Visual Outcomes after Implantation of Lucidis EDOF IOL

Abstract

Purpose:
To evaluate the visual performance and clinical outcomes after implantation of Lucidis EDOF IOL following cataract surgery.

Design:
In this retrospective study, medical records from all enrolled patients were analyzed, and the following information was extracted retrospectively over 3 months following surgery.

Materials and methods:
We reviewed retrospectively 181 eyes of 98 patients, who underwent cataract surgery with Lucidis extended depth of focus IOL.

Results:
44 patients were males (45%) and 54 were females (55%). The average age of the study population was 68 ± 11 years. The mean preoperative BCVA (logMAR) was 0.19 ± 0.18. The mean root mean square (RMS) high order aberration (HOA) was 0.18 ± 0.1. Monocular BCVA results were 0.02 ± 0.04 (logMAR) and 0.028 ± 0.04 (logMAR) 1 month and 3 months postoperatively, respectively. Between the baseline and 1-month measures, monocular distance BCVA improved by an average of 0.17 ± 0.14 logMAR (p = 0.0001). Between the baseline and 3-month postoperative measures, monocular distance BCVA improved by an average of 0.16 ± 0.13 logMAR (p = 0.0001). Monocular UDVA 1 and 3 months postoperatively was 0.08 ± 0.1 logMAR and 0.067 ± 0.08 logMAR, respectively. 1-Month postoperative binocular UDVA was 0.036 ± 0.05 logMAR, binocular UIVA was 0.1 ± 0.08 logMAR, and binocular UNVA was 0.12 ± 0.14 logMAR. 3-Month postoperative binocular UDVA was 0.038 ± 0.05 logMAR, binocular UIVA was 0.09 ± 0.1 logMAR, and binocular UNVA was 0.16 ± 0.14 logMAR.

Conclusions:
Lucidis EDOF IOL achieves good visual performances in all distances.

Full text

Research Article
Visual Outcomes after Implantation of Lucidis EDOF IOL
Mark Rabinovich , Gaia Ceresara, Ana Aramburu del Boz, Danial Al Khatib,
Marie Crespe, and Jerome Bovet
Ophthalmology Network Organisation, Clinique de L’Oeil SA, Onex, Geneva, Switzerland
Correspondence should be addressed to Mark Rabinovich; rabinovicmark@gmail.com
Received 7 April 2022; Accepted 7 May 2022; Published 28 May 2022
Academic Editor: Alessandro Meduri
Copyright ©2022 Mark Rabinovich et al. is is an open access article distributed under the Creative Commons Attribution
License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is
properly cited.
Purpose. To evaluate the visual performance and clinical outcomes after implantation of Lucidis EDOF IOL following cataract
surgery. Design. In this retrospective study, medical records from all enrolled patients were analyzed, and the following in-
formation was extracted retrospectively over 3 months following surgery. Materials and Methods. We reviewed retrospectively 181
eyes of 98 patients, who underwent cataract surgery with Lucidis extended depth of focus IOL. Results. 44 patients were males
(45%) and 54 were females (55%). e average age of the study population was 68 ±11 years. e mean preoperative BCVA
(logMAR) was 0.19 ±0.18. e mean root mean square (RMS) high order aberration (HOA) was 0.18±0.1. Monocular BCVA
results were 0.02 ±0.04 (logMAR) and 0.028 ±0.04 (logMAR) 1 month and 3 months postoperatively, respectively. Between the
baseline and 1-month measures, monocular distance BCVA improved by an average of 0.17 ±0.14 logMAR (p�0.0001). Between
the baseline and 3-month postoperative measures, monocular distance BCVA improved by an average of 0.16 ±0.13 logMAR
(p�0.0001). Monocular UDVA 1 and 3 months postoperatively was 0.08 ±0.1 logMAR and 0.067 ±0.08 logMAR, respectively. 1-
Month postoperative binocular UDVA was 0.036 ±0.05 logMAR, binocular UIVA was 0.1 ±0.08 logMAR, and binocular UNVA
was 0.12 ±0.14 logMAR. 3-Month postoperative binocular UDVA was 0.038 ±0.05 logMAR, binocular UIVA was 0.09 ±0.1
logMAR, and binocular UNVA was 0.16 ±0.14 logMAR. Conclusions. Lucidis EDOF IOL achieves good visual performances in
all distances.
1. Introduction
Cataract surgeons are constantly in search of better re-
fractive postoperative outcomes and better visual perfor-
mances. New designs of intraocular lens (IOLs) help to
achieve a more optimal visual performance and patient
satisfaction.
Normally, the surgeons treat cataract patients by
replacing the lens with a monofocal posterior chamber IOL.
erefore, patients should make a decision preoperatively
which range of vision they prioritize postoperatively.
e introduction of the newest IOLs with extended
depth of focus (EDOF) technology enabled a relatively good
visual performance in intermediate distances as well as for
far and near distances [1–6]. ese ranges of distance are
usually important for patients who perform activities such as
using an iPad or a computer.
Furthermore, EDOF IOLs have been found to be as-
sociated with fewer halos and less contrast sensitivity loss
than traditional multifocal IOL technology [7].
e basic principle of such IOLs is to create a single-
elongated focal point to enhance the depth of focus, to
eventually eliminate the overlapping of near and far images,
as seen with other IOLs [8].
e Swiss innovation of the Lucidis IOL (Swiss Ad-
vanced Vision, SAV-IOL SA, Neuchˆ
atel, Switzerland) is a
new type of refractive/EDOF hybrid IOL involving a central
aspheric element surrounded by an outer refractive ring [9].
e central aspheric zone in an area of 1 mm acts as an
axicon, so that the emerging light forms a Bessel beam,
resulting in a beam of focal fields that allow a continuous
vision from intermediate to short distances. is aspheric
geometry does not generate any additional spherical aber-
ration to the lens.
Hindawi
Journal of Ophthalmology
Volume 2022, Article ID 5100861, 5 pages
https://doi.org/10.1155/2022/5100861

