Over the past few decades, advancements in ophthalmic technology have transformed cataract and refractive surgery into highly personalized procedures. Traditionally, monofocal intraocular lenses (IOLs) were used to restore vision at a single distance, often requiring patients to rely on glasses for near and intermediate tasks. Today, multifocal IOLs offer greater spectacle independence by providing vision correction at multiple distances.
Extended depth of focus (EDOF) lenses, another innovation, provide a continuous range of vision while maintaining high contrast sensitivity and reducing nighttime visual disturbances compared to traditional multifocal lenses. The materials and optical designs of these lenses vary, which can influence visual outcomes and potentially cause adverse effects like nighttime halos, glare, or reduced contrast sensitivity. Some lens types may be contraindicated or yield suboptimal results for patients with certain underlying ocular conditions.
Given these circumstances, it is essential to educate patients about the unique features, benefits, limitations and cost of each lens type. A thorough preoperative discussion to understand each patient’s visual needs, lifestyle, and ocular health is vital to identifying the most appropriate IOL for that individual.
Multifocal
Multifocal IOLs are suited for patients who want the highest spectacle independence: full-range vision, from near work to computer work to distance. Since these lenses have been associated with increased halos and glare, ideal candidates are typically easygoing and have minimal nighttime driving requirements.
The Clareon PanOptix (Alcon) is a trifocal IOL that has been FDA- approved since 2019. With its updated glistening-free hydrophobic acrylic material, the Clareon PanOptix provides patients with excellent near, intermediate, and distance vision. Up to 90% of patients achieve complete spectacle independence, but some patients may experience nocturnal visual disturbances or low contrast sensitivity in dim lighting.1
The Clareon PanOptix Pro is the latest iteration of the original PanOptix trifocal IOL. It utilizes 94% of incoming light (up from 88%) to reduce light scatter, thus improving image contrast and potentially decreasing visual disturbances.2,3,4
The TECNIS Synergy(Johnson & Johnson) is a diffractive multifocal IOL with EDOF that provides a continuous range of vision and excellent near vision. It also provides improved image contrast in low-light conditions compared to other trifocal IOLs.5 However, limitations include suboptimal distance vision and significant nocturnal dysphotopsia, making it a less than ideal choice for patients who desire high-quality distance vision with minimal disturbances.5
More recently, the Synergy IOL has largely been replaced by the new TECNIS Odyssey (Johnson & Johnson), an IOL that offers a full range of vision and was FDA-approved in October of 2024. The Odyssey uses a digitally optimized design process to minimize aberrations and provide a continuous range of vision. It has custom echelettes and small step heights that allow more precise light control, thus minimizing dysphotopsias. At 1-month post-op, up to 93% of patients report mild or no visual disturbances.6
The enVista Envy (Bausch + Lomb), FDA-approved in October of 2024, is the newest diffractive trifocal IOL that uses the enVista toric platform to correct a wider range of corneal astigmatism (0.90 D to 4.03 D) than other full-range-of-vision IOLs on the market. The lens also features a posterior-squared step edge design to slow posterior capsular formation. Postoperatively, 93% of patients were satisfied with their near vision and 92% did not need spectacles for near vision.7
Unlike the other full-range-of-vision IOLs discussed, the ClearView3 (Lenstec) is a non-diffractive, segmented multifocal IOL that was designed to reduce the frequency and severity of nighttime dysphotopsia compared to traditional multifocal IOLs. However, it requires precise centration for optimal performance and is not available in a toric version, limiting its suitability for patients with significant astigmatism or those needing IOL powers outside the available range. Because of its hydrophilic acrylic composition, the ClearView3 is also contraindicated in eyes that may need endothelial keratoplasty or retinal surgeries due to risk of opacification.
Extended Depth-of-Focus
Extended depth-of-focus (EDOF) intraocular lenses are a good option for patients who prioritize better distance vision with better nighttime vision and reduced glare while still achieving greater spectacle independence than monofocal lenses provide. Patients should be informed that they might still occasionally need readers for fine print.17
Introduced in 2022, the TECNIS Symfony OptiBlue (Johnson & Johnson) is a diffractive EDOF IOL that provides a continuous range of vision from distance to intermediate and has a violet-light filter to reduce nighttime dysphotopsia caused by its diffractive optics.8 Patients can achieve greater near vision and spectacle independence through a mini- monovision approach or “mixing- and-matching” the Symfony IOL with the Synergy IOL (Symfony in the dominant eye; Synergy in the non-dominant eye).9
While the TECNIS Odyssey IOL has also replaced the Symfony IOL in many cases, some surgeons still favor the Symfony for eyes with mild pathology due to its excellent contrast sensitivity and tolerance to mild decentration.
