An Update on Advanced Technology IOLs

IOL options in the United States have expanded substantially since the first trifocal IOL received US FDA approval in 2019. In a previous CRST article, we discussed several enhanced monofocal IOL platforms.¹ This article explores the optical designs of and candidate selection for several advanced technology IOLs that have received US FDA approval or been launched commercially in the United States since October 2023. Lenses are grouped by optical category; The Table compares key design features, range of focus, and other data points. Evidence was drawn from peer-reviewed clinical studies, regulatory or manufacturer labeling, and select manufacturer-reported bench or launch data when peer-reviewed outcomes were limited.

Enhanced Monofocal IOLs

Compared with conventional monofocal lenses, enhanced monofocal IOLs provide incremental depth of focus through higher-order aspheric optic modifications rather than diffractive surfaces. This design strategy minimizes dysphotopsias and preserves patients' contrast sensitivity while extending their uncorrected intermediate visual acuity (UIVA).²

enVista Aspire and enVista Aspire Toric

Design. The enVista Aspire (Bausch + Lomb) is built upon the enVista hydrophobic acrylic platform and is associated with a lower risk of dysphotopsias and a lower incidence of postoperative Nd:YAG laser capsulotomies compared with conventional monofocal IOLs.^3,4 The Aspire's higher-order posterior aspheric surface increases central and intermediate depth of focus.³

The toric model is available in a range of cylinder steps from +1.25 to +5.75 D at the IOL plane, with 0.50 D steps from 1.50 to 3.00 D, and, in Canada, uniquely offers a cylinder option of 0.90 D.⁵ This range permits more precise astigmatism management for patients whose refractive errors would fall between correction options on competing platforms.³

Candidate selection. The enVista Aspire Toric lens can benefit patients with astigmatism who wish to improve their UIVA while maintaining excellent distance visual acuity, with only a modest increase in their dysphotopsia risk compared to a conventional monofocal lens.

The enVista Aspire Toric IOL features an aberration-neutral design that makes it suitable for patients who have a history of corneal refractive surgery, particularly hyperopic LASIK, given that the aberration-neutral optic does not add to the eye's existing spherical aberration.⁶ Major contraindications include recurrent anterior or posterior segment inflammation, uncontrolled glaucoma, a compromised posterior capsule, and zonular instability.

Clareon TruPlus and Clareon TruPlus Toric

Design. Launched at the 2026 ASCRS Annual Meeting, the Clareon TruPlus is Alcon's first enhanced monofocal IOL. Built with the Clareon hydrophobic acrylic material, the lens' proprietary Opti-Balance Technology is designed to optimize light distribution in the central optic zone to extend depth of focus while preserving high-quality distance image quality.⁷ The IOL is available in a single-use, preloaded delivery system. The toric version addresses astigmatism on the same platform. Manufacturer-sponsored clinical trials are ongoing.

Candidate selection. The Clareon TruPlus can benefit patients who wish to improve their UIVA but prioritize the quality of their distance visual acuity and a low risk of dysphotopsias. The lens may therefore be particularly well suited to highly demanding professionals, patients who frequently drive at night, and those who have previously declined multifocal or extended depth of focus (EDOF) IOLs due to photic concerns. This suitability profile is based on the lens' optical design rather than published clinical outcomes because manufacturer-sponsored trials are still ongoing.

Major contraindications include severe ocular surface disease (OSD), irregular astigmatism, and unrealistic expectations regarding spectacle independence.⁷ Candidate selection criteria will be further refined as clinical data emerge.

RayOne EMV Toric

Design. The RayOne EMV Toric IOL (Rayner) is built on the RayOne EMV platform for patients with corneal astigmatism. Something that distinguishes the EMV family of lenses from most other enhanced monofocal IOLs is the use of controlled positive - rather than negative - spherical aberration in the center of the optic.^1,8 The positive central spherical aberration creates a myopic power offset that elongates the focal range from distance into intermediate. A blended edge, moreover, creates a transition zone at the periphery of the optic with nearly neutral spherical aberration, minimizing visual disturbances when the pupil is large.^1,8 The design was optimized specifically for a mini-monovision strategy; the dominant eye is targeted for distance and the nondominant eye receives a myopic offset to extend intermediate and functional near vision.¹

A multicenter randomized trial (n = 238) demonstrated rotational stability and refractive precision comparable to those of the aspheric monofocal control IOL.⁹

Candidate selection. Ideal candidates for this IOL have up to approximately 1.50 D of regular corneal astigmatism and are not suited to diffractive lens technology. Contraindications include a history of severe OSD and a high amount of regular or irregular astigmatism.

Because the central positive spherical aberration adds to any positive spherical aberration present in the cornea, the RayOne EMV Toric IOL is also contraindicated for patients who have a history of myopic LASIK but would likely be useful for those who have undergone hyperopic LASIK.

