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Extended Depth of Focus IOLs: How Do They Work?

Home / Guide to Cataract Surgery / Extended Depth of Focus IOLs

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Extended depth of focus intraocular lenses (IOLs) are for people with presbyopia. In some cases, they can help with cataracts and astigmatism.

intraocular lenses

These lenses can be implanted to alleviate the need for eyeglasses or contact lenses. They work well as an alternative to these eye correction devices for some people.

Once someone determines that these lenses are a good choice, they are implanted via a fairly simple surgical procedure. As part of the process, the doctor will discuss the brands and options that are available, so patients can make an informed decision.

What Are Extended Depth of Focus Intraocular Lenses?

Extended depth of focus IOLs were approved by the FDA in July 2016, so this is a fairly new technology. This lens works by compensating for a chromatic aberration of the cornea.

A chromatic aberration is characterized by the lens of the eye failing to focus on all the colors at the same point, according to research published in the Journal of Optical Society of America. When this aberration is present, people see fringes of color along the lines that separate the bright and dark elements of an image.

When someone is using these lenses, it enhances the sharpness of their vision at intermediate, far, and near distances. This eliminates chromatic aberration, so color boundaries are clearly distinguished.

Extended depth of focus intraocular lenses (IOLs) are for people with astigmatism, cataracts and presbyopia. In cataracts specifically, the cloudy lens is removed and replaced with an artificial IOL.

Who May Not Benefit From These Lenses?

Woman with glasses suffering from eyestrain after long hours working on computer

Not everyone is a good candidate for these IOLs.

Presence of any of the following should be conveyed to the eye doctor, so they can determine if the person should have these lenses implanted:

  • Fuchs’ dystrophy
  • Advanced macular degeneration
  • History of post-refractive surgeries
  • Advanced dry eye
  • Anterior basement membrane dystrophy
  • Weak zonules
  • Glaucoma

Extended Depth of Focus IOL Brands

TECNIS

TECNIS was the first brand to offer an extended depth of focus IOLs. Below are the EDOF IOLS that the TECNIS brand offers today:

  • Tecnis Symfony: Includes the ZXR00 model for correcting aphakia (missing lens in one or both eyes).
  • Tecnis Symfony Toric: Includes the ZXT150, ZXT225, ZXT300, and ZXT375 models for correcting astigmatism and aphakia.
  • Tecnis Synergy: Includes model ZFR00V.
  • Tecnis Synergy Toric II: Includes models ZFW150, ZFW225, ZFW300, and ZFW375.

Alcon

A non-diffractive EDOF IOL from Alcon, a company based in Switzerland, was made available in the United States in January 2021 following approval in 2020 by the U.S. Food and Drug Administration (FDA)/ The company also released the first FDA-approved trifocal IOL in the U.S. in 2019. The brand offers the following IOLs to correct presbyopia:

  • AcrySof IQ Vivity IOL – utilizes diffractive X-Wave technology.
  • PanOptix Trifocal IOL – mitigates three ranges of vision (near, intermediate, and distant).

The Surgical Procedure

The purpose of the surgery is to remove a person’s natural lens and replace it with an extended depth of focus IOL. The surgeon usually does each eye about a week apart, and each surgery takes approximately 15 minutes.

Before the surgery, the doctor will put drops into the eyes to anesthetize them, so the patient is comfortable. People are not put to sleep with general anesthesia for this procedure.

Surgeons performing an eye surgery under the microscope at the hospital - healthcare and medicine concepts

During the procedure, the doctor will start by removing the eye’s natural lens. Once this is successfully removed, the new IOL is put into place.

About a week after surgery, people can resume their normal activities. It may be several weeks before they get the final results from the lens replacement. Ultimately, the usual results are that people no longer need to wear contact lenses or glasses.

During the recovery period, it is not uncommon to experience halos, a scratchy sensation in the eye, blurry vision, and glare.

