Extended depth of focus IOLs are an option for IOL exchange in patients intolerant of multifocal IOLs
Ike Ahmed, MD, of the Prism Eye Institute, spoke with Ophthalmology 360 at the 2026 ASCRS Annual Meeting about using the TECNIS PureSee lens as an exchange lens for patients who are unsatisfied with their multifocal IOL.
Ike Ahmed, MD:
Hey everyone. It’s Ike Ahmed from the Prism Institute and Moran Eye Center, University of Utah. Happy to share a few of my insights on their paper that we just recently presented, which is on the use of the TECNIS PureSee lens, a novel refractive EDOF as an exchange lens for dissatisfied concerned patients who’ve had multifocal IOLs. We’ve had experience with the PureSee lens for over 2 years. We’ve used it, of course, in a wide variety of different patients, patients who may not be suitable for multifocal lenses, but want extended range of vision. The data is quite supportive of that monofocal like dysphotopsia with no real significant loss of contrast, with still some improvement in range of vision compared to monofocals with some near.
The multifocal patients who have received the lens who are unhappy because of dysphotopsia or chronic test issues are probably the most discerning of all of our patients. They have challenge with neuroadaption, their optics are more challenging. These patients who are very unhappy typically receive a monofocal lens if it comes time for exchange. That makes sense. You don’t want to take any chances, minimize risk for anything to be unusual, and accept the fact that patients will need to wear glasses.
Well, with our experience over the last few years with the refractive EDOF lens from PureSee, we’ve had now a group of patients that we’ve done exchanges for, for multifocal for PureSee. Now, some might say it’s a bit of a risk. We’re still changing the optics a bit. We’re still changing the focal range as well. But because of our experiences, we felt this was a good, reasonable, cautious approach. Our papers show that of our patient population, all patients had a significant improvement in their contrast issues or just autopsy issues. All patients basically had improvement. Vast majority of patients has basically resolution, complete resolution of their issues around the multifocality related to contrast or just dysphotopsia.
I still express caution in choosing a lens and exchange lens for multifocal patients, but I think it’s great to be able to retain some benefit. Our patients who lose multifocality are very upset losing it, but by giving them an EDOF lens from PureSee, we’re able to still give them that range of vision from distance to intermediate. What I do is I typically do a bit of micro monovision minus half in the non-dominant eye, and they’re pretty well almost able to get that full range of vision. Our experience has been very positive. We don’t want to do exchanges if we don’t have to. We’re doing them less because of more patient selection criteria and improved technology. But when we have to do it, we have this option to do this lens.
Most importantly, I think it just shows you how incredibly tolerant this lens is. If it can do well in patients who are very discerning and can’t tolerate multifocal lenses, it’s certainly likely to do very well in all patients prior to having any surgery in terms of an EDOF lens that can still get range of vision with monofocal-like experiences. That’s been our experience with the TECNIS PureSee lens as an exchange lens for unhappy multifocal IOL patients. Thank you very much.
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