e aim of the current study is to evaluate the visual
performance and clinical outcomes with Lucidis EDOF IOL.
2. Patients and Methods
is is a single-center, retrospective study of 98 patients (181
eyes) who underwent implantation of the Lucidis EDOF IOL
(Swiss Advanced Vision, SAV-IOL SA, Neuchˆ
atel, Swit-
zerland) during cataract surgery by 4 experienced surgeons
between 2019 and 2022.
We performed a monocular unilateral analysis of pre-
operative and postoperative best corrected visual acuity
(BCVA) and monocular uncorrected distant visual acuity
(UDVA) of each eye. Uncorrected near visual acuity
(UNVA) and uncorrected intermediate visual acuity (UIVA)
were analyzed bilaterally. UDVA was also analyzed bilat-
erally for the purpose of visual acuity reporting.
Institutional board approval of the study and patients’
consents were obtained. No conflicts of interest to be re-
ported for this study.
Exclusion criteria were the presence of a concomitant
ophthalmic condition, including age-related macular de-
generation, diabetic retinopathy, glaucoma, uveitis, corneal
opacities, or astigmatism of >1.00 D, age <18 years, and no
previous corneal surgery.
e decision to perform cataract surgery and the choice
of the IOL were based on clinical indications.
2.1. Intraocular Lens. Lucidis is a single-piece foldable
multizone refractive/aspheric IOL, with a 360°square edge
design and closed-loop haptics. e lens has a 6.0 mm optical
diameter and a total diameter of either 10.8 mm or 12.4 mm.
It is made from hydrophilic acrylic with a 26% water content.
Optically, the Lucidis IOL uses both refraction and an
aspheric element—the Axicon. e 1 mm aspheric zone
occupies the center of the IOL and is surrounded by a 6 mm
refractive ring.
2.2. Surgery. All surgeries were performed under local an-
esthesia and a venous sedation with Rapifen and propofol on
demand. All interventions were performed using the same
standard protocol on a temporal side, 2 mm main incision,
and phacoemulsification machine (Stellaris, Bausch USA);
for all FLACS, a femto laser LDV Z8 (Ziemer Ophthalmic
Systems, Switzerland) was used.
A foldable Lucidis IOL was implanted in the capsular
bag. No Lucidis IOLs were implanted in the sulcus.
2.3. Follow-Up Visits. Patients attended follow-up visits as a
local protocol, at 1 day, 7 days, 1 month, and 3 months
postoperatively. Additional appointments were planned at
the surgeon’s discretion. At each of the follow-up visits, the
results were recorded in the patients’ medical notes. 1-
Month postoperative follow-up was done for 181 eyes, and
3-month postoperative follow-up was available for 78 eyes.
For refractive purposes, we tested monocular best-cor-
rected visual acuity (BCVA), monocular and binocular
uncorrected distant visual acuity (UDVA) at 6 meters, and
binocular uncorrected visual acuity for near and interme-
diate distances (UNVA and UIVA, respectively) at 40 cm
and 80 cm in photopic conditions. e surgeons performed
the visual acuity testing in the same room and with the same
ambience illumination using a Snellen decimal chart. e
ophthalmologists recorded their observations following a
slit-lamp examination as well as any subjective complaint or
adverse event.
2.4. Statistical Analysis. Statistical analysis was performed
on all available 1-month data. Quantitative and qualitative
variables are described in terms of sample size, mean,
standard deviation, median, range, and missing data.
Excel (Microsoft, WA, USA) was used for data anal-
ysis. e following analyses were performed for all pa-
rameters: an independent t-test to compare two means,
and a Wilcoxon test to compare nonparametric contin-
uous data. Results were considered statistically significant
if p<0.05.
SPSS version 26 (IBM, USA) was used for the ANOVA
test and regression analysis for independent risk factor
identification. Results were considered statistically signifi-
cant if p<0.05.
3. Results
181 eyes of 98 patients were included, all of which had up to
3-month data. In the cohort, 44 patients were males (45%)
and 54 were females (55%). e average age of the study
population was 68 ±11 years. e mean preoperative BCVA
(logMAR) was 0.19 ±0.18, as shown in Table 1. e mean
root mean square (RMS) high order aberration (HOA) was
0.18 ±0.1.
3.1. Postoperative Best-Corrected Visual Acuity.
Monocular BCVA results were 0.02 ±0.04 (logMAR) and
0.028 ±0.04 (logMAR) 1 month and 3 months postopera-
tively, respectively. Between the baseline and 1-month
postoperative measures, monocular distance BCVA im-
proved by an average of 0.17 ±0.14 logMAR (p�0.0001).
Between the baseline and 3-month postoperative measures,
monocular distance BCVA improved by an average of
0.16 ±0.13 logMAR (p�0.0001).
3.2. Monocular Postoperative Uncorrected Visual Acuity.
Monocular UDVA 1 and 3 months postoperatively was
0.08 ±0.1 logMAR and 0.067 ±0.08 logMAR, respectively.
3.3. Binocular Postoperative Uncorrected Visual Acuity.
Binocular UCVA was recorded until 3 months postopera-
tively. 1-Month postoperatively, binocular UDVA was
0.036 ±0.05 logMAR, binocular UIVA was 0.1 ±0.08 log-
MAR, and binocular UNVA was 0.12 ±0.14 logMAR. 3-
Months postoperatively, binocular UDVA was 0.038 ±0.05
logMAR, binocular UIVA was 0.09 ±0.1 logMAR, and
binocular UNVA was 0.16 ±0.14 logMAR.
2Journal of Ophthalmology