The hydrophilic acrylic lens material is a relative contraindication for patients who may require intraocular gas in the future (eg, those with Fuchs dystrophy or retinal tears) because of the risk of IOL calcification.^10-16

Preoperative scotopic pupil measurements are recommended to ensure maximal benefit from the IOL's blended edge transition because larger scotopic pupils have been associated with a reduction in the lens' modulation transfer function.^1,14,15

Extended Depth of Focus IOLs

EDOF IOLs are designed to extend the range of clear focus beyond that provided by a conventional monofocal lens without creating discrete secondary focal points, thereby limiting the photic phenomena associated with diffractive designs.¹⁷

Tecnis PureSee and Tecnis PureSee Toric II

Design. Approved by the US FDA in March, the nondiffractive Tecnis PureSee (Johnson & Johnson Vision) is built on the Tecnis hydrophobic acrylic platform. This EDOF IOL uses a higher-order aspheric profile to extend depth of focus without a diffractive surface.^18,19

Clinical data have suggested distance and intermediate visual performance with functional near vision and a low rate of bothersome visual disturbances. The PureSee is currently the only EDOF IOL that does not carry a warning label regarding a loss of contrast sensitivity.^17,18

Before its US approval, approximately 500,000 Tecnis PureSee lenses had been implanted globally.¹⁸ In a pivotal US study, 97% of patients reported experiencing no very bothersome visual disturbances, and 97% said they would recommend the lens to family or friends.¹⁸

Candidate selection. The Tecnis PureSee IOL is indicated for patients with less than 1.00 D of preexisting corneal astigmatism who desire an EDOF range of vision but are hesitant about, or intolerant of, diffractive dysphotopsias.¹⁸

The toric model extends the platform to patients with up to 2.50 D of corneal astigmatism. It is available in cylinder powers ranging from +1.50 to +3.75 D at the IOL plane in +0.75 D steps.

The IOL's refractive-only design makes it particularly well suited to patients who drive at night, those who work in dimly lit environments, and those who have previously rejected diffractive or multifocal lenses because of photic concerns. Surgeons in Europe and Canada, where the PureSee launched before gaining US FDA approval, are increasingly adopting this EDOF option for visually demanding patients with mesopic concerns.¹⁹

As with all EDOF IOLs, irregular astigmatism and severe OSD are contraindications.

Multifocal IOLs

In 2024, the International Organization for Standardization (ISO) introduced an independently verifiable standard for a full visual range (ISO 11979-7:2024), reserved for IOLs for which seamless clear vision from distance through near with consistent performance across the full defocus curve has been documented.²⁰ Two IOLs, the Tecnis Odyssey (Johnson & Johnson Vision) and the enVista Envy (Bausch + Lomb), have received US FDA approval for this classification. For clinical purposes, these lenses may be considered full-range presbyopia-correcting IOLs.

Another type of presbyopia-correcting lens, the trifocal IOL, creates discrete distance, intermediate, and near focal points. These IOLs are associated with high rates of spectacle independence, but preoperative patient education on dysphotopsias is important. In 2025, the US market gained a few trifocal additions - the Clareon PanOptix Pro and Clareon PanOptix Pro Toric (both from Alcon) and the FineVision HP (BVI).

Tecnis Odyssey and Odyssey Toric II

Design. The Tecnis Odyssey was the first IOL to receive US FDA approval and meet the ISO standard for a full visual range.^20,21 It has a hybrid optical architecture: a posterior diffractive surface generates two primary focal points at distance and near, and an aspheric anterior surface corrects higher-order aberrations to enhance contrast sensitivity.²¹

A comparative study found that the Odyssey provided increased contrast sensitivity and an extended defocus profile relative to the Clareon PanOptix (Alcon), a trifocal IOL.²² Other clinical trials have shown high rates of spectacle independence following bilateral implantation of the Odyssey, with 93% of patients demonstrating spectacle independence at all distances. Additionally, 94% of patients reported satisfaction with their overall vision without glasses, and 93% reported no or only mild halos, glare, or starbursts 1 month after surgery.²¹

The Odyssey Toric II extends the platform to patients with up to 2.50 D of corneal astigmatism in the United States (with a broader range available internationally).²¹

Candidate selection. The Tecnis Odyssey is an option for patients who desire a broad continuous range of vision and a high degree of spectacle independence and can tolerate photic phenomena. Its contrast sensitivity performance in low-light conditions compared to trifocal lenses²² makes it particularly well suited to active patients and those who drive at night.

Laboratory data have indicated that the Odyssey is more tolerant of residual refractive error than conventional multifocal IOLs, which could improve refractive outcomes in surgically challenging cases.²¹

As with all diffractive IOL designs, patient counseling should include a realistic discussion of postoperative photic phenomena, particularly halos. Irregular astigmatism, significant OSD, advanced glaucoma, and preexisting macular pathology are contraindications for both lens models.

enVista Envy and Envy Toric

Design. The enVista Envy is built on the enVista hydrophobic acrylic platform and incorporates two proprietary technologies. Bausch + Lomb's ActivSync Optic is a pupil-adaptive design that dynamically allocates light energy based on pupil diameter,^23,24 and the company's ClearPath Technology reduces the sharp edges of the echelettes and intraoptic light scattering, enhancing image quality under variable illumination.^23,24 Apodization, rounded echelettes, and fewer rings than other diffractive IOLs help minimize dysphotopsias.

