Extended Depth of Focus Intraocular Lenses for Presbyopia

Sruti S. Akella; Viral V. Juthani


Curr Opin Ophthalmol. 2018;29(4):318-322. 

In This Article

Abstract and Introduction


Purpose of review: To summarize the various extended depth of focus (EDOF) intraocular lenses currently available to patients and to describe visual outcomes and patient satisfaction.

Recent findings: EDOF lenses are a relatively new option for presbyopic correction. Preliminary studies show high levels of spectacle independence and patient satisfaction. The only United States Federal Drug Administration-approved intraocular lens currently on market is the TECNIS Symfony (Johnson and Johnson Vision, Jacksonville, FL).

Summary: Early studies show that EDOF lenses may provide satisfactory near and intermediate vision with reduced incidence of haloes and glares often noted by patients implanted with multifocal lenses. Results are promising, but limited.


The majority of intraocular lenses (IOLs) implanted worldwide are monofocal;[1] however, as cataract surgery techniques have become more sophisticated, there is increasing demand from patients who seek independence from spectacles after surgery. The monofocal lens is designed to replace the lens dioptric power to a single focal point and can provide satisfactory distance vision, but requires patients to wear correction for near and intermediate distances.[2]

Multifocal IOLs were introduced in the 1980 s and have the benefit of promoting near and distance vision simultaneously. However, there is inevitably some loss of contrast sensitivity inherent to the lenses' mechanism of light splitting.[3] Multifocal IOLs depend on two or more fixed focal points that each represents fixed working distances with which they deliver a sharp image to the retina. However, some light is simultaneously redirected to the images resulting from the other focal point or points; these coexisting images can result in lower contrast sensitivity. Furthermore, the working distances between these fixed focal points are often associated with suboptimal visual acuity.[4] Postoperative patients have also reported a variety of subjective complaints including halos, glare, starbursts, and unsatisfactory distance vision.[3,4] In addition, intermediate vision has become increasingly sought after with the popularization of smartphones, tablets, and computers.

The goals of reducing spectacle dependence and optimizing postoperative visual quality after cataract surgery have driven the development of extended depth of focus (EDOF) IOLs, approved for use in the United States by the Federal Drug Administration (FDA) on July 15, 2016. The basic principle behind these lenses is to create a single-elongated focal point to enhance depth of focus or range of vision. The optical properties of these lenses, as well as preliminary patient outcomes, will be discussed here.