Enhanced monofocal IOLs provide better intermediate vision with no rings or dysphotopsia
Michael Endl, MD, of Fichte, Endl & Elmer Eyecare, spoke with Ophthalmology 360 about his presentation at the 2026 ASCRS Annual Meeting, which covered the “next generation” of intraocular lenses (IOLs). Dr. Endl shared how the enhanced monofocal IOLs offer improved vision outcomes without bothersome effects, leading to patient satisfaction.
Michael Endl, MD:
Hi, my name is Michael Endl, MD. I have a cataract refractive practice in Western New York, and I’ve been asked to talk a little bit about our symposium at ASCRS. With Rayner, I’ve had the fortune over the last 4 years now to be using some of the enhanced monofocal IOLs. The EMV lens first came out in monofocal, and then just this last fall, in 2025, was available in a toric form. Since about 2022, I’ve had the opportunity to use the EMV monofocal lens. This lens, designed by Graham Barrett, a genius in optics, has been able to enhance a monofocal lens by just adding some spherical aberration to the center, and very much increasing the depth of focus for a patient. We’ve known for years that we can try to get a little more range of patients. If maybe we set 1 eye for the best distance, but then we might not have a lot of other ranges, and the other eye for a little bit up close being some monovision.
For many people, maybe 75% will like that; and that’s with weeks, if not months, of trying to get used to it. They’ll have some depth perception problems or other difficulties where it’s a little bit of a gamble to just try that de novo on a patient that’s never done it for life with contact lenses. With these new IOLs, I’ve had so much luck and so much patient satisfaction because there’s so much built into the lens itself with no rings, no extra adaptation problems. We presented a paper a couple of years ago, both at ESCRS in Vienna and at the Academy, that showed no changes in patient satisfaction with their distance vision or nighttime glare, or problems we know that we can see with multifocals or other technologies. If you’re giving people maybe two-thirds, three-quarters more range than they had with a typical monofocal and no depth perception problems, well, that’s really a win.
What we’re able to present at ASCRS, which was some of our newest data, is since October of 2025. We’ve been able to have our hands on the recently FDA-approved EMV toric lens. This same enhanced monofocal lens can give you up to one and a quarter to 150 diopters of more near vision without any rings, without any lines, and without any differences in the quality of their distance vision—as in no more dysphotopsias or problems. The patient satisfaction rate has been much higher than any other toric lens I’ve used. I start off by talking to my patients, and I think this resonates very well for docs. If you’re going to adapt to technology, you’d like to know what you think you can do for your patients; what you think it’s going to cost you and your practice, both in chair time and actual dollars; and what do you think it’s going to do for your patient’s satisfaction?
I really think of our distances, which is easiest to explain to patients, as 3 distances in our lives. Anything from 12 inches to maybe the end of your fingertips is usually near vision. From your fingertips out to about 10 feet is usually thought of as intermediate vision, and beyond the 10 feet is your distance vision. Almost every other toric lens that’s on the market, certainly, that isn’t a multifocal, you get about 10 feet out. Everything closer is a little bit of a blur unless you start to do a monovision. A monovision, if you set that near eye to just up close, its distance might be 20/100, 20/400, not very good. The beauty of how Dr. Barrett designed the EMV lens, if you set that distance eye for Plano to even +0.25, you will have decent intermediate as well on that eye.
Then you only have to set the near eye at –50, –75 with that extra +150 on there. They’re reading J1, J2, but there’s so much overlap in the middle that there’s no depth perception problems. The patient satisfaction rate is off the charts. I’m not having problems with even the 5% of folks that have multifocals and really aren’t too happy with their nighttime driving or their adjustment. They’re really walking in saying, “Boy, I was just hoping to see a little bit clearer. I was hoping to have a little better range of vision, but the fact that I can drive and look at my cell phone, maybe move my font up a little bit, this is spectacular.” I think my biggest worry is that my co-managing optometrist would like me to not put them out of business.
I hope what people will take away from the symposium at ASCRS, and in general our educational meetings, is thankfully these technologies really keep moving forward. We can very easily get in a comfortable zone in our practices, as this is what I did in residency, or this is what my patients have liked, or this is where I feel I take the least risk. If you don’t talk to some of your colleagues and look at some of these technologies and try yourself, maybe even after visiting a colleague and watching how they do it and present in the practice, you’re never going to really be able to take advantage. I many times say, “Boy, the VCR was pretty neat, but you’re probably not going to Blockbuster anymore, and sometimes these technologies are worth doing.” If you can have a less expensive lens that gives a patient much more range with an easier adjustment, you have to at least give it a try.
Related Content