Unlike Symfony, the Clareon Vivity is a non-diffractive IOL that extends and shifts the wavefront to achieve vision from distance to functional near with a monofocal-like dysphotopsia profile, making it ideal for night driving.10 Bilateral implantation with a mini-monovision approach (aiming -0.50 D or more in the non-dominant eye) often achieves J2 or better near vision, while the Clareon material improves optical clarity.10 Our practice finds success in mix-and-matching Clareon Vivity and PanOptix to further improve spectacle independence.11,12
The IC-8 Apthera uses pinhole optics and an optical mask with a small central aperture to enhance depth of focus by filtering peripheral light. Because the pinhole mask filters scattered light, it can be used to improve best corrected visual acuity for patients with irregular astigmatism including keratoconus, post-radial keratotomy, and other corneal aberrations (off-label).13 For optimal results, we implant it in the non-dominant eye with a monofocal lens in the dominant eye to minimize the dimming side effect. A 6-7 mm dilated pupil is needed to perform YAG capsulotomy around the filter mask, and the lens is also contraindicated in eyes with central corneal scars or restricted visual fields.14
Enhanced Monofocal
Greater spectacle independence can also be achieved in the monofocal IOL category, thanks to “monofocal plus” or “enhanced” monofocals. These lenses provide a slightly greater range of vision compared to traditional monofocal IOLs, especially when combined with a mini-monovision approach.17,18
When discussing enhanced monofocal lenses with patients, it is important to explain why these lenses might be the right fit for them. For some, it could be a matter of cost, while for others it could be due to the dysphotopsia side effects of multifocal lenses; pre-existing ocular pathology that limits their lens options; or a desire to have no glare at night or to continue wearing glasses for certain activities. Luckily, there are many types of enhanced monofocal lenses available for patients depending on their individual needs.
The RayOne EMV IOL is particularly unusual because of its controlled positive aberration design used to extend its depth of focus.16 Spectacle independence is maximized when used with a mini-monovision approach, especially for countering negative spherical aberration in patients with a history of hyperopic LASIK.15 However, the hydrophilic acrylic material has drawbacks, such as higher risk of posterior capsular opacification post-surgery and opacification with procedures involving air exchange.18
The enVista Aspire IOL is an enhanced monofocal with a 1.5 mm central zone on the posterior surface that adds 1.25D of continuous depth of focus to enhance intermediate vision. This IOL maintains excellent distance visual acuity and exhibits a more neutral aberration profile which increases tolerance to decentration in more aberrated eyes.17,18
The TECNIS Eyhance is another enhanced monofocal IOL that provides a slightly extended range of vision. In particular, this IOL was found to provide superior intermediate vision compared to a standard monofocal lens while maintaining similar distance vision quality.15 Due to its negative spherical aberration profile, it is especially suitable for eyes with positive spherical aberration, including post-myopic LASIK eyes.17
The Light Adjustable Lens (LAL) is unique in that its monofocal lens is made with a UV light-sensitive silicone material that allows for dioptric adjustments (through a 6 mm or larger dilated pupil) after initial cataract surgery.19 The high negative spherical aberration profile allows for some increased depth of focus, especially when used in a mini-monovision approach, which can be titrated during the adjustment period.19 The highly negative spherical aberration profile makes this lens ideal for post myopic LASIK and post RK eyes in our practice. Caution should be taken in post-hyperopic LASIK eyes due to added negative spherical aberration that may worsen vision quality.15 The main downside of the LAL lens is that patients must return to the clinic for a minimum of 3 visits to undergo the adjustment and lock-in procedures.
