Comparing IOLs Without the Need for Implantation

Spectacle independence – at near, intermediate, and far distances – is increasingly expected by patients after cataract or lens exchange surgery. However, the compromises traditionally required to achieve this level of visual acuity at all distances can be significant.

Visual side effects primarily include glare and haloes around light sources; as well as light loss that negatively affects contrast sensitivity. Dim-light conditions increase the impact of contrast sensitivity loss and bright light sources, and can result in glare and haloes, leading to difficulties in activities like nighttime driving or reading a menu in dim light. One anonymised published study of 2,500 patients across 26 countries explored the impact of dysphotopsia on patient satisfaction following cataract surgery concluding that, “dysphotopsia was a stronger determinant of patient satisfaction than spectacle independence”.¹

In the quest to find a lens that minimises dysphotopsias, while optimising for near, intermediate, and far distances, there has been an evolution of IOL designs over the past two decades: from monofocal to trifocal and extended depth of focus (EDOF) / increased range of focus (IROF) designs.

At the 2024 European Society of Cataract and Refractive Surgeons (ESCRS) Congress, Rayner launched the world’s first spiral IOL – the RayOne Galaxy, developed in partnership with Brazilian ophthalmologist Professor João Marcelo Lyra. The Galaxy IOL differs from other IOLs in that it is designed with a novel non-diffractive spiral optic using a proprietary artificial intelligence (AI) engine.

A research institute, led by Professor Michael Amon in Vienna, Austria, put the RayOne Galaxy IOL to the test, enrolling healthy individuals to use RALV to compare it with Rayner’s RayOne diffractive trifocal IOL, for monocular corrected distance visual acuity, contrast sensitivity, defocus curve, halo/glare size, and subjective preference.² Additionally, postoperative clinical outcomes were subsequently analysed from 10 sites following bilateral RayOne Galaxy IOL implantation.

How RALV Works

RALV is a brand-agnostic system that enables all IOLs (monofocal, EDOF, and multifocal – refractive and diffractive) to be evaluated for:

• Visual acuity and contrast sensitivity at near (40 cm), intermediate (74 cm), and far (4 m) distance,
• Halo/glare size,
• Defocus curve, and
• Lens preference.

The IOLs to be evaluated are mounted in IOL shuttles, which are magnetically inserted into the optical path of RALV, allowing rapid exchange for direct comparison of different IOLs.

RayOne Galaxy IOL Findings

A total of 30 participants with no coexisting ocular pathologies were selected for the preclinical study conducted by Prof Amon. Using the RALV system, they compared their vision impression with Rayner’s spiral and trifocal full range of vision (FROF) designs (Figure 1).²

Figure 1.

Cycloplegic drops were administered before the test, ensuring there was no natural accommodation of the eye during the simulations. Further, effective pupil diameter size was constricted to 3.55 mm by the RALV device.

Prof Amon reported that “mean monocular visual acuity (VA) achieved by the Galaxy IOL for distance (4 m), intermediate (74 cm), and near (40 cm) was -0.05, 0.03, and 0.07 logMAR, respectively” (Figure 2).^2,3

Figure 2

When compared to the trifocal IOL, the Galaxy IOL achieved significantly better intermediate VA (p=0.005) than the trifocal IOL, while near and distance VA remained similar (p=0.315 and p=0.993, respectively). Additionally, distance vision with the Galaxy IOL was comparable to that of the IROF IOL (p=0.14), while both intermediate and near VA were significantly improved (p≤0.001) (Figure 3).

Figure 3

It was concluded that the Galaxy IOL defocus curve “showed a full range of vision, with better VA at intermediate distances when compared to the trifocal IOL”. It also demonstrated better contrast sensitivity at distance, intermediate, and near, and haloes were significantly smaller than with the diffractive trifocal IOL (p<0.001), more closely resembling the size observed with the IROF IOL (Figure 4).^2,3

Figure 4.

Subjective lens preference testing – where subjects compared how text and/or image targets at various distances were visualised through the Galaxy IOL and the diffractive trifocal IOL – found the vast majority of subjects preferred the Galaxy IOL at distance, intermediate, and near (p≤0.001) (Figure 5). This, Rayner stated, implied “a natural and more comfortable optic to look through, compared with a diffractive trifocal IOL”.^2,3

Rayner concluded that the “preclinical findings suggested that the design innovations of the Galaxy IOL offer promising advantages in terms of visual acuity, contrast sensitivity, and patient satisfaction”.²

Commenting on the RALV device and the findings from this study, Prof Amon said, “Being able to compare real IOLs without implantation is hugely beneficial, and the results of the new Galaxy lens are quite astonishing”.²

Experience RALV at AUSCRS

The RALV system will be on display on the Rayner stand at the Australasian Society of Cataract and Refractive Surgeons’ 2026 conference on the Sunshine Coast from 15–18 July. Drop by any time to experience looking through Rayner’s Galaxy, EMV, and trifocal IOLs.

This article was sponsored by Rayner.

References

1. Botta J, Barsam A, Windsor S, et al. Factors influencing outcome satisfaction after cataract surgery: patient-reported insights from the RayPro database. BMC Ophthalmol. 2024;24(1):528. doi: 10.1186/s12886-024-03800-3.
2. Abela-Formanek C, Amon F, Saad A, et al. Redefining vision with the Galaxy IOL: A revolution in advanced technology optics. The Ophthalmologist supplement, Apr 2025.
3. Abela-Formanek C, Pre-clinical comparative study. Medical University of Vienna. Powerpoint presented at Rayner ESCRS 2024 lunchtime symposium.