From left: Avni Parikh (Bausch and Lomb) with Dr Aanchal Gupta, Dr Matt Russell, Dr Rob Paul and Professor Chameen Samarawickrama.
A panel of expert ophthalmologists has explored how advanced intraocular lens (IOL) technologies are reshaping approaches to refractive lens surgery and patient satisfaction.
Presenting at a Bausch and Lomb breakfast symposium during the Royal Australian and New Zealand College of Ophthalmologists (RANZCO) Congress, the clinicians shared their early experiences with the enVista Envy lens, a full range of vision IOL that promises to address one of the most persistent challenges in premium lens implantation: dysphotopsia.
A New Approach to Multifocal Technology
Dr Aanchal Gupta, a leading cataract, refractive, and corneal surgeon, and founder of Ivision Laser in Adelaide, served as moderator for the symposium. She opened proceedings by outlining the breadth of the Bausch and Lomb intraocular lens portfolio now available to surgeons. Dr Gupta noted that the enVista platform — particularly the enVista Envy lens — offers a comprehensive refractive toolkit, enabling surgeons to individualise lens selection according, not only to refractive goals, but also to each patient’s lifestyle, visual expectations, and clinical profile.
Dr Matt Russell, founder of the OKKO Eye Specialist Centre in Brisbane, presented his initial clinical experience with the enVista Envy. He addressed the fundamental question facing many surgeons: why consider another multifocal IOL?
Normally there’s that inverse relationship between good reading and dysphotopsia profile, and that’s the beauty of this lens. You’re not seeing that
“We have a multitude of lenses to choose from and most of us have two, three, or four lenses that we use routinely,” Dr Russell explained. “It’s like our daily drive. It’s like a car we’ve used for five to ten years. We know it well. It’s comfortable. It gets us from A to B… we know how to deal with it.”
However, he noted that patient dissatisfaction with traditional multifocal implants remains a concern. Citing historical data showing dissatisfaction rates of 12 to 20% and explantation rates of around 7% in the 2000s, Dr Russell observed that even with significant improvements in trifocal technology, his practice still sees 1.5-2% of patients requiring lens exchange due to glare, haloes or poor vision quality.
Promising Early Results
Dr Russell reported that his practice integrated the enVista Envy initially into refractive lensectomy rather than cataract surgery, motivated by reports from the United States of significantly lower intensity haloes and improved night vision quality. His early data from approximately 100 implantations showed encouraging outcomes.
“We’ve got 90% of patients seeing 6/7.5 or better and 100% 6/9 or better,” he reported. “Looking at the near results, 80% were getting N5 or better and 100% N6 or better. So very, very impressive near vision results with this implant.”
Perhaps most significantly, Dr Russell noted that his team had not yet encountered any patients requiring explantation due to haloes or dysphotopsia with the enVista Envy. He attributed this to the lens design, particularly the low light scatter from what the company terms ‘ActiveSync’, where aberration transitions are smoothed to reduce visual disturbances.
“It’s now becoming our primary go-to implant for refractive lens surgery based on our initial results,” Dr Russell concluded.
Western Australian Experience
Dr Rob Paul , medical director of WA Laser Eye Centre, the first ophthalmologist in Western Australia to complete formal fellowship training in laser and refractive eye surgery, and Perth’s highest volume laser in-situ keratomileusis (LASIK) and refractive surgeon, echoed these findings. He noted that modern cataract patients have evolved significantly, with heightened expectations driven by social media, digital device dependency, and post-COVID scepticism.
Dr Paul’s study of the enVista Envy, predominantly in refractive lens exchange patients with a mean age of 59, demonstrated that nearly 89% achieved 6/7.5 or better uncorrected distance vision and 88% achieved equivalent intermediate vision. Critically, 88 to 89% achieved N5 or better near vision, with 100% achieving N6.
“That’s one of the features of this lens – the reading is very, very good,” Dr Paul observed. “Normally there’s that inverse relationship between good reading and dysphotopsia profile, and that’s the beauty of this lens. You’re not seeing that. You’re seeing good reading and minimal dysphotopsia.”
His overall satisfaction rate was 95%. Dr Paul also highlighted the improved unfolding characteristics of the enVista platform and its stability, particularly important for toric correction.
Matching Technology to Corneal Profiles
Professor Chameen Samarawickrama, head of the corneal unit at Westmead Hospital and Professor of Cornea and Cataract Surgery at the University of Sydney, broadened the discussion, addressing how surgeons can optimise outcomes by matching IOL technologies to individual patient characteristics.
“At the moment we have over 700 different lenses available from over 60 different companies,” Professor Samarawickrama noted. “For the first time in many ways we are able to provide personalised care where we can match a lens to an eye to optimise vision and sometimes even give better vision than the patient had before.”
He proposed a systematic approach based on higher-order aberrations (HOAs), using Pentacam measurements to stratify patients. For those with low HOAs (up to 0.4), he suggested that any trifocal would perform well since the corneal optics are excellent. For moderate HOAs (0.4 to 0.7), monofocal lenses become important, while high HOAs (greater than 0.7) are best managed with pinhole technology such as Bausch and Lomb’s IC-8 lens.
Finding the Advantage
The symposium concluded with a panel discussion and consensus that the enVista Envy represents a significant advancement in multifocal IOL technology, particularly for its favourable dysphotopsia profile while maintaining excellent reading vision.
Acknowledging the marked difference in patient experience with the enVista Envy compared to traditional trifocals, Dr Gupta said patients typically do not report significant haloes, even on the first postoperative day when cycloplegia effects persist.
“I’ve been trained to counsel patients about glare, haloes, dysphotopsia with all our trifocal lens use and I still do that,” she observed. “And now the Envy patients often say, ‘I don’t know what you were talking about’. So it’s been a really refreshing change.”
