EDOF implant: continuous vision without night halos

What is an EDOF implant?

EDOF — for Extended Depth of Focus — refers to a family of intraocular implants whose optics stretch the zone of sharpness rather than creating several distinct focal points. This approach differs from the two main existing families:

• Monofocal implant: sharp vision at a single distance (most often far), with glasses needed for reading.
• Diffractive multifocal implant (bifocal or trifocal): two or three focal points of sharpness (far, intermediate, near), at the cost of halos and night glare in a non-negligible proportion of patients.
• EDOF implant: a continuous range of vision from far to intermediate, with appreciably fewer halos than conventional diffractive multifocals.

In practical terms, an EDOF implant allows patients to regain comfortable vision for driving (including at night in most cases), screen work and most everyday activities. Reading small print may require backup glasses. The target group is therefore the active patient aged 55 to 70 for whom night driving and prolonged screen use matter.

The EDOF implants used in my practice

Three EDOF implant models are used depending on the patient’s profile and biometric results: Vivity, TECNIS PureSee and LuxSmart. All are implanted at the Clinique Sainte-Geneviève (Paris 14), the surgical facility where I carry out all of my cataract procedures.

Vivity (Alcon) — non-diffractive EDOF using wavefront-shaping

Vivity uses a proprietary technology known as wavefront-shaping (X-WAVE™): a central micro-elevation of the optical profile (less than one micrometre) stretches the focal point to broaden the depth of field, without diffractive segmentation. This strongly limits night halos and glare, with a profile very close to that of a standard monofocal implant.

Jeon et al. (Graefes Arch Clin Exp Ophthalmol, 2022) showed that Vivity gives satisfactory visual results even in the presence of a low-grade epiretinal membrane, which broadens its indication to patients who would not have been candidates for a conventional diffractive multifocal. Arrigo et al. (Graefes Arch Clin Exp Ophthalmol, 2021), in a real-world study on a heterogeneous cohort, confirm the favourable profile in terms of dysphotopsia and patient satisfaction.

Limitations to be aware of: near vision remains moderate — reading small print often requires backup glasses. Vivity is suited to patients who accept the trade-off “no halos, but reading glasses”.

TECNIS PureSee (Johnson & Johnson) — continuous refractive EDOF

TECNIS PureSee, marketed by Johnson & Johnson Vision, is a latest-generation refractive EDOF implant. Its continuous optics, with no diffractive rings, restore an extended range of vision from far to intermediate, with a halo profile very close to that of a monofocal implant.

Alfonso-Bartolozzi et al. (J Refract Surg, 2025) report favourable optical and visual outcomes in implanted patients in a prospective study, with high far and intermediate visual acuity and a low level of dysphotopsia. This profile makes it a particularly suitable option for patients sensitive to night-time light artefacts — regular drivers, screen workers, professions exposed to point light sources.

Limitations similar to Vivity: fine near vision remains the weak point of current EDOF lenses. Light glasses for prolonged reading are common.

LuxSmart (Bausch + Lomb) — non-diffractive EDOF using spherical aberrations

LuxSmart relies on Pure Refractive Optics (PRO) technology: a 2 mm centre combining 4th- and 6th-order spherical aberrations of opposite signs to create an extended depth of field, surrounded by a transition zone and then a monofocal periphery. The whole surface is purely refractive — no diffractive rings — which limits dysphotopsic phenomena.

A comparative analysis published in 2024 (Transl Vis Sci Technol) assessed the functional design of LuxSmart against Vivity: the two lenses, although based on different optical mechanisms (wavefront-shaping for Vivity, combined spherical aberrations for LuxSmart), offer comparable extended depth-of-field profiles. LuxSmart is often offered to patients seeking a monofocal-plus profile with good refractive stability and a hydrophobic platform.

Limitations: like other non-diffractive EDOF lenses, fine near vision remains moderate; optical performance is sensitive to pupil size.

