In January 2021, Alcon launched a new intraocular lens implant (IOL) called “Vivity”. Vivity is described as a “first-of-its-kind”, non-diffractive, extended depth of focus intraocular lens implant. The lens received FDA approval in February 2020, and is now widely available to patients across the United States.

In this article we’re going to review the details of what the Vivity IOL is, how it works, and the results you can expect from it. Let’s get started!

What Does “Extended Depth of Focus” Mean?

“Extended depth of focus” IOL’s are designed to give patients a broader range of vision than “monofocal” implants that have a single focal point,  and are typically aimed for either distance or near vision. “Multifocal” implants have multiple focal points, and can be thought of as bifocal or trifocal implants. 

As an example, consider a bifocal implant, such as the ZMB00 Multifocal implant made by Johnson & Johnson. The ZMB00 is designed to give excellent distance vision, and excellent reading vision at approximately 13 inches. However, the intermediate range vision, which is typically where a computer monitor or the dashboard in the car sits, may be blurry. The “sweet spots” of vision with this type of lens does not have a large range. For example, a patient with the ZMB00 may have excellent reading vision at 13 inches, but when they move the object just a few inches forwards or backwards, it quickly becomes blurry.

“Extended depth of focus” means that instead of having a relatively small sweet spot of clear vision, the lens is designed to ideally give patients a larger range of useful vision.

 

What Makes The Design Of Vivity Different?

One of the side effects of many Multifocal IOL’s (MFIOL’s) is glare and halo symptoms. The benefit of many Multifocal IOL’s is achieved by “diffracting” light. Essentially this means “scattering light” in a controlled way. As light enters the eye “diffractive MFIOL’s” split this light into distance and near focal points for distance and near vision. As a side effect, some of this scattered light is perceived as glare, halos and a reduction in the sharpness of vision. Different MFIOL’s cause different amounts of glare and halo symptoms. If you are interested in MFIOL’s, this is a conversation to have with your surgeon.

The Vivity was designed to reduce glare and halo symptoms as much as possible compared to other MFIOL’s on the market. 

As a trade-off, the Vivity does not provide as close of near vision as some other MFIOL’s. The Vivity is targeted more for patients interested in the “intermediate” range of vision (approximately 26 inches), which would be more suited for computer and dashboard range vision than near reading of small print.

How Does The Vivity IOL Perform?

A clinical trial for the Vivity IOL studied 220 patients, with 107 receiving the Vivity IOL, and 113 receiving a monofocal control IOL at 11 sites in the United States. The average age of patients in the study was 68 years old. One patient from the Vivity group did not receive the Vivity in their 2nd eye, and was not included in the analysis. 

Let’s first take a look at how patients’ Distance vision compared after surgery between the Vivity IOL and the standard monofocal control IOL:

how patients’ Distance vision compared after surgery between the Vivity IOL and the standard monofocal control IOL

 

Let’s next take a look at how the Vivity compared to the monofocal control lens for Intermediate range vision:

how the Vivity compared to the monofocal control lens for Intermediate range vision

Let’s look at glare and halos next… We would expect the Monofocal control to have a minimal amount of complaints of glare and halos. The goal of the Vivity is to achieve its “extended depth of focus” without significantly increasing glare/halos symptoms compared to the monofocal IOL:

The goal of the Vivity is to achieve it’s “extended depth of focus” without significantly increasing glare / halos symptoms compared to the monofocal IOL

 

Finally, let’s look at functional outcomes… In other words, most patients would choose the Vivity IOL with the goal of decreasing their dependence on glasses in mind… so let’s look at how patients reported their need for glasses after surgery for distance, intermediate, and near vision:

 

how patients reported their need for glasses after surgery for distance, intermediate, and near vision

(Note: The study asked patients about their need for glasses in both bright light and dim light conditions. One reason for this is that, in addition to the brightness of light illuminating objects being viewed, pupil size is also different in light versus dark conditions.)

Patient Testimonials

Let’s take a look at a few patient testimonials to hear about their experience with the Vivity IOL (Videos provided by Alcon):

 

Overall Summary Of The Vivity IOL

The Vivity is an excellent lens and will make for a lot of happy patients… However, you’ll hear us say this a lot when it comes to implants…. There is no “best” or “one-size-fits-all” implant. All IOL’s come with a different profile of trade-offs, or risks & benefits. While the Vivity performed better than the Monofocal IOL for Intermediate range vision, it was not 100% effective in achieving complete independence from glasses at this range. There also was a slight worsening of distance vision with the Vivity compared to the Monofocal IOL. This can be thought of as a trade-off of being willing to give up a slight amount of distance vision (which many patients may not even notice) for the benefit of gaining intermediate range vision. 

Overall, there are many nuances to selecting the right IOL for your lifestyle, and that’s why it’s more important than ever to choose an exceptional surgeon.  

Sources

  1. Alcon Vivity IOL “Directions for Use”
  2. FDA Summary of Safety and Effectiveness Data (SSED) for the AcrySof™ IQ Vivity Extended Vision Intraocular Lens (IOL) (Model DFT015), AcrySof™ IQ Vivity™ Toric Extended Vision IOLs (DFT315, DFT415, DFT515), AcrySof™ IQ Vivity™ Extended Vision UV Absorbing IOL (DAT015), and AcrySof™ IQ Vivity™ Toric Extended Vision UV Absorbing IOLs (DAT315, DAT415, DAT515) – P930014/S126. Available June 2021: https://www.accessdata.fda.gov/cdrh_docs/pdf/P930014S126B.pdf 
  3. Mechanism of Action and Patient Testimonial videos courtesy of Alcon.