The eye world has recently been introduced to a completely new and unique intraocular lens (IOL) design, in the spiral form of the RayOne Galaxy IOL from Rayner. This innovative technology is now widely available in Australia and while first experiences from global users, including myself, have been positive, the company is yet to receive Prostheses List approval allowing healthcare reimbursement. In this article, Dr Ben LaHood reports on the multicentre data analysis of outcomes from early adopters, as well as providing tips and advice from his own experience for those wanting to get started.
RayOne’s full range refractive spiral lens – the Galaxy IOL – was designed using artificial intelligence in conjunction with Brazilian ophthalmologist, Dr João Marcelo Lyra.
The buzz about this lens is not simply because of the subtle spiral shape of surface elements aimed at providing patients with full depth of field from distance to reading, but that this range of vision comes with greatly reduced visual side effects when compared to existing diffractive multifocal technology. Sticking with the space theme, the Galaxy IOL should be one small step for refractive lens design, and one giant leap for reducing dysphotopsias. Traditional diffractive multifocal lenses create haloes around lights at night and typically have light loss of around 11%. The refractive nature of the Galaxy results in zero diffractive light lost to scatter and is expected (and so far delivering) to produce minimal dysphotopsias including haloes and glare.
This early outcome data (unpublished) for the Galaxy IOL comes from nine sites in Europe and New Zealand. Patient outcomes were assessed at one month (114 eyes) and three months (50 eyes) post-operatively, by measuring visual acuity, defocus, contrast sensitivity, and visual side effects. Demographic data for study participants showed a balanced gender profile (43%:57% male:female) with a mean age of 64 (± 9 years). The Galaxy IOL was released with both toric and non-toric versions available, and the participating sites showed an even distribution of non-toric (47.5%) and toric (52.5%) implantations. Pre-operative biometry parameters were all within an expected range for a set of normal, healthy eyes.
Refractive Outcome and Predictability
One of the most important factors to analyse for a new IOL entering the market is refractive outcome and predictability, as you can have the best lens in the world, but if you don’t hit the refractive target, surgeons will be nervous to use it. Even for multifocal IOLs, in my opinion, achieving optimal distance vision is a key factor in overall patient satisfaction. The Galaxy IOL performed very well in this regard with a mean subjective refractive spherical equivalent at three months post-op of -0.29D ± 0.35D when aiming for emmetropia. Given small variances in refractive targeting between surgeons, the more important measure of prediction error (target refractive error minus achieved refractive error) gave a mean value of -0.16D ± 0.33D at three months post-op using the Barrett Universal II formula. Looking specifically at the Galaxy Toric sub-group, residual refractive astigmatism was -0.25D ± 0.28D at three months post-op. Overall, this gave a spherical equivalent outcome within ±0.50D in 78% of eyes and refractive astigmatism within ±0.50D in 90% of eyes at three months post-op.
The Galaxy IOL aims to provide excellent visual acuity for distance, intermediate, and near targets. Multifocal IOLs, in general, function synergistically when implanted binocularly to provide this range, however, it is important to look at both monocular and binocular results. Early outcomes have exceeded the ISO 11979-7 requirements to classify the Galaxy IOL as a “full vision range IOL” with monocular distance and intermediate mean visual acuities being better than 0.1 logMAR and near vision of 0.11 logMAR at three months post-op. As anticipated, binocular results were even more impressive (mean distance unaided visual acuity -0.01 logMAR; intermediate -0.04 logMAR; and near 0.05 logMAR). These results were comparable between toric and non-toric subgroups.
When assessing defocus curves for an IOL, ensuring good vision quality requires the curve to remain consistently as high as possible, ideally above 0.2 logMAR and extend as far as possible along the x-axis towards negative powers, which reflect reading distances. Additionally, the curve should demonstrate minimal dips to maintain consistent performance across the range of vision. With diffractive multifocal IOLs, we often see a major dip in visual acuity between the defined focal points of distance, intermediate, and near targets. The binocular defocus curve for the Galaxy IOL appears smooth, without major dips, and is elongated, retaining a visual acuity greater than 0.2 logMAR to a near point approaching ~-3.00D (corresponding to ~33 cm reading distance). This indicates a full range of vision from distance to near without distinct focal points that we often encounter with traditional diffractive trifocal IOLs.