3.4. Postoperative Spherical Equivalent and Cylinder.
1-Month postoperatively, 24% of the eyes had emmetropic
spherical equivalents (SE) between 0.13 and +0.13D. e mean
monocular UDVA for that range of SE was 0.07 ±0.09 logMAR.
3 months postoperatively, 27% of the eyes had emme-
tropic spherical equivalents (SE) between 0.13 and + 0.13D,
as shown in Figure 1. e mean monocular UDVA for that
range of SE was 0.07 ±0.09 logMAR.
1 month postoperatively, 57% of the eyes had a cylinder
value <-0.5D. e mean monocular UDVA for that range of
postoperative cylinder was 0.078 ±0.09 logMAR.
3 months postoperatively, 38% of the eyes had a cylinder
value <−0.5D, as seen in Figure 2. e mean monocular
UDVA for that range of postoperative cylinder was 0.08 ±0.1
logMAR.
Perioperative and postoperative negative outcomes in-
cluded complications, glares, or halos reported by patients
and discomfort with near vision that requiring spectacles or
an eventual add-on operation, as seen in Table 2.
4. Discussion
In our study, we demonstrated good results for far, inter-
mediate, and short uncorrected visual acuity for eyes after
implantation of Lucidis EDOF IOLs up to 3 months
postoperatively.
<-1.5 (-1.5 to
-1.0)
(-1.0 to
-0.5)
(-0.5 to
-0.13)
(-0.13 to
+0.13)
(+0.13 to
+0.5)
(+0.5 to
+1.0)
(+1.0 to
+1.5)
> +1.5
Postoperative spherical equivalent refraction (D) (%)
30
25
20
15
10
5
0
3 months
1 month
Figure 1: Postoperative spherical equivalent.
0 -0.25 (-0.26 to
-0.5)
(-0.6 to
-0.75)
(-0.76 to
-1)
(-1.1 to
-1.25)
(-1.26 to
-1.5)
(-1.6 to
-1.75)
> -2
Postoperative refractive cylinder (D) (%)
30
25
20
15
10
5
0
3 months
1 month
Figure 2: Postoperative cylinder.
Table 1: Demographics of cohort.
Patients n�98
(181 eyes)
Male/female 44/54
Age 68 ±11
Preoperative best-corrected visual acuity (logMAR) 0.19 ±0.18
RMS HOA 0.18 ±0.1
Journal of Ophthalmology 3