The other EDOF implants available in France

Other EDOF implants are present on the European market, with a variety of optical technologies. They are not used systematically in my practice, either out of preference for the three models above or because of their availability at the surgical facility.

Mini WELL Ready (SIFI Medtech) — non-diffractive EDOF

An Italian progressive implant with aspheric optics divided into three concentric zones, with spherical aberrations of opposite signs in the central and middle zones and a monofocal periphery. Marketed in Europe for several years, it aims for an extended depth of field with few photic phenomena, depending in particular on pupil size.

TECNIS Symfony (Johnson & Johnson) and AT LARA 829MP (Zeiss) — diffractive EDOF

TECNIS Symfony, launched in 2014, is the first EDOF implant with a diffractive echelette. It extends the depth of field through a diffractive grating combined with chromatic aberration correction. The AT LARA 829MP (Zeiss), CE-marked in 2017, relies on a diffractive technology called Light Bridge with a Smooth Microphase (SMP) profile designed to reduce light scatter and visual side effects.

These two implants remain historical references. Diffractive EDOF lenses induce a slight increase in photic phenomena (fine halos around point light sources) compared with the latest-generation non-diffractive EDOF lenses — which partly explains the market shift towards the Vivity, PureSee and LuxSmart models.

EDOF or “enhanced monofocal”? An important distinction

Several implants marketed in recent years are sometimes presented as “EDOF” in manufacturers’ communications, whereas the scientific literature classifies them more precisely as enhanced monofocals (or mono-EDOF). This is notably the case for the TECNIS Eyhance (Johnson & Johnson), the Isopure 123 (BVI PhysIOL) and the RayOne EMV (Rayner).

The distinction is technical: enhanced monofocals apply minor modifications to the monofocal profile (adjusted spherical aberrations, accentuated central curvature) to extend intermediate vision moderately, without reaching the official criteria of an EDOF as defined by the ANSI standard (an increase of at least 0.5 dioptre at 0.2 logMAR of visual acuity). They form an intermediate category between the standard monofocal and the EDOF, useful for certain patient profiles but different from a true EDOF in terms of the breadth of the focal range.

This clarification does not disqualify these implants — each has its indications — but it avoids the frequent confusion in consultation when a patient arrives with the “EDOF” label whereas the model under consideration is in fact an enhanced monofocal.

How I choose between Vivity, PureSee and LuxSmart

The choice between the three EDOF implants used in my practice is made during the preoperative consultation, after analysing several clinical and technical parameters:

• Optical biometry (IOLMaster 700): precise measurements of axial length, corneal curvatures and anterior chamber depth.
• Corneal astigmatism: from 0.75 to 1 dioptre, a toric version of the implant may be offered to correct both the cataract and the astigmatism simultaneously.
• Corneal topography: looking for irregularities or subclinical keratoconus that would contraindicate certain implants.
• Mesopic pupil size: some non-diffractive EDOF implants are sensitive to pupil diameter, which influences the choice.
• Lifestyle: frequent night driving, screen work, leisure activities demanding intermediate vision.
• Macular status (OCT): progressive AMD or significant macular disease generally points towards a monofocal rather than an EDOF implant.
• Availability at the Clinique Sainte-Geneviève surgical facility on the day of the procedure.

The three implants are offered according to the individual profile, without any a priori bias. Each model relies on a different optical technology — wavefront-shaping for Vivity, continuous refractive for PureSee, combined spherical aberrations for LuxSmart — and may suit certain clinical profiles better than others. The final decision is made in discussion with the patient, after explaining the benefits and limitations of each option.

Who is eligible for an EDOF implant?

The EDOF implant is mainly intended for patients operated on for an established cataract, or for those considering refractive clear lens surgery (RLE, Refractive Lens Exchange) to correct presbyopia and hyperopia together. The indications rest on a complete preoperative assessment.

