First Tecnis Eyhance IOLs in the U.S. implanted
By Jan Beiting
Four patients in Houston recently had the opportunity to undergo cataract surgery with implantation of a new monofocal IOL, the Tecnis Eyhance (ICB00; Johnson & Johnson Vision). Although the lens is a monofocal, it was designed with a gradual decrease in power from the center to the mid-periphery. This optimized power profile improves the depth of focus while maintaining the distance acuity of a standard aspheric monofocal.
“The lens is very easy to use because it has the same A constants, material, haptics and edge design as the ZCB00 lens,” said Douglas D. Koch, MD, professor and Allen Mosbacher and Law Chair in Ophthalmology at the Baylor College of Medicine in Houston, Texas, who was involved in the development of the lens and performed the first U.S. cases. The Tecnis Eyhance IOL comes pre-loaded in the company’s new Simplicity injector, and is available in both sphere and toric powers, with the latter incorporating the new Tecnis Toric II haptic design for improved rotational stability.
Optical bench testing demonstrated that the Eyhance lens provided better simulated visual acuity than the Tecnis Monofocal throughout the intermediate range of -1.00 to -2.00 D.1 “The European clinical study data have also been very impressive,” said Dr Koch. “Gerd Auffarth, MD, and colleagues demonstrated that patients routinely get one additional line of distance-corrected near and distance-corrected intermediate vision compared to a standard monofocal, with no significant differences in contrast sensitivity, photic phenomena, or adverse events.2”
Patients in the European multicenter study also completed a validated Catquest-SF9 questionnaire about daily-life activities.2 Significantly more patients in the Eyhance group said they had no difficulty seeing well enough to walk on uneven surfaces, such as cobblestones, compared to monofocal controls. “Small improvements in intermediate vision can have a big impact on quality of life because intermediate vision is so essential for using a computer or electronic device and many other everyday tasks,” said Dr Koch. “If patients are able to see the ground a little better, perhaps they can avoid falls.”
Dr Koch’s first four patients all had excellent distance results on the first day postoperatively, with all seeing at J5 or better for intermediate (Table 1).
“While they didn’t achieve the range of vision that is possible with a trifocal or extended depth of focus (EDOF) IOL, their intermediate vision is clearly better than one would expect with a standard monofocal,” he said.
Where it fits
According to Dr Koch, the Eyhance IOL is likely to become his go-to lens for most monofocal patients. “Even a small increase in depth of focus provides a broader landing zone and more refractive forgiveness, which is a great boon to surgeons,” he said. Because the Eyhance lens doesn’t have any diffractive optics, Dr Koch said that also makes it suitable for post-LASIK patients and others who really would prefer a presbyopia-correcting IOL but who aren’t candidates due to macular degeneration, glaucoma, or significant dry eye. “There really are no contraindications, so I think this is a lens that surgeons can feel comfortable implanting in any eye,” he said.
Dr Koch noted that there will continue to be a strong role in his practice for EDOF lenses like Tecnis Symfony (Johnson & Johnson Vision) and Acrysof IQ Vivity (Alcon) for patients who want greater depth of focus, but that it is exciting to see innovations for the large percentage of patients who choose a monofocal lens. “In recent years, we have seen a zero-aspheric IOL, the enVista (Bausch + Lomb), that I like for post-hyperopic-LASIK patients, and Alcon will be introducing an update to its lens material in the near future,” he said. “But the Eyhance lens is really the first monofocal to offer a meaningful change in performance in the past 20 years.”
1. Alarcon A, Canovas C, Koopman B, et al. Enhancing the intermediate vision of monofocal intraocular lenses using a higher order aspheric optic. J Refract Surg. 2020;36(8):520-7.
2. Auffarth GU, Gerl M, Tsai L, et al; Quantum Study Group. Clinical evaluation of a new monofocal IOL with enhanced intermediate function in patients with cataract. J Cataract Refract Surg. 2021;47(2):184-91.
Disclosure: Dr Koch is a consultant for Alcon, Carl Zeiss Meditec, and Johnson & Johnson Vision.