Nowadays, we are familiar with many types of IOLs with
EDOF characteristics that were described under the term
EDOF.
Among these are pure EDOF IOLs (e.g., TECNIS
Eyhance) and EDOF IOLs using the pinhole effect (e.g.,
XtraFocus). ere are also hybrid MF/EDOF IOLs that are
further subdivided to diffractive/EDOF IOLs (e.g., TECNIS
Symfony), refractive/EDOF IOLs (e.g., Lucidis IOLs), and
refractive-diffractive/EDOF IOLs (e.g., EDEN, Harmonis,
TECNIS Synergy) [8].
e particularity of the Lucidis IOL is the central
aspheric zone in an area of 1 mm that acts as an axicon,
resulting in a beam of focal fields that allow a continuous
vision from intermediate to short distances. is aspheric
geometry does not generate any additional spherical aber-
ration to the lens.
Furthermore, the main benefit of the design of the
Lucidis IOL is to provide additional visual comfort at near
and intermediate distances [9, 10]. Notwithstanding the
benefits, this IOL was found inferior for distant uncorrected
visual acuity, compared to results of other EDOF IOLs [10].
EDOF IOLs (Mini Well; SIFI, Catania, Italy) were
previously demonstrated to perform similarly to multifocal
IOLs (ReSTOR SV25T; Alcon Laboratories, Inc., Fort
Worth, TX) for far and near distances, with superiority at the
intermediate level [11].
Compared to Trifocal IOLs (AT LISA tri 839MP IOL),
for the intermediate distance visual performance, EDOF IOL
(Symfony IOL) was also found superior [12].
EDOF IOLs were found to provide not only a subjective
satisfaction but also a good quality of uncorrected postop-
erative visual acuities at all distances [13, 14].
In our study, monocular UDVA 1 and 3 months
postoperatively was 0.08 ±0.1 logMAR and 0.067 ±0.08
logMAR, respectively.
In a meta-analysis of 24 studies, Rosen et al. demon-
strated a mean UDVA of 0.11 logMAR, achieved after
multifocal IOL implantation [15]. Hogarty et al. found a
mean binocular UDVA for TECNIS Symfony ERV IOL
(TECNIS Symfony; Abbott Medical Optics, Inc., Abbott
Park, IL) of 0.04 logMAR [16]. In our study, for Lucidis
EDOF IOLs, we found a comparable 1-month postoperative
binocular UDVA of 0.036 ±0.05 logMAR and 3-month
postoperative binocular UDVA of 0.038 ±0.05 logMAR.
Furthermore, in our study, we found binocular UIVA of
0.1 ±0.08 logMAR and 0.09 ±0.1 logMAR 1 and 3 months
postoperatively, respectively. Our results for the interme-
diate uncorrected visual acuity were comparable to those
reported by Cochener et al. for TECNIS EDOF IOL [17]. e
authors showed the latter achieved a mean UIVA of 0.18
logMAR for the intermediate range.
In addition, we found that binocular UNVA was
0.12 ±0.14 logMAR and 0.16 ±0.14 logMAR, 1 and 3 months
postoperatively, respectively, which were also comparable to
previous reports of TECNIS Symfony IOL of 0.28 logMAR at
the near range [17], the latter with a mean binocular VA
(decimal) of 0.64 ±0.07.
In our study, we also demonstrated an emmetropic
spherical equivalent in 24% of the eyes (−0.13 and + 0.13 D)
and 27%, 1 and 3-months postoperatively, respectively. e
SE corresponded to a mean monocular UDVA of 0.07 ±0.09
logMAR and 0.07 ±0.09 logMAR, 1 and 3 months post-
operatively, respectively. On the other hand, Cochener et al.
found emmetropic SE outcomes for TECNIS Symfony
(Abbott Medical Optics, Inc., Abbott Park, IL) for 8% of the
eyes (17).
In addition, in our study, we demonstrated that 57% and
38% of the eyes had a cylinder value of less than −0.5 D, 1 and
