ASCRS News: EyeWorld Journal Club
Summer 2025

by Pete Weber, MD, Nikita Mokhashi, MD, Sukriti Mohan, MD, Chris Maatouk, MD, Daniella Schochet, MD, Arjav Shah, MD, Rebecca Tanenbaum, MD, Lauren Ciulla, MD, Phil Zhou, MD, University of Chicago ophthalmology residents, Peter Veldman, MD, Residency Program Director

Introduction

Enhanced monofocal intraocular lenses (IOLs) are a promising new option for patients seeking to reduce their spectacle dependence after cataract surgery.^1–3 While multifocal IOLs can optimize near and intermediate vision with limited compromise of distance vision, they variably induce unwanted visual symptoms such as glare or halos in some cases. Enhanced monofocal IOLs offer a suitable alternative to multifocal IOLs, as they minimize these undesirable visual disturbances while also providing some intermediate vision compared to a conventional monofocal lens.^4,5 This article compared the outcomes of two enhanced monofocal IOLs, the Vivinex Impress XY1-EM (Hoya Surgical Optics) and the TECNIS Eyhance DIB00V (Johnson & Johnson Vision), with the conventional monofocal Vivinex XY-1 lens.

Methods

This retrospective study included patients who underwent cataract surgery and IOL implantation with the XY1-EM, DIB00V, or XY-1 IOLs. The Vivinex Impress XY1-EM features a combined aspherical anterior surface design, where the central portion allocates incident light to the intermediate range, and the peripheral portion allocates light to the distance range. The TECNIS Eyhance DIB00V incorporates a unique anterior surface design with a continuous power gradient from the periphery to the center, characterized by progressive central steepening. Both lenses aim to extend the depth of focus beyond what is achieved with a standard monofocal lens.

Patients included had no prior history of ocular surgery or ocular disease that might have affected surgical outcomes. Those with clinically significant corneal astigmatism were excluded. All surgeries were performed by a single surgeon using a standard 2.2-mm incision phacoemulsification technique with capsular bag IOL implantation. Demographic data collected included age and sex. Objective data were gathered from preoperative and 3-month postoperative visits. Preoperative examinations included corneal curvature, axial length, and topography. IOL power was calculated using the Barrett Universal II formula, targeting emmetropia for all patients. At the 3-month postoperative visit, manifest refraction, corrected distance visual acuity (CDVA), intermediate visual acuity (VA) at 70 cm and 50 cm, VA under photopic conditions, and depth of focus within a range of +2.00 D to –3.00 D were recorded. Patients also completed a spectacle independence assessment and a subjective visual satisfaction survey.

Statistical analysis employed the Mann-Whitney U test for two-group comparisons, the Kruskal-Wallis test with Bonferroni correction for three-group comparisons, and chi-square and Fisher’s exact tests for categorical data. Statistical significance was set at p<0.05.

Results

One hundred and thirty eyes from 75 patients were included in this study. Forty-six eyes were treated with the XY1-EM, 47 with the DIB00V, and 37 with the XY-1 monofocal lens. Patients were similar across all demographic and clinical baseline factors, including age, sex, baseline corrected distance visual acuity (CDVA), axial length, and keratometry.

Between the three groups, there was no significant difference in CDVA at 3 months postoperatively. The XY1-EM and DIB00V groups demonstrated superior intermediate CDVA at 50 and 70 cm compared to the XY-1 group (p<0.01). The defocus curve was measured for the XY1-EM and DIB00V groups; visual acuity was superior in the XY1-EM group at –1.5 D (p<0.05), although the two groups were similar at all other points along the curve. Postoperative manifest refractions were similar across the three groups with respect to spherical power, spherical equivalent, and prediction error, but the XY-1 group had higher cylinder power than the DIB00V group (p=0.013).

Nineteen patients in the XY1-EM group, 21 in the DIB00V group, and 15 in the XY-1 group underwent bilateral surgery. Of those patients, 78.9%, 71.4%, and 53.3% were spectacle independent at the 3-month postoperative visit in the XY1-EM, DIB00V, and XY-1 groups, respectively. The rate of spectacle independence was significantly higher in the XY1-EM and DIB00V groups (p<0.001), but no significant differences were noted between these two enhanced monofocal groups (p=0.721). Subjective satisfaction was also assessed in patients who underwent bilateral implantation with XY1-EM or DIB00V. Higher satisfaction was found among the XY1-EM group compared to DIB00V for reading a newspaper and speed of adaptation to daily vision. Otherwise, there was no statistically significant difference between the two groups on other survey questions.

Discussion

In this retrospective study of 130 eyes, the authors found that an enhanced monofocal IOL, Vivinex Impress XY1-EM, provided a significantly improved range of focus compared to the conventional XY-1 monofocal IOL. Furthermore, it demonstrated somewhat higher subjective satisfaction compared to the TECNIS Eyhance DIB00V, another enhanced monofocal IOL.