In a multicenter, randomized, controlled US pivotal trial conducted across 23 investigational sites, the enVista Envy demonstrated excellent visual outcomes; patients' mean postoperative visual acuity was approximately 20/20 at distance, 20/25 at intermediate, and J1 at near.²⁵ In the US cohort, 86% of patients reported little to no bothersome dysphotopsias.²⁵ Separate Canadian clinical data demonstrated a high level of satisfaction, with more than 90% of patients reporting moderate to complete satisfaction with their visual outcomes.²⁶

The toric model treats from +1.25 to +5.75 D of corneal astigmatism at the IOL plane. The lens is available in 0.50 D cylinder steps in powers ranging from 1.50 to 3.50 D.

Candidate selection. The enVista Envy is well suited to patients who desire a high degree of spectacle independence but with a lower dysphotopsia burden than is associated with traditional trifocal IOLs. The Envy's pupil-adaptive design may be particularly useful for patients with mesopic visual demands, although they should still be counseled about potential dysphotopsias.^23,24 The fine toric step intervals (0.25 D or 0.50 D steps) and wide toric range make the enVista Envy Toric an attractive option for patients with low to high cylinder whose magnitude of astigmatism falls between or above the correction options available on competing toric platforms.

Contraindications include irregular astigmatism, severe OSD, and unrealistic expectations for dysphotopsia-free vision.

Clareon PanOptix Pro and Clareon PanOptix Pro Toric

Design. The Clareon PanOptix Pro is an updated trifocal IOL based on the Clareon hydrophobic acrylic platform. The lens retains the PanOptix trifocal optical profile: +2.17 D intermediate and +3.25 D near add powers at the IOL plane (representing approximately +1.74 D and +2.40 D at the corneal plane, respectively). It incorporates Alcon's proprietary Enlighten NXT optical technology, which reportedly increases light utilization from 88% to 94%.²⁷ The lens is available in powers ranging from +6.00 to +34.00 D, and it is delivered through the company's preloaded Clareon AutonoMe system.^27,28 A yellow chromophore version with blue-light filtering is also available.

Candidate selection. The PanOptix Pro is best suited to patients seeking a high degree of spectacle independence across distance, intermediate, and near vision. The toric model expands candidacy to patients with regular corneal astigmatism.

Preoperatively, patients should be counseled on the potential for halos and glare. Ideal candidates have a healthy ocular surface, regular corneal astigmatism, and no significant macular or retinal pathology.

FineVision HP

Design. The FineVision HP is a trifocal hydrophobic acrylic IOL built on the FineVision platform, which accumulated more than a decade of international clinical experience before US FDA approval.^29-31 The lens incorporates BVI's proprietary apodization CoPODize technology to distribute light across distance, intermediate (+1.75 D), and near (+3.50 D) powers at the IOL plane. These intermediate and near add powers represent focal points of approximately +1.40 D and +2.80 D at the corneal plane.²⁹ The lens features a double C-loop, four-point haptic design intended to enhance centration and rotational stability.²⁹ Convolution and apodization help reduce dysphotopsias, and the lens has a yellow chromophore that selectively filters blue-violet light.

Previous studies of the FineVision platform have reported binocular uncorrected distance visual acuity of 20/25 or better in greater than 90% of eyes and high rates of spectacle independence.^30,31

Candidate selection. The FineVision HP is appropriate for patients seeking a high degree of spectacle independence across distance, intermediate, and near. The IOL's intermediate and near focal points differ from those of the other diffractive lenses and may be preferred by some patients.^30,31 The FineVision HP has the closest near point of any trifocal lens available in the United States³² and may therefore be attractive to highly myopic patients who have short arms and/or desire a close near point for near tasks (eg, detailed rock painting, electrical wiring, embroidery, calligraphy).

Candidate selection is otherwise similar to that for other trifocal IOLs; a healthy ocular surface, normal macular function, and realistic expectations regarding halos and glare are required.

A toric version is not currently available in the United States.

Conclusion

Since October 2023, eight advanced technology IOLs spanning multiple optical categories have entered the US market.

Successful IOL selection is guided by the patient's goals, ocular characteristics, and tolerance for photic phenomena as well as the available clinical evidence. Enhanced monofocal lenses generally prioritize the quality of distance vision and minimize dysphotopsias, EDOF lenses extend functional range vision while preserving visual quality, and multifocal lenses provide the broadest range of vision but with an increased risk of dysphotopsias. As more real-world and peer-reviewed data emerge, particularly for recently introduced platforms, candidate selection and outcome expectations will evolve.

Together, these IOL technologies expand ophthalmologists' ability to tailor cataract surgery to each patient's visual needs and lifestyle preferences.