Make sure to follow all the recovery instructions exactly. Proper use of all medications and resting the eyes are recommended. These practices may decrease the risk of complications.

Possible Surgical Complications

The possible complications of surgery are very similar to those of cataract surgery since the procedures are essentially the same. These complications may include the following:

  • Inflammation
  • Bleeding
  • Drooping eyelid
  • Retinal detachment
  • Infection
  • Swelling
  • Artificial lens dislocation
  • Glaucoma
  • Vision loss

If someone has a serious medical condition or another eye disease, they are at a higher risk for experiencing complications. It is important to follow all of the preparation instructions before the surgery as these can reduce the risk of complications.

For example, the doctor might prescribe antibiotic eyedrops before the lens replacement. Using these reduces the risk of an infection during the recovery process.

People who have presbyopia might consider extended depth of focus intraocular lenses. They may help to improve vision without the need for contact lenses or eyeglasses. Talk to your doctor about what is best for your particular situation.

Outcome and Success Rates

The primary goals of EDOF IOLs are to optimize visual outcomes and ensure patient satisfaction. EDOF IOLs have been shown to provide patients with satisfactory results in both near and distance vision without eyeglasses.

One study compared the outcomes for the PanOptix and Symfony IOLs offered by Alcon and TECNIS, respectively. The PanOptix IOL produced total eyeglasses and contact lens independence in more than 80% of the patients. The PanOptix IOL provides better initial outcomes for near-distance vision, but both IOLs exhibit similar outcomes after several months.

In a clinical trial studying the effectiveness of the recently FDA-approved TECNIS Synergy IOLs, patients reported improved visual acuity at near and intermediate distances.

Overall, EDOF IOLs have high success rates, with most patients reporting satisfaction. Nonetheless, some patients will report spectacle dependence and residual refractive errors.

References

  1. FDA Approves First Intraocular Lens with Extended Range of Vision for Cataract Patients. U.S. Food and Drug Administration.
  2. Matching Color Images: The Effects of Axial Chromatic Aberration. Journal of the Optical Society of America.
  3. Premium IOLs: How to Spot Poor Candidates. Review of Ophthalmology.
  4. Indications and Important Safety Information for TECNIS Symfony and TECNIS Symfony Toric Extended Range of Vision IOLs. Johnson & Johnson Vision.
  5. Refractive Lens Exchange (Lens Replacement Surgery). All About Vision.
  6. Cataract Surgery. Mayo Clinic.
  7. Astigmatism. American Optometric Association.
  8. Facts About Presbyopia. National Eye Institute.
  9. Presbyopia. All About Vision.
  10. Facts About Cataracts. National Eye Institute.
  11. JOHNSON & JOHNSON VISION BRINGS TECNIS SYNERGY AND TECNIS SYNERGY TORIC II PC-IOLS TO NORTH AMERICA FOR CATARACT PATIENTS (June 23, 2021). Johnson & Johnson Vision.
  12. TECNIS Synergy Intraocular Lens, Tecnis Synergy Toric II IOL, TECNIS Synergy with TECNIS Synergy Delivery System, TECNIS Synergy Toric II IOL with TECNIS Simplicity Delivery System. (July 2021). U.S Food and Drug Administration.
  13. Alcon Introduces AcrySof IQ PanOptix Trifocal IOL in the U.S., the First and Only FDA-Approved Trifocal Lens (August 2019). Alcon Media Release.
  14. Alcon launches extended depth of focus intraocular lens. (January 2021). Mass Device.
  15. Comparison of the Visual Outcomes of an Extended Depth-of-Focus Lens and a Trifocal Lens. (July 2021). Journal of Clinical Ophthalmology.
  16. The PanOptix Trifocal IOL vs the ReSTOR 2.5 Active Focus and ReSTOR 3.0- Add Multifocal Lenses: A Study of Patient Satisfaction, Visual Disturbances, and Uncorrected Visual Performance. (March 2021). Journal of Clinical Ophthalmology.

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