Head-to-Head Comparison of Five Enhanced Depth of Focus IOLs and One Monofocal IOL

Patients will be implanted with CT ASPHINA 409M during catarct surgery. The CT Asphina 409M has been commercially available for several years and is widely used in clinical practice. Designed with aberration-neutral optical properties, it could improve contrast sensitivity and visual quality. This monofocal aspheric IOL features four-point plate haptics and a one-piece design made from hydrophilic acrylic material with hydrophobic surface properties. It also has an overall diameter of 11 mm and a 6 mm optical diameter. The lens has a sharp posterior optic edge to minimize posterior capsule opacification. It is ideally suited as a comparative referent lens to new EDOF IOLs.

Patients will be implanted with TECNIS Eyhance ICB00 during catarct surgery. TECNIS Eyhance ICB00 is a one-piece, posterior chamber lens with an overall diameter of 13.0 mm and an optic diameter of 6.0 mm. The lens has a spherical posterior surface and a modified aspheric anterior surface that offers a smooth and continuous change in power from the periphery to the center of the lens, without a demarcation zone.

Patients will be implanted with AcrySof® IQ Vivity® during catarct surgery. The AcrySof® IQ Vivity® is a single-piece, hydrophobic acrylic IOL that utilizes non-diffractive wavefront-shaping technology (X-wave™) on its anterior surface to achieve an extended range of vision. Its aspheric anterior surface features a 2.2 mm central zone composed of two smooth transition elements: the first forms a slightly elevated plateau (\~1 µm) that stretches the wavefront, while the second shifts the wavefront to create a negative extended focal range. Together, these elements could create advanced and delayed wavefronts resulting in a continuous extended focal range instead of multiple focal points, while optimizing light transmission. This UV-absorbing and blue light filtering foldable IOL has a refractive index of 1.55 at 35 °C, an optic diameter of 6 mm and an overall length of 13 mm. The lens is available in spherical powers ranging from +10.0 to +30.0 diopters.

Patients will be implanted with LuxSmart™ during catarct surgery. The LuxSmart™ intraocular lens is a single-piece, acrylic hydrophobic and aspheric IOL with an overall diameter of 11 mm, an optical diameter of 6 mm, and a 4-point fixation haptic design. This non-diffractive IOL utilizes a technology known as Pure Refractive Optics (PRO), incorporating a 2.0 mm central EDOF zone that combines fourth- and sixth-order spherical aberrations of opposite signs designed to improve perceived depth of focus. The paracentral region, on the other hand, is a transition zone meant to gradually decrease the optic vergence from the center to the monofocal periphery. It has also a 360° continuous square edge on the posterior surface to prevent epithelial lens cells migration and posterior capsule opacification.

Patients will be implanted with Eyecryl SERT during catarct surgery. EyeCryl-SERT (Biotech) is a new advanced monofocal, single-piece hydrophobic IOL with an aspheric surface, continuous vision from distance to intermediate, spectacle independence for intermediate vision, an extended range of vision: \>1.75 D at spectacle plane with visual acuity 0.2 LogMAR or better, an intermediate vision up to 57 cm and a design for fast neural adaptation.

Patients will be implanted with RayOne EMV during catarct surgery. RayOne EMV (Rayner) is a new EDOF lens that has recently emerged in the market. It is a truly non-diffractive, single-piece hydrophilic IOL which does not use light splitting technology like many IOLs which increase depth of focus, resulting in low levels of dysphotopsia, similar to standard monofocal lenses. RayOne EMV is the only patented aspheric IOL that induces controlled positive spherical aberration. Compared to a lens with zero spherical aberration, the carefully controlled positive spherical aberration induced by RayOne EMV spreads light along the visual axis, elongating the focal range from far into intermediate with up to 1.5 D of depth of focus (per lens on the spectacle plane).