The PanOptix Plus, an upgraded version of PanOptix with enhanced intermediate vision, is expected to launch in the U.S. soon. Additionally, Johnson & Johnson’s upcoming Symfony Odyssey, an evolution of the Symfony OptiBlue, aims to improve contrast sensitivity and minimize dysphotopsias (glare and halos).

Market Ranking Based on Adoption (2024 Data)

1. PanOptix – Most widely implanted trifocal IOL.
2. Vivity – Leading non-diffractive EDOF IOL.
3. Symfony OptiBlue – Popular diffractive EDOF IOL.
4. Eyhance – Rising in use due to its monofocal-like quality.
5. PanOptix Plus & Symfony Odyssey – Expected to gain traction in 2025-2026.

2. Visual Quality (Glare, Halos, and Contrast Sensitivity)

Visual disturbances such as glare, halos, and starbursts are major concerns for patients receiving multifocal or EDOF lenses. Studies indicate the following trends:

• PanOptix provides excellent near, intermediate, and distance vision but has a higher incidence of glare and halos compared to EDOF lenses like Vivity. In one study, 69% of PanOptix patients reported little to no glare or halos, compared to 85% of Vivity patients.
• Vivity has fewer dysphotopsias (glare and halos) than PanOptix and Symfony, making it more suitable for night driving and low-light conditions.
• Symfony OptiBlue has improved contrast sensitivity compared to the original Symfony, but still shows a higher rate of night vision complaints than Vivity.
• Eyhance is closest to a monofocal in terms of vision quality, meaning virtually no glare or halos but only a mild extension of intermediate vision.

A comparative study found that 34% of Symfony patients reported moderate or severe starbursts, while only 8.8% of Vivity patients did. Moreover, 0% of Vivity patients reported severe halos, compared to 17% of Symfony patients. This indicates that Vivity is the best option for minimizing glare and halos, while Symfony and PanOptix remain prone to these side effects.

Ranking Based on Visual Disturbances

1. Eyhance (Minimal dysphotopsias)
2. Vivity (Mild dysphotopsias)
3. Symfony OptiBlue (Moderate dysphotopsias)
4. PanOptix (Highest dysphotopsias)

3. Near Vision Performance

For patients seeking spectacle independence for near tasks, PanOptix outperforms all EDOF lenses due to its trifocal design.

• PanOptix provides the highest level of near vision, making it the best choice for patients who prioritize reading and detailed near work.
• Symfony OptiBlue offers better near vision than Vivity, with greater spectacle independence.
• Vivity provides functional near vision but still requires reading glasses for fine print.
• Eyhance has the least near vision capability and functions closer to a standard monofocal IOL.

A comparative study of PanOptix, Vivity, Symfony, and Eyhance found that PanOptix had the highest rate of spectacle independence at near distances, while Eyhance required glasses for most near tasks.

Ranking Based on Near Vision Performance

1. PanOptix (Best near vision)
2. Symfony OptiBlue
3. Vivity
4. Eyhance (Limited near vision)

As you can see from the lists above, better near vision is inversely proportional to the dysphotopsias (night glare and haloes/rings around lights). Day time vision is extremely good however, with patients who may not even notice any dysphotopsias, and even less likely to be bothered by the glare/haloes/rings around lights.

4. Patient Complaints and Explant Rates

While most premium IOLs achieve high satisfaction rates, explantation due to dissatisfaction remains a concern, particularly with night vision issues.

• PanOptix and Symfony OptiBlue have the highest explant rates, mainly due to glare, halos, and contrast sensitivity issues.
• Vivity has a lower explant rate, as its non-diffractive optics reduce night disturbances.
• Eyhance has had the fewest reported explants, likely because it functions similarly to a monofocal IOL.

One study noted that Symfony and Vivity explants were common due to night vision disturbances, while Eyhance had no reported explants in the study group.

Ranking Based on Explantation Rates (Lowest to Highest)

1. Eyhance (Fewest explants)
2. Vivity
3. Symfony OptiBlue
4. PanOptix (Most explants)

What does each IOL do best?

Best for Overall Vision & Spectacle Independence

• PanOptix – Ideal for patients prioritizing near and intermediate vision, despite a higher risk of glare/halos.

Best for Reducing Glare and Halos

• Vivity – Excellent choice for patients who need better night vision but don’t mind using reading glasses for fine print.

Best for Patients Concerned About Contrast Sensitivity & Dysphotopsias

• Eyhance – Closest to a monofocal, best for patients who prioritize quality of vision over range of vision.

Best for a Balanced Approach

• Symfony OptiBlue – Good intermediate and near vision, but some trade-offs with night disturbances.

As new IOLs such as PanOptix Plus and Symfony Odyssey enter the U.S. market, patients will have even more options tailored to their specific visual needs. Surgeons must carefully evaluate a patient’s lifestyle, tolerance for visual disturbances, and desire for spectacle independence when selecting the best IOL.

Future Trends (2025-2026)

• PanOptix Plus is expected to improve contrast sensitivity while maintaining PanOptix’s trifocal benefits.
• Symfony Odyssey aims to refine the Symfony design to further minimize dysphotopsias.
• RayOne EMV is an emerging non-diffractive EDOF option that could offer a middle ground between Vivity and Eyhance.

Key IOLs in the U.S. Market: Review

1. AcrySof IQ PanOptix (Alcon) – The Leading Trifocal IOL

PanOptix is the only FDA-approved trifocal IOL in the U.S. and remains one of the most popular premium IOL choices. It provides excellent vision at near (40 cm), intermediate (60 cm), and distance (beyond 6 m) without significant gaps in focus.