As expected, corrected distance visual acuity was similar among all three groups. Importantly, both enhanced monofocal groups achieved significantly higher spectacle independence than the conventional monofocal group. The enhanced monofocal lenses both performed well; however, the XY1-EM demonstrated improved intermediate vision compared to the DIB00V lens, with superior performance at –1.5 D on the defocus curve. Additionally, the XY1-EM demonstrated higher patient satisfaction scores, specifically with respect to intermediate-to-near vision tasks such as reading a newspaper. Patients also reported faster adaptation to daily vision with the XY1-EM.

Limitations included the study’s retrospective design, which introduced the potential for selection bias, as the surgeon chose which lens to use in each patient case. Patient satisfaction was evaluated using survey questions, but issues with dysphotopsias and contrast sensitivity were not specifically assessed. In addition, the authors remarked that while VA was tested at both 50 cm and 70 cm, it was not tested at 40 cm, which is a commonly used distance for pure reading vision. Finally, the study only evaluated patients whose visual target for IOL selection was emmetropia; however, additional strategies to improve range of vision, such as mini-monovision, might have been beneficial to study in those who underwent bilateral surgery.

Enhanced IOLs provide better visual outcomes for tasks at intermediate distances relative to standard monofocal lenses. This paper demonstrates that the XY1-EM IOL provides comparable visual outcomes and patient satisfaction when compared to the established DIB00V IOL. While the XY1-EM lens had higher scores for reading a newspaper and adaptation to vision, other tasks had similar scores, and there was no significant difference in overall satisfaction. Importantly, the mean overall satisfaction was high for both enhanced monofocal IOLs (8.0±0.97 for the XY1-EM and 7.62±1.94 for the DIB00V).

Conclusion

In conclusion, the new enhanced monofocal IOL, Vivinex Impress XY1-EM, demonstrated superior intermediate vision compared to the conventional monofocal IOL (XY-1) while maintaining excellent distance vision. It also compared favorably with an established enhanced monofocal IOL, TECNIS Eyhance DIB00V, including some enhanced patient satisfaction with newspaper reading and adaptation to vision. Given the overall excellent patient satisfaction rate, this new lens merits surgeon consideration for patients seeking good distance and intermediate range vision and an increased probability of spectacle independence relative to monofocal lenses alone. 

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Comparative evaluation of clinical results and patient-reported outcomes of enhanced monofocal and conventional monofocal intraocular lenses

Kabura R, et al. J Cataract Refract Surg. 2025;51:520–524. 

• Purpose: To evaluate and compare visual performance of two enhanced monofocal intraocular lenses (IOLs), XY1-EM (Vivinex Impress, Hoya) and DIB00V (TECNIS Eyhance, Johnson & Johnson) with that of a conventional monofocal IOL, XY-1 (Vivinex, Hoya).
• Setting: Kamiamakusa General Hospital, Kumamoto, Japan.
• Methods: A retrospective analysis was conducted on 130 eyes from 75 patients, including 46 eyes (27 patients) implanted with XY1-EM, 47 eyes (26 patients) with DIB00V, and 37 eyes (22 patients) with XY-1.
• Results: Corrected distance visual acuity was comparable across all three groups. Both enhanced monofocal IOLs (XY1-EM and DIB00V) demonstrated significantly superior distance-corrected visual acuity at 70 cm and 50 cm compared to the conventional monofocal IOL (XY-1). The rates of spectacle independence were also significantly higher in the enhanced monofocal IOL groups. In a direct comparison between the two enhanced monofocal IOLs, XY1-EM exhibited a significantly better defocus curve at –1.5 D than DIB00V. Patients reported higher subjective satisfaction for “reading a newspaper” and “speed of adaptation to daily vision” in the XY-1 group compared to the DIB00V group.
• Conclusions: The new enhanced monofocal IOL, Vivinex Impress XY1-EM, demonstrated significantly improved intermediate visual acuity compared to the conventional monofocal IOL. It also showed slightly superior intermediate visual acuity and higher subjective satisfaction compared to the other enhanced monofocal IOL evaluated in this study.

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References

1. Wan KH, et al. Enhanced monofocal versus conventional monofocal intraocular lens in cataract surgery: a meta-analysis. J Refract Surg. 2022;38:538–546.
2. Fernández J, et al. Positioning of enhanced monofocal intraocular lenses between conventional monofocal and extended depth of focus lenses: a scoping review. BMC Ophthalmol. 2023;23:101.
3. Li J, et al. Comparative efficacy and safety of all kinds of intraocular lenses in presbyopia-correcting cataract surgery: a systematic review and meta-analysis. BMC Ophthalmol. 2024;24:172.
4. Jung H, et al. Real-world outcomes of cataract surgeries using a new type of enhanced monofocal toric intraocular lens. Sci Rep. 2024;14:27758.
5. Fujita Y, et al. A comparative study of mini-monovision, crossed mini-monovision, and emmetropia with enhanced monofocal intraocular lenses.
   Sci Rep. 2025;15:916.

Contact 

Veldman: pveldman@bsd.uchicago.edu