Trade-Offs
When I am counselling patients about their IOL choices, one of the key moments is when I discuss multifocal IOLs and explain that although the positive outcome of a full range of vision sounds fantastic, it does come with a trade-off of haloes around lights at night. This can be off-putting for certain patients and is particularly disappointing for those where monovision options with other lens designs have also been deemed inappropriate. The holy grail of IOL technology remains to be a fully accommodating IOL without visual side effects. So far, the Galaxy appears to come closer to that target than other available options. At one-month post-op, Galaxy patients reported significantly lower scores for halo and glare compared to published data of diffractive trifocal IOLs at three months. I have certainly noticed from my own records, far milder dysphotopsias with Galaxy compared to other multifocal IOLs.
RayOne Galaxy halo and glare simulator at one month (n=52).
At Lisa tri (ZEISS) at three months, (n=28). Adapted from Kretz FT et al. J Refract Surg. 2015 Aug;31(8):504-10.
My Experience
The results of the multicentre data collection for the Galaxy IOL appear impressive, but I would also like to add my own personal experience and tips for people considering getting started with this lens. Although I do consult for Rayner, this is my own, honest opinion on the Galaxy IOL since my first implantation in October 2024.
I have now bilaterally treated a number of both cataract and refractive lens exchange patients. My impression is that day one visual acuity with the Galaxy is not as impressive compared to my expectations with diffractive trifocal IOLs. However, day one is all about my ego, and it is the rest of the patient’s life that really matters. Visual acuity outcomes at one month have been good and now I am seeing the same patients come back around three months and agree with the presented data that visual acuity continues to improve. I am routinely achieving unaided distance visual acuity of 6/6 or better. The range of vision achieved seems to be as good as with diffractive multifocal lenses, and the lack of dips in the defocus curve appears true as patients do not report sweet spots or problem distances, but have a smooth, complete range in focus. I have been targeting very mild predicted residual hyperopia (first plus) as a refractive aim under the advice of the Rayner calculations team. This approach enables Rayner to track post-operative outcomes and assess the necessity of constant optimisation as with all new lenses.
Calculation of IOL power can now be done using the upgraded RayTrace website. I have not had any refractive surprises requiring intervention, which is great. Implantation is very similar to working with the RayOne EMV (Enhanced Monovision) IOL where attention needs to be paid to the unfolding lens to ensure correct orientation. Rotating the IOL into place is simple, and I have found anecdotally, rotational stability to be excellent.
Most importantly from my perspective, my Galaxy patients have reported no haloes, even at night. Despite small numbers of implants, this is very promising, but also surprising, given that the presented data from the bigger multicentre cohort indicates that Galaxy patients can have very mild dysphotopsias that do not bother them. At the slit lamp you can see the surface spiral design (clearly differing from classical diffractive optics), which yet might reasonably lead some surgeons to expect a certain degree of optical side effects.
However, my patients and I are very pleased with the absence of noticeable visual disturbances.
Overall, the results of the multicentre data collection, along with my personal experience, are very positive. I am enjoying providing a full range of vision, with an extremely low side effect profile to my patients, especially those who were not suitable for other multifocal options. I am always happy to discuss cases and help with any tips, advice, or insights to ensure the best possible outcomes.
Dr Ben LaHood is a world recognised expert in cataract and refractive surgery. His research work is frequently published and presented worldwide and he is frequently invited to speak on cataract and refractive surgery topics worldwide. Dr LaHood also regularly teaches other ophthalmologists, trainee surgeons, and optometrists. Alongside fellow ophthalmologist Dr Nick Andrew, he hosts the podcast Ophthalmology Against The Rule. He is in private practice at Adelaide Eye and Laser Centre in Adelaide.
Dr LaHood consults for Rayner, however the views expressed are his own.