Main contraindications:

• Progressive age-related macular degeneration (AMD)
• Unstabilised or advanced glaucoma
• Significant macular disease (oedema, advanced epiretinal membrane)
• Irregular cornea, extensive corneal scarring, progressive keratoconus
• Severe, uncontrolled dry eye syndrome
• Unrealistic visual expectations (seeking complete spectacle independence at all distances — in which case a trifocal multifocal is more suitable, with its trade-offs on halos)

Expected results and honest limitations

Recent comparative studies confirm the positioning of EDOF lenses. Asena et al. (J Cataract Refract Surg, 2023) compare a non-diffractive EDOF implant with a trifocal implant: EDOF patients report higher night vision quality and fewer halos, while the trifocal offers better unaided near vision. The choice is therefore a trade-off: near spectacle independence versus night-time comfort.

In practice, a majority of EDOF patients do without glasses for driving, leisure activities and screen work. For prolonged reading of small print (books, leaflets, handheld screens), light reading glasses (around +1.00 to +1.50 dioptre) are frequently used.

The neuroadaptive adjustment period is generally 2 to 4 weeks. Some patients perceive slight “ghosting” or transient irregularities during the first week, which fade quickly.

Care pathway

The evaluation consultation takes place at the Cachan practice (94), at 01 45 47 08 11 or directly on Doctolib. It includes a complete ophthalmological examination, IOLMaster 700 biometry, corneal topography and a macular OCT to confirm eligibility. The detailed preoperative assessment is set out on the Cataract preoperative assessment page.

The procedure is carried out at the Clinique Sainte-Geneviève (Paris 14), as a day case, under topical anaesthesia, whichever EDOF implant is chosen (Vivity, TECNIS PureSee or LuxSmart). The procedure lasts 15 to 20 minutes per eye; both eyes are generally operated on 2 to 4 weeks apart to secure recovery. Post-operative follow-up includes a check at day 1, then at 1 week, 1 month and 3 months.

For the complete cataract surgery pathway, see the pillar page.

EDOF implant pricing

The cataract surgical procedure is fully covered by the French national health insurance (Assurance Maladie) and complementary insurance (mutuelle) once the indication is medically justified. The standard monofocal implant is also covered. Premium implants (EDOF, multifocal, toric) carry an additional fee that is not reimbursed by the social security system, the amount of which varies according to the model and version chosen (standard or toric).

Many complementary insurers offer a “premium implant” package that covers all or part of this surcharge. A detailed quote is provided after the preoperative assessment. The full breakdown of pricing, reimbursement terms and insurance packages is set out on the dedicated page: Cataract pricing.

Frequently asked questions

Sources

1. Jeon S, Choi A, Kwon H, et al. 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;260(12):3883-3888. PMID: 35796821
2. Arrigo A, Gambaro G, Fasce F, Aragona E, Figini I, Bandello F. Extended depth-of-focus (EDOF) AcrySof® IQ Vivity® intraocular lens implant: a real-life experience. Graefes Arch Clin Exp Ophthalmol. 2021;259(9):2717-2722. PMID: 34050809
3. Alfonso-Bartolozzi B, Martinez-Alberquilla I, Fernández-Vega-Cueto L, et al. Optical and Visual Outcomes of a New Refractive Extended Depth of Focus Intraocular Lens. J Refract Surg. 2025;41(4):e333-e341. PMID: 40197065
4. Asena L, Kırcı Dogan İ, Oto S, Dursun Altınors D. Comparison of visual performance and quality of life with a new nondiffractive EDOF intraocular lens and a trifocal intraocular lens. J Cataract Refract Surg. 2023;49(5):504-511. PMID: 36700928
5. Berger T, Stahl M, Daas L, et al. Functional Design Analysis of Two Current Extended-Depth-of-Focus Intraocular Lenses (Vivity / LuxSmart comparison). Transl Vis Sci Technol. 2024. PMC11343009

This article is for informational purposes. A personalised ophthalmological opinion remains essential for any treatment decision.