Comparative Photopic and Mesopic Visual Performance of Enhanced Monofocal Versus Non-Diffractive Extended Depth-of-Focus Intraocular Lenses

Abstract

Background/Objectives: Enhanced monofocal and non-diffractive extended depth-of-focus (EDoF) intraocular lenses (IOLs) aim to improve intermediate vision while maintaining contrast sensitivity. However, direct comparative evidence under both photopic and mesopic conditions remains limited. This study prospectively compared the visual performance of two enhanced monofocal IOLs (Tecnis® Eyhance™ and ISOPure®) and one non-diffractive EDoF IOL (AcrySof® IQ Vivity™). Methods: Sixty patients undergoing bilateral cataract surgery were implanted with one of three IOL groups (n = 20 each). Patients were assigned to one of three IOL groups based on preoperative consultation and clinical indications. One month postoperatively, monocular corrected distance (CDVA), distance-corrected intermediate (DCIVA), and near visual acuity (DCNVA) were measured under photopic and mesopic conditions. Photopic defocus curves, contrast sensitivity under photopic and mesopic conditions and correlation between pupil diameter and visual acuities were also assessed. Results: Baseline characteristics were comparable among groups. Under photopic conditions, Vivity™ achieved significantly better UDVA, DCIVA and DCNVA than both Eyhance™ and ISOPure®. Under mesopic conditions, distance acuity did not differ significantly, but Vivity™ showed superior DCIVA and DCNVA. Defocus curves demonstrated a broader functional range of vision with Vivity™, while Eyhance™ and ISOPure® showed nearly overlapping profiles. Contrast sensitivity was similar among all IOLs under both lighting conditions, with no statistically significant differences. Conclusions: The non-diffractive EDoF AcrySof® IQ Vivity™ provided a wider and more functional depth-of-focus than the enhanced monofocal lenses evaluated, without compromising contrast sensitivity. Eyhance™ and ISOPure® offered comparable performance, with good distance vision and modest depth-of-focus extension. All three IOLs maintained CS levels comparable to those typically reported for standard monofocal IOLs under both photopic and mesopic illumination, indicating no clinically relevant contrast penalty.