Visual Outcomes with Enhanced Monofocal and Non-Diffractive Extended Depth-of-Field Intraocular Lenses

Purpose: To directly compare visual outcomes and quality of vision between an enhanced monofocal intraocular lens (IOL), a non-diffractive extended depth-of-field (EDOF) IOL, and a standard monofocal IOL. Methods: This single-center, cohort study included patients undergoing bilateral cataract surgery targeted for emmetropia. Groups were stratified by implanted IOL: RayOne EMV (enhanced monofocal), AcrySof IQ Vivity (EDOF), and RayOne Aspheric (standard monofocal control). Outcomes included monocular and binocular visual acuities at distance, intermediate (66 cm), and near (40 cm), defocus curves, contrast sensitivity, and patient-reported outcomes (PRSIQ, QoV) assessed > 3 months postoperatively. Results: Corrected distance visual acuity was comparable across groups. The Vivity group demonstrated significantly better uncorrected and distance-corrected intermediate and near acuity compared to both EMV and monofocal groups (p< 0.001). The EMV group showed significantly better intermediate acuity than the monofocal control (p< 0.05) but no difference for near vision. The binocular functional depth of field (0.2 logMAR threshold) was 1.6 D for Vivity, 1.3 D for EMV, and 1.1 D for the monofocal control. Contrast sensitivity was significantly lower in the Vivity group compared to the EMV and monofocal groups (p< 0.05). While Vivity achieved higher near-spectacle independence (31.8%), the EMV group reported significantly lower “bothersome” scores on the QoV questionnaire than both other groups. Conclusion: The Vivity IOL provided the broadest range of vision, extending efficacy into near tasks, but was associated with reduced contrast sensitivity. The RayOne EMV IOL effectively bridged the gap between standard monofocal and EDOF technologies, significantly improving intermediate vision while maintaining a monofocal-like contrast sensitivity and safety profile. Keywords: enhanced monofocal IOL, EDOF IOL, cataract, presbyopia