CATARACT SURGERY
Finding the Middle Ground:
A Clareon® Vivity® Q&A with Dr. Paul Ernest
5 minute read
Updated September 6, 2024
Paul Ernest, MD, is a cataract surgeon and founder of Specialty Eye Institute in Jackson, Michigan, and the largest implanter of Clareon® Vivity® intraocular lenses (IOLs) in the U.S. We sat down with Dr. Ernest to learn more about his unique approach to implanting the lens and how engaging patient conversations helped him get there.
Today, Vivity® is now your go-to IOL but that wasn’t always the case. What led to your initial skepticism?
When it comes to advanced technology intraocular lenses (ATIOLs), cataract surgeons are typically conditioned to recommend a lens that provides the most near, middle and distance vision. Many often assume that visual range at all distances is what patients value the most.
Accordingly, when I first learned about Clareon® Vivity®, Alcon’s extended depth of focus (EDOF) ATIOL, I thought it wouldn’t be successful. I was concerned that some patients would require low-power readers to read small print, since 20/20 near vision is not guaranteed.1
As a result of my propensity to prioritize near vision, I mistakenly thought patients would immediately write off Vivity® as a viable option.
How has your view of Vivity® changed?
Clareon® Vivity® now accounts for 60% to 70% of all my surgeries, outpacing monofocals 3-to-1.
Why the change? I spent more time listening to my patients. 1
Sure, if you ask them when they first walk in for their appointment, they will typically say they want 20/20 near vision. But, if you dig deeper, they will usually tell you they find the most enjoyment in their day at lunch with friends, playing pickleball or golf, watercolor painting, or even using a computer to catch up with long-distance relatives. Most of these activities are in the range of 20-40 inches away.
In these cases, Clareon® Vivity®, which is designed to provide a continuous extended depth of focus, is ideal for patients looking for a broader range of vision compared to a monofocal lens.1 And, since Vivity® is non-diffractive, there are minimal disturbances like halos or dysphotopsias, which can be especially troublesome for my patients who drive at night.1
What I hear from patients after implanting Vivity® is how excited they are about this new range of vision and how much it’s improved their lifestyle. In my experience, this “qualitative” outcome resonates with them more than any quantitative measurement.
Tell us more about the response from your patients.
“with Vivity®, I know the lens can deliver the range of vision my patients want and target accordingly. In doing so, this expands visual possibilities for patients so you can match the focal point to a patient's lifestyle.”
For example, I recently had a 67-year-old woman as a patient. During our consultation, I discovered that she spends 90% of her day on activities requiring middle-to-near vision, and only a small part of her day is spent on other activities that can require distance vision, such as walking her dog, watching TV, and driving. We used Clareon® Vivity® in each eye with a –1.00D OU target, which resulted in a range of vision from –1.00D to –2.50D.
The patient was thrilled with her outcome, and ecstatic that she only needed glasses for driving. Outcomes like this are why I’m so passionate about Clareon® Vivity®—it can help patients who feel they are past their prime see with the vision of someone younger.1,2
Are monovision patients candidates for Vivity®?
If a cataract patient is used to monovision—perhaps because they are already using contact lenses for this purpose—then Vivity® is the ideal IOL. Traditional monovision with a monofocal lens dedicates one eye to distance vision and the other to near vision. The downside is that neither eye has the important mid-range that patients routinely desire.
Vivity® gives an extended depth of focus so that both the distance eye and the near eye have mid-range vision.1 This also eliminates the disparity between the eyes that traditional monovision gives. In other words, it’s monovision with greater depth of focus in mid-range.1,3
What about post-Lasik patients?
Vivity® delivers a high level of satisfaction to post-Lasik patients, typically delivering 20/20 distance, 20/20 intermediate and 20/30 near vision.4,**,†
For my post-Lasik patients who qualify for an ATIOL, Vivity® is my go-to lens because it is already designed to “self-correct” and stretches light to provide a built-in 1.5D of range.1
In your opinion, what should surgeons do to help ensure success when implanting Clareon® Vivity®?
Making sure you have the proper patient for the procedure is crucial. While diagnostics are critical to this, I’ve also found that engaging your patients in conversations about what they are looking for with their new vision can be just as important.
That’s what led me to Clareon® Vivity® in the first place—by really listening to my patients and matching them with the best lens for their lifestyle.
IMPORTANT PRODUCT INFORMATION: CLAREON® FAMILY OF IOLS
Caution: Federal law restricts these devices to sale by or on the order of a physician.
Indication: The family of Clareon® intraocular lenses (IOLs) includes the Clareon® Aspheric Hydrophobic Acrylic and Clareon® Aspheric Toric IOLs, the Clareon® PanOptix® Trifocal Hydrophobic IOL, Clareon® PanOptix® Toric, Clareon® Vivity® Extended Vision Hydrophobic Posterior Chamber IOL and Clareon® Vivity® Toric IOLs. Each of these IOLs is indicated for visual correction of aphakia in adult patients following cataract surgery. In addition, the Clareon® Toric IOLs are indicated to correct pre-existing corneal astigmatism at the time of cataract surgery. The Clareon® PanOptix® lens mitigates the effects of presbyopia by providing improved intermediate and near visual acuity, while maintaining comparable distance visual acuity with a reduced need for eyeglasses, compared to a monofocal IOL. The Clareon® Vivity® lens mitigates the effects of presbyopia by providing an extended depth of focus. Compared to an aspheric monofocal IOL, the lens provides improved intermediate and near visual acuity, while maintaining comparable distance visual acuity. All of these IOLs are intended for placement in the capsular bag.
WARNINGS/PRECAUTIONS:
General cautions for all Clareon® IOLs:
Careful preoperative evaluation and sound clinical judgment should be used by the surgeon to decide the risk/benefit ratio before implanting any IOL in a patient with any of the conditions described in the Directions for Use that accompany each IOL. Physicians should target emmetropia, and ensure that IOL centration is achieved.
For the Clareon® Vivity® IOL, most patients implanted with the Vivity® IOL are likely to experience significant loss of contrast sensitivity as compared to a monofocal IOL. Therefore, it is essential that prospective patients be fully informed of this risk before giving their consent for implantation of the Clareon® Vivity® IOL. In addition, patients should be warned that they will need to exercise caution when engaging in activities that require good vision in dimly lit environments, such as driving at night or in poor visibility conditions, especially in the presence of oncoming traffic. It is possible to experience very bothersome visual disturbances, significant enough that the patient could request explant of the IOL. In the parent AcrySof® IQ Vivity® IOL clinical study, 1% to 2% of AcrySof® IQ Vivity® IOL patients reported very bothersome starbursts, halos, blurred vision, or dark area visual disturbances; however, no explants were reported.
Prior to surgery, physicians should provide prospective patients with a copy of the Patient Information Brochure available from Alcon informing them of possible risks and benefits associated with these IOLs.
ATTENTION: Reference the Directions for Use labeling for each IOL for a complete listing of indications, warnings and precautions.
* Vivity® IOL and 113 with the AcrySof® IQ IOL with 6 months follow-up.
** Based on a IOLSAT questionnaire at 3 months (n=20 patients).
† Based on a study of 50 eyes with previous LASIK (25 patients, age, 46-70 years) at 3-month follow-up. The safety and effectiveness of this IOL have not been studied in patients with certain pre-existing conditions (e.g. previous refractive surgery) in the registration clinical studies.
References
- Clareon Vivity Directions for Use
- 2023 Global Alcon Cataract Survey
- Clareon Monofocal Directions for Use
- Alcon data on file. IIT#61877353 Summary, Vivity performance in patients after corneal refractive surgery. April 16, 2024.
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