The wide variety of intraocular lenses available on the market today provides an abundance of choices for patients seeking to improve their vision and reduce spectacle independence. Tailoring IOL selection to each patient’s visual and lifestyle goals will help to optimize patient outcomes and satisfaction. OM
References
1. Zhu D, et al. Rate of Complete Spectacle Independence with a Trifocal Intraocular Lens: A Systematic Literature Review and Meta- Analysis. Ophthalmol Ther. 2023;12(2):1157-1171. doi:10.1007/s40123-023-00657-5
2. Alcon. Data on file. 2025. REF-25218.
3. Alcon. Data on file. 2024. REF-25221.
4. Alcon. Data on file. 2015. REF-08546.
5. Johnson & Johnson Surgical Vision. DOF2020CT4014 v2.0. Forte 1: A Comparative Clinical Evaluation of a New TECNIS™ Presbyopia-Correcting Intraocular Lens Against a PanOptix® Intraocular Lens – Defocus Curves and Visual Acuity Results. February 18, 2021.
6. Johnson & Johnson Surgical Vision. Data on file. DOF2023CT4050.
7. Muzychuk A, Harasymowycz P. Efficacy and Safety Evaluation of a New Full Visual Range Versus Monofocal IOL in Cataract Patients: A Randomized, Controlled Canadian Clinical Trial. J Cataract Refract Surg. 2022; May 13:10-97.
8. Moshirfar M, et al. Assessing Visual Outcomes: A Comparative Study of US-FDA Premarket Approval Data for Multifocal and EDOF Lens Implants in Cataract Surgery. J Clin Med. 2023;12(13):4365. doi:10.3390/jcm12134365
9. Van der Mooren M, Alarcon A, Jenkins Sanchez MD, Chang DH. Effect of violet light-filtering and manufacturing improvements in an extended depth-of-focus intraocular lens on visual performance. Clin Ophthalmol. 2023;Dec 31:701-709.
10. Werner L, Thatthamla I, Ong M, et al. Evaluation of clarity characteristics in a new hydrophobic acrylic IOL in comparison to commercially available IOLs. J Cataract Refract Surg. 2019;45(10):1490-1497.
11. Arrigo A, Gambaro G, Fasce F, et al. Extended depth-of-focus (EDOF) AcrySof® IQ Vivity® intraocular lens implant: a real-life experience. Graefes Arch Clin Exp Ophthalmol. 2021;259(9):2717-2722.
12. Zhou I, Zhu D. Outcomes and Satisfaction after Mix-and-Match Implantation of a Trifocal and EDOF IOL Made of a New Hydrophobic Acrylic Material. Presented at: 2024 ASCRS-ASOA Annual Meeting; April 5–8, 2024; Boston, MA.
13. Northey LC, Holland SP, Lin DTC, Moloney G. New treatment algorithm for keratoconus and cataract: small-aperture IOL insertion with sequential topography-guided photorefractive keratectomy and simultaneous accelerated corneal crosslinking. J Cataract Refract Surg. 2021;47(11):1411-1416.
14. Bausch + Lomb Surgical. IC-8 Apthera Intraocular Lens. Bausch Surgical. 2025. Accessed June 18, 2025. www.bauschsurgical.com/cataract/ic-8-apthera-iol/
15. Zhu D, Williamson B. Advanced implant technologies to fit patient goals and their eyes. Presented at ASCRS-ASOA summit; April 25-28, 2025; Los Angeles, CA.
16. RayOne EMV: Monovision enhanced. Rayner. Accessed January 19, 2025. www.rayner.com/us/en/iol/rayone-emv/#more
17. Auffarth GU, Gerl M, Tsai L, et al. Clinical evaluation of a new monofocal IOL with enhanced intermediate function in patients with cataract. J Cataract Refract Surg. 2021;47(2):184. doi:10.1097/j.jcrs.0000000000000399
18. Min H, Ambati B. Design and visual outcomes of enhanced monofocal iols. Cataract & Refractive Surgery Today. 2024;24(11). https://crstoday.com/articles/nov-dec-2024/design-and-visual-outcomes-of-enhanced-monofocal-iols.
19. Folden, DV, Wong JR. Visual outcomes of an enhanced UV protected Light Adjustable Lens using a novel co-managed, open-access methodology. Clinical Ophthalmol. (Auckland, N.Z.), vol. 16, 2413-2420. 4 Aug. 2022, doi:10.2147/OPTH.S378525
