiple zones to produce an elongated zone, while nondiffractive Vivity changes the shape of the wavefront as it passes through the lens.

The nondiffractive design helps reduce the incidence of visual disturbances compared with diffractive designs (reported at < 3.8%, according to data on file with Alcon). The X-Wave technology functions independently of pupil size, therefore providing excellent vision in bright and dim environments. Alcon says the lens delivers “monofocal-quality distance vision with excellent intermediate and functional near vision.”


  • AcrySof IQ Vivity extended vision IOL product information. Accessed Sept. 20, 2022.
  • AcuFocus announces FDA approval for the IC-8 Apthera intraocular lens, the first and only small aperture lens for cataract surgery. Published July 25, 2022. Accessed Sept. 20, 2022.
  • Clinical evaluation of a small aperture extended depth of focus intraocular lens.
  • Mainster MA. Br J Ophthalmol. 2006;doi:10.1136/bjo.2005.086553.
  • Mainster MA. Am J Ophthalmol. 2009;doi:10.1016/j.ajo.2008.08.020.
  • Masket S, et al. J Cataract Refract Surg. 1993;doi:10.1016/s0886-3350(13)80336-7.
  • Masket S, et al. Ophthalmology. 2020;doi:10.1016/j.ophtha.2020.08.009.
  • Olson RJ. J Cataract Refract Surg. 2005;31:653-654.

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Josh Johnston, OD, is the clinical and residency director at Georgia Eye Partners in Atlanta.

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