3 months postoperatively, respectively. e corresponding
mean monocular UDVA was 0.078 ±0.09 logMAR and
0.08 ±0.1 logMAR, 1 and 3 months postoperatively, re-
spectively, while Cochener showed that, for TECNIS
Symfony IOL, 56% of the eyes had a postoperative cylinder
of less than 0.5 D(17).
In our study, only 5% of the patients complained of
visual aberrations during the follow-up period, 4% com-
plained of diplopia, 20% were provided with reading glasses
for a suboptimal postoperative UNVA, and 3% opted for an
additional Add-On IOL (HumanOptics AG, Erlangen,
Germany), a line of sulcus-fixated silicone lenses.
However, it was previously shown that dysphotopsias
such as halos were inevitable in EDOF IOLs and increase
with higher near addition powers [18, 19].
Preoperatively, it is important to consider the specific
patient’s visual needs as well as the extent to which they are
willing to accept such optical side effects.
If, for example, the patients would not tolerate dys-
photopsias and were willing to accept glasses for reading,
one possibility with EDOF IOLs could be micro monovision
of −0.75 Danisometropia.
While our study focused on virgin eyes undergoing
cataract surgery with Lucidis EDOF IOL implantation, fu-
ture studies are warranted to evaluate dysphotopsia and
spherical aberration incidence in eyes with a previous re-
fractive surgery (e.g., radial keratotomy) that are scheduled
to have cataract surgery and an EDOF IOL implantation.
Any previous refractive surgery can be associated with a
more challenging IOL power calculation, as well as a
postoperative refractive surprise and corneal instability
(postoperative astigmatism).
For such less convenient conditions for an EDOF IOL
consideration, Meduri et al. suggested some perioperative
methods such as stabilizing sutures that lowered the risk of
dehiscence as well as the postoperative astigmatism
[20, 21].
Furthermore, Baartman et al. found that for eyes with
previous radial keratotomy that had undergone phaco-
emulsification with implantation of the TECNIS Symfony
Table 2: Negative outcomes.
Negative outcomes 98 patients (%)
Capsular rupture 1
Diplopia 4
Eventual add-on 3
Eventual IOL change 1
Endophthalmitis 1
Halos/glare 5
Indication for reading glasses 20
4Journal of Ophthalmology

EDOF IOL, there were good visual outcomes and a sub-
jective satisfaction of the patients [22].
e current study has several limitations. Firstly, its
retrospective nature. Secondly, this study lacks long-term
follow-up with only 3-month data available that does not
allow for analysis of potential long-term complications.
e retrospective nature of the study did not allow to
include corrected near and intermediate visual acuity which
would have allowed the confirmation as to whether the
previously documented performance of this IOL for distance
vision was due to its design or to a myopic postoperative
spherical equivalent. Nor did it allow to include a baseline
UCVA measured preoperatively or the postoperative con-
trast perception.
In conclusion, in our study, we demonstrated good vi-
sual outcomes for Lucidis EDOF IOL for all ranges of vision.
Furthermore, investigations of the long-term performance
of this IOL is warranted in future studies.
Data Availability
Data are available upon request.
Conflicts of Interest
e authors declare that they have no conflicts of interest.
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