Pros:

• Excellent spectacle independence
• Strong intermediate vision, making it ideal for digital device use
• Good contrast sensitivity compared to older multifocal designs

Cons:

While the PanOptix lens offers excellent vision across multiple distances, it is not without drawbacks:

• Glare and Halos: One of the most common complaints is the presence of nighttime glare and halos, particularly around lights. This is due to the diffractive design of the trifocal lens, which splits incoming light to provide vision at near, intermediate, and distance points.
• Contrast Sensitivity Loss: Some patients experience reduced contrast sensitivity, particularly in low-light conditions. This can be problematic for night driving.
• Not Ideal for Younger Patients: Studies suggest that younger patients (under 65) may struggle with contrast sensitivity loss and the required neuroadaptation process.
• Requires Precise Alignment: To achieve optimal results, the PanOptix lens must be perfectly centered in the eye. Any decentration can cause visual disturbances.

2. AcrySof IQ Vivity (Alcon) – A New Approach to EDOF Lenses

Vivity is the first non-diffractive EDOF IOL approved in the U.S. It uses wavefront-shaping technology instead of diffractive rings, providing an extended range of vision while minimizing glare and halos.

Pros:

• Minimal Glare and Halos: Compared to multifocal IOLs, Vivity has significantly fewer photic phenomena.
• Good Distance and Intermediate Vision: Patients report excellent vision for activities like computer work and watching TV.
• Better Low-Light Performance: Vivity outperforms diffractive multifocals in dim environments, making it ideal for night driving.
• Toric Version Available: Corrects astigmatism while providing EDOF benefits.

Cons:

• Weaker Near Vision: Unlike trifocal lenses, Vivity does not provide strong near vision, meaning some patients may still require reading glasses.
• Mild Contrast Sensitivity Loss: While better than multifocals, Vivity still has some loss of contrast sensitivity compared to monofocal IOLs.

3. Tecnis Symfony OptiBlue (Johnson & Johnson Vision) – The EDOF Alternative

Symfony OptiBlue is a diffractive EDOF IOL that extends depth of focus while maintaining good contrast sensitivity. The OptiBlue version incorporates a violet-light filtering technology to reduce glare and halos.

Pros:

• Seamless Visual Transitions: Provides a continuous range of vision with fewer gaps compared to multifocals.
•  Better Night Vision Than Traditional Multifocals: While some glare and halos persist, they are reduced compared to standard Symfony.
• Stronger Near Vision Than Vivity: Offers more near vision clarity than Vivity, though not as much as a trifocal.

Cons:

• Glare and Halos Still Present: While reduced with the OptiBlue filter, some patients still experience photic disturbances.
• Contrast Sensitivity Issues: Though improved, it still has slightly lower contrast than monofocal lenses.

4. Tecnis Eyhance (Johnson & Johnson Vision) – The Monofocal Plus

Eyhance is positioned between a traditional monofocal and an EDOF lens. It provides slightly improved intermediate vision without diffractive optics.

Pros:

• Minimal Visual Disturbances: No halos or glare, making it ideal for night driving.
• Improved Intermediate Vision Over Monofocals: Allows better vision for computer use and daily activities.
• Cost-Effective: Less expensive than premium multifocal and EDOF lenses.

Cons:

• Limited Near Vision: Unlike EDOF and multifocal lenses, Eyhance does not provide strong near vision.
• Not Ideal for Complete Spectacle Independence: Many patients still need reading glasses.

Upcoming IOLs in the Next Two Years

1. PanOptix Plus (Alcon) – An Enhanced Trifocal. Expected to improve contrast sensitivity while retaining trifocal benefits. Early trials suggest better neuroadaptation, reducing glare and halos
2. Synergy Plus (Johnson & Johnson Vision) – A Hybrid Multifocal/EDO. Expected to provide a wider range of vision with fewer halos. Incorporates new material to improve contrast sensitivity .
3. Light Adjustable Lens (RxSight) – Customizable After Surgery. Gaining traction due to its ability to fine-tune vision postoperatively. Requires additional post-op visits for adjustments .

Market Trends and Explant Rates

• Market Leaders: PanOptix and Vivity dominate the U.S. market, with Symfony OptiBlue and Eyhance gaining ground .
• Explant Rates: Multifocals like PanOptix have higher explant rates due to glare complaints, while Vivity and Eyhance have lower rates .
• Patient Satisfaction: Vivity has the highest satisfaction among EDOF lenses due to reduced glare, while PanOptix leads in spectacle independence .

Conclusion: Which Lens is Best?

• Best for Full Spectacle Independence: PanOptix
• Best for Minimal Glare and Halos: Vivity
• Best for Extended Range Without Multifocal Side Effects: Symfony OptiBlue
• Best for Budget-Conscious Patients Wanting Some Extended Vision: Eyhance

The best IOL choice depends on patient preferences, lifestyle, and tolerance for visual disturbances. With upcoming advancements, patients will have even more options for personalized vision correction. At SharpeVision, we discuss all the options extensively with our patients who opt for the most advanced lens technology at about 80%, or 4 out of 5. It’s essential that each patient understands exactly what they may expect so that they are not surprised and not disappointed. Admittedly, no lens currently is perfect, but they are extremely popular. Don’t wait to get your lens replaced if you’re over 45 years old-Enjoy clear uncorrected distance and near vision now, vs. 20 years from now.

References:

• Comparison of Trifocal and EDOF IOLs Study (IOVS, ARVO Journals, 2022)
• Symfony vs. Vivity Randomized Study (Eye News, 2023)
• Market Trends in IOLs (Review of Optometry, 2024)
• Visual Disturbance Data (MillennialEYE, EyeWorld, NVision, 2023-2024)