Vivity™: The Lens for Active Patients

I work in a busy general ophthalmology practice where the main activities are cataract surgery and refractive lens surgery. We conduct approximately 10 to 15 thousand consultations and perform on up to 2,000 IOL procedures per year.

I’ve been working with the AcrySof® IQ Vivity™ lenses from Alcon for over two years now, and they have quickly become the most popular advanced technology IOL in my practice. Most patients coming into my office are very active outdoors, through skiing, golfing, hunting or other activities; they don’t want to sacrifice night vision or distance vision, but they can accept having to use glasses for close up reading – and this is what makes Vivity™ so successful among them.

One other reason for the success of this IOL in my practice is how we prepare the patient before they decide on the lens. We have a very structured interview ahead of surgery and we conduct all the examinations, but then we also go through patients’ professional needs, leisure activity needs, and their motivation for the surgery. We ask if they only came across this option last week or if it is something that they have thought about for a long time. I have found that there is a correlation between how prepared the patient is ahead of surgery, and their satisfaction afterwards, so we try to have as much knowledge of the patient’s needs as we can ahead of making the final decision.

One of the most talked about issues that patients experience following EDoF and multifocal IOLs surgery is dysphotopsia. In my experience, it is a common optical side effect of implanting the lens, but I wouldn’t say that it’s disturbing for all patients. In general, I have noticed that if the potential halo or sunburst effect is described to the patient ahead of surgery, then are usually happy afterwards. A very small minority of patients see these photic phenomena as an optical difficulty for them. Compared with other lenses with diffractive optical designs, I have found that with Vivity™ I don’t have to spend much time explaining halo and glare, which shortens the pre-operative conversation I have with my patients.

Barriers to entry
 

There are, of course, medical contraindications to using the IOL, such as concurrent ocular disease, but mostly, it’s the patient’s personal attitude that will always be the most significant hurdle. If the patient starts asking for guarantees, is very petty on details, has a history of conflicts in their personal life, you as the surgeon have to take it all into consideration when deciding on the procedure. It can be taken for granted that every interested surgeon examines their patient thoroughly from a clinical point of view, with good documentation on their visual acuity, but how you deal with the patient’s mental state and their motivation is probably one of the most important factors that contribute to the surgery’s success or failure.

Real World Data
 

My team set out to collect real-world evidence on how the Vivity™ lens was performing at a long distance, intermediate, and up close. We examined a number of subjects, made a very thorough defocus curve and collected data on the optical performance, combining both qualitative and quantitative measurements (1). Overall, we found – in accordance with other similar studies – that this lens really performs well, with excellent visual acuity at distance and intermediate ranges, and a fairly good optical performance up close.

Vivity™ gives us the option of playing with mini-monovision and even extending it, resulting in a wide range of optical performance. Based on the first paper we published (1), we created a simulation, starting out with a defocus curve report for emmetropic eyes, and then adding in 0.5 D myopia in the non- dominant eye, and 1.0 in the dominant eye during another set of defocus curve – thereby studying how the optical range changed with increasing myopia in the non- dominant eye (2). Interestingly, we ended up with an optical range above 3.0 D, which is more than enough to have a full range of optical performance.

Based on what we saw in the emmetropic stages, our positive study results did not come as a big surprise, but it’s great that our initial observations were confirmed by objective data. Of course, both positive and negative findings are important to surgeons, as the only way to really get to know the lens is to objectively document post-operative results.

Having used Vivity™ for over two years now, I have found that our real-world results are exactly what was expected from testing, and the lens really lives up to those expectations in real life. I can attest that this lens really delivers a close-to-full-range optical performance, with very few and mild optical side effects.

Patient satisfaction
 

My patients don’t care much for lens labels, but they have to trust me as their surgeon to choose the best option for them, and – in general – they are very satisfied post- op. To achieve this result, there are two things that I address: one is obvious – hitting the refractive target, and the other is controlling the patient’s ocular surface. If there is any sign of dry eye or other ocular surface issues, the optical quality and satisfaction is very likely to do down, and risk of infection increases. 

In all cases, we document the patient’s ocular status ahead of surgery and we pre-treat them, but if people forget about this after surgery, they don’t use the necessary drugs to look after their ocular surface, and they end up unhappy. We ask our patients whether they have used the prescribed ocular surface medications, and in upwards of around 10 to 15 percent of the cases they don’t, which highlights the importance of reminding patients about looking after their ocular surface to make sure the procedure is a success.

The surgeon’s perspective
 

I would say that, compared with trifocal lenses, getting familiar with Vivity™ is much easier and quicker. It is important to address the issue of astigmatism, as with more than 0.75, patient satisfaction is likely to be diminished.

I think the easiest way to get started with Vivity™ is to begin with the subgroup of patients that is easiest to satisfy. That group includes straightforward hyperoptic patients over 50, at +2.0-3.0 D, who are completely dependent on glasses for distance, intermediate, and near. These patients will really benefit from this lens, especially for distance and intermediate ranges, but will also experience that close visual capabilities are improved. This group represents probably the lowest hanging fruit for surgeons starting with Vivity™. When they’re familiar with the lens, they can expand its use to emmetropic patients, high myopes, and probably the “worst to satisfy” group, which includes the -2.0-3.0 D mild myopic patients, who are used to seeing brilliantly up close.

Surgeons should always remember to respect the patient’s needs and perform a structured interview to collect that data ahead of surgery. This is not only to show what the patient wants; it also educates them, and ultimately manages their expectations. For surgeons new to this procedure, this also serves as their education – to properly understand their patients’ needs. I recommend using specific prompts for patient’s reported outcomes and experience as they provide a structured way of collecting data after surgery, which can really help improve surgical skills to the benefit of future patients.

Please refer to relevant product direction for use for list of indications, contraindications, and warnings (3).Opinion based on Surgeon’s experience. Kjell Gunnar Gundersen is a paid consultant of Alcon.