Real-World Excellence with Clareon IOL Platform

Dr Ben LaHood from Adelaide Eye and Laser Centre, Dr Justin Sherwin from the Peninsula Eye Centre in Melbourne, and Professor Chee Soon Phaik from Duke-NUS Medical School in Singapore, were speaking at a Royal Australian and New Zealand College of Ophthalmologists (RANZCO) breakfast meeting hosted by Alcon.

Rotational Stability

Dr LaHood opened the session by presenting real-world data on the Clareon monofocal toric platform, explaining that while “everyone makes a good monofocal,” the key differentiator lies in consistent, superior outcomes.

His recently published study examined 161 consecutive cases with meticulous follow-up at one day, one week, and one month postoperatively. The results demonstrated exceptional rotational stability, with a mean rotation of just 1.02 degrees between implantation and one month – effectively keeping the lens exactly where positioned.¹

“The big highlight of this paper is just over one degree of rotation between putting it in and a month,” Dr LaHood explained. “We didn’t have any eyes where the IOL rotated more than four degrees.”

The study revealed distance unaided visual acuity very close to zero logMAR (6/6), with surprisingly good intermediate vision as a bonus – comparable to monofocal plus technologies without compromising the optical profile.¹ Surgically induced astigmatism (SIA) remained minimal, attributed partly to the AutonoMe injector system that comes with Clareon products.

Dr LaHood’s optical coherence tomography (OCT) analysis demonstrated minimal corneal wound disruption with the AutonoMe injector, translating to tighter data clustering and reduced surgical astigmatism – critical for achieving those incremental gains in outcomes.¹

Describing the Clareon monofocal toric IOL as his “go-to lens”, Dr LaHood concluded, “I think these days you could even think about using it preferentially for a monofocal plus”.

Optimising Vivity for Diverse Populations

Dr Sherwin shifted focus to the Clareon Vivity platform, an extended depth of focus (EDOF) lens he has been implanting for over five years. His presentation explored strategies for optimising Vivity utilisation across varied patient populations, including those with ocular comorbidities.

Dr Sherwin presented evidence from systematic reviews showing Vivity delivers across all key metrics: excellent distance and intermediate acuity, functional near vision, and a dysphotopsia profile very consistent with monofocal lenses, resulting in high patient satisfaction rates.^2-4

Addressing the common concern about using premium IOLs in glaucoma patients, Dr Sherwin cited systematic review data demonstrating high spectacle independence with Vivity, with no significant loss of contrast sensitivity at far distance except in advanced disease cases.^5-7 “Unless glaucoma is at the severe end of the spectrum, contrast sensitivity is actually maintained really well,” he observed.

However, age-related macular degeneration requires more careful consideration given its progressive nature.^8,9 Patients with mild, asymptomatic pathology that is unlikely to reduce best-corrected acuity, can be suitable candidates.

He highlighted an emerging paradigm shift in refractive targeting.^10,11 “We’re increasingly recognising the benefits of having a different postoperative refractive target than may have been performed traditionally,” he explained. He recommended aiming for as close to plano as possible in the dominant eye, or even slight hyperopia, with micro-monovision strategies in the non-dominant eye for additional near improvement.

Real-World Registry Data Supports Broad Utility

Professor Chee presented data from the Vivity Outcomes IQ Registry, a multicentre, prospective study capturing real-world visual performance across 885 patients in eight countries, including Australia and New Zealand.¹²

The registry included patients with significant comorbidities – toric lenses for astigmatism, age-related macular degeneration, glaucoma, and previous refractive surgery patients. Mean uncorrected distance visual acuity reached 6/6, intermediate vision at 66 cm exceeded 6/7.5, and functional near vision achieved 6/9 at 40 cm.*¹²

Spectacle independence rates proved impressive: over ~90% required no correction for distance, ~80% for intermediate, and ~50% for near tasks.^{^12} Equally important, dysphotopsia rates remained minimal – ~92% reported no haloes, ~92% no glare, and ~95% no starburst. ^†13

Professor Chee analysed various subgroups, finding glaucoma patients performed well with good vision across distances and no issues with the blue-filtering lens despite theoretical contrast sensitivity concerns. She highlighted the importance of ocular surface optimisation both pre- and postoperatively.¹⁴

“I keep my patients on artificial tears for at least six months,” Professor Chee advised, “because cataract surgery increases dry eye when we cut through the corneal nerve, and recovery takes approximately six months”.

For her practice serving a predominantly myopic population in Singapore, Professor Chee routinely employs mini-monovision, targeting slight myopia (around -0.25D) in the dominant eye and -0.5D to -1.25D in the fellow eye for patients wanting enhanced near vision, without significantly compromising distance acuity.

Material Advantages

All three speakers highlighted the Clareon platform’s material advantages: glistening-free technology, rotational stability, faster unfolding speed, and reduced light scatter compared to predecessor materials. ^‡1,15,16

Professor Chee particularly valued the visible central optical centre facilitating centration on the visual axis, and the material’s tackiness, which enables surgical flexibility in complex cases, including partial lens dislocation scenarios.

– When reviewing the Vivity® results, Professor Chee presented bench testing data suggesting Vivity® maintains superior intermediate vision performance versus monofocal IOL, and demonstrates minimal pupil dependency – making it more predictable across varying pupil sizes.

Concluding, Dr Sherwin said, “We’re fortunate in today’s age to have an excellent range of intraocular lenses that we can tailor and match to our patients”. The surgeons agreed that the Clareon Vivity delivers remarkable flexibility across a wide variety of clinical scenarios, offering functional vision improvement while maintaining a favourable safety profile comparable to monofocal lenses.

References

1. LaHood B, Peterson R C. Real-World Visual Outcomes and Rotational Stability of a Monofocal Toric Intraocular Lens. Clinical Ophthalmology. 2025: 2945-2953, doi: 10.2147/OPTH.S532933
2. Werner L, Thatthamla I, Teus MA, et al. Evaluation of clarity characteristics in a new hydrophobic acrylic IOL in comparison to commercially available IOLs. J Cataract Refract Surg. 2019 Oct;45(10):1490-1497. doi: 10.1016/j.jcrs.2019.05.017.
3. Bala C, Poyales F, Lemp-Hull J, et al. Multicountry clinical outcomes of a new nondiffractive presbyopia-correcting IOL. J Cataract Refract Surg. 2022 Feb 1;48(2):136-143. doi: 10.1097/j.jcrs.0000000000000712.
4. Alcon Data on File, 2019: A Prospective, Randomized, Controlled, Multi-Center Clinical Study of the Acryssof®IQ Extended Depth of Focus (EDF) IOL
5. Wilensky JT, Hawkins A. Comparison of contrast sensitivity, visual acuity, and Humphrey visual field testing in patients with glaucoma. Trans Am Ophthalmol Soc. 2001;99:213-7; discussion 217-8. PMID: 11797309.
6. Hong ASY, Ang BCH, Dorairaj E, Dorairaj S. Premium intraocular lenses in glaucoma – A systematic review. Bioengineering (Basel). 2023 Aug 22;10(9):993. doi: 10.3390/bioengineering10090993.
7. Alcon Data on File, 2023: Clinical Investigational Report for ILE871-P001 Vivity Registry.
8. Thananjeyan AL, Siu A, Jennings A, Bala C. Extended depth-of-focus intraocular lens implantation in patients with age-related macular degeneration: A Pilot Study. Clin Ophthalmol. 2024 Feb 13;18:451-458. doi: 10.2147/OPTH.S442931.
9. Jeon S, Choi A, Kwon H. Clinical outcomes after implantation of extended depth-of-focus AcrySof Vivity intraocular lens in eyes with low-grade epiretinal membrane. Graefes Arch Clin Exp Ophthalmol. 2022 Dec;260(12):3883-3888. doi: 10.1007/s00417-022-05751-1.
10. Schallhorn SC, Hettinger KA, Schallhorn JM, et al. Effect of residual sphere on uncorrected visual acuity and satisfaction in patients with monofocal and multifocal intraocular lenses. J Cataract Refract Surg. 2024 Jun 1;50(6):591-598. doi: 10.1097/j.jcrs.0000000000001418.
11. Wanten JC, Bauer NJC, Nuijts RMMA, et al. Dissatisfaction after implantation of EDOF intraocular lenses. J Cataract Refract Surg. 2025 May 1;51(5):399-405. doi: 10.1097/j.jcrs.0000000000001615.
12. Howes F, et al. Vivity registry outcomes. J Refract Surg. 2025;41(2):e131. doi:10.3928/1081597X-20241230-01
13. Alcon data on file, 2021. Ref-15398
14. Alcon data on file, 2023. Ref-20681
15. Oshika T, Fujita Y, Inamura M, Miyata K. Mid-term and long-term clinical assessments of a new 1-piece hydrophobic acrylic IOL with hydroxyethyl meth-acrylate. J Cataract Refract Surg. 2020 May;46(5):682-687.
16. Maxwell A, Suryakumar R. Longterm effectiveness and safety of a three-piece acrylic hydrophobic intraocular lens modified with hydroxyethyl-methacrylate: an openlabel, 3-year follow-up study. Clin Ophthalmol. 2018;12:2031-2037.
17. Berdahl JP, Grosinger L, Reed O. Visual Performance of a Novel Wavefront Shaping Extended Depth-of-Focus Intraocular Lens on a New Hydrophobic Acrylic Platform. J Cataract Refract Surg. 2025 Jul 21
18. Corbett D, et al. Quality of vision with a new fully refractive EDOF IOL. Eye. 2024. doi:10.1038/s41433-024-03039-8.
19. Niknahad A, et al. Evaluation of Clareon Vivity and PureSee intraocular lenses: optical quality, depth of focus and misalignment effects. Sci Rep. 2025 Jul 24;15(1):26943

*Snellen VA was converted from logMAR VA. A Snellen notation of 20/20 or better indicates a logMAR VA of 0.04 or better, which means three or more of the five ETDRS chart letters in the line were identified correctly. ETDRS, Early Treatment Diabetic Retinopathy Study; logMAR, logarithm of the minimum angle of resolution. Assessed by Catquest-9SF

^IOLSAT questionnaire, in bright conditions, 6 months post-implantation

†The intensity of various visual disturbances (halos, glare, or starburst) was reported as “none” to “severe.”

‡ Defined as Modified Miyata grade 0, <25mv/mm2 over 3 years (n=138), and over 9 years (n=20), respectively.

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