Cataract surgeons have more intraocular lens (IOL) options than ever for patients who want good distance vision without completely giving up the intermediate range needed for computers, tablets, and other everyday tasks.
Enhanced monofocal IOLs are intended to help fill that space.
Now, a new multicenter study offers a look at how two of those lenses performed outside a prospective clinical study and in routine cataract practice.
Give me some background first.
Traditional monofocal IOLs generally prioritize a single focal point—typically distance. Enhanced monofocal lenses, meanwhile, are designed to broaden depth of focus (DOF) toward intermediate vision while retaining a visual profile closer to a conventional monofocal.
Enter in: Bausch + Lomb’s enVista Aspire and enVista Aspire Toric IOLs, which made their U.S. debut to the U.S. commercial market in 2023.
These are designed to use an optical modification of the posterior aspheric surface that creates a small continuous increase in IOL power within the central 1.5-mm diameter.
And we've seen promising clinical data before.
I’m listening …
In a previous prospective observational study, 29 eyes implanted with the enVista Aspire achieved a mean corrected distance visual acuity (CDVA) of 20/20 while also demonstrating useful intermediate and near vision.
The defocus curve indicated approximately 1.50 diopter (D) of continuous DOF at 0.2 logMAR or better.
- Related: See here for our coverage on this.
But one unanswered question remained: How do those results translate into everyday clinical practice?
Which brings us to this real-world study?
Indeed. Researchers conducted a multicenter, retrospective real-world case series involving six U.S. cataract surgeons.
Each surgeon supplied a convenience sample of at least five cases involving implantation of enVista Aspire or enVista Aspire Toric and completed a retrospective survey about their experience with the lenses.
The analysis captured CDVA and uncorrected distance visual acuity (UDVA), uncorrected intermediate visual acuity (UIVA), refractive outcomes, and safety.
So who were the patients included in this evaluation?
The final analysis included 84 patients (ages 62 to 84) and 141 eyes:
- 88 eyes received enVista Aspire.
- 53 eyes received enVista Aspire Toric
The surgeries included in the analysis were performed between October 2023 and December 2024.
What else?
Nine additional eyes with a planned myopic target of −0.50 D or lower were excluded so the analysis could focus on eyes targeted for emmetropia.
And take note: Unlike a tightly controlled prospective trial, the investigators did not impose additional prespecified patient-level inclusion or exclusion criteria. The intent was to capture the lenses’ performance in routine clinical practice.
And how did they perform?
Distance vision was strong with both lenses.
At the last available postoperative visit, 97.2% of enVista Aspire eyes and 94.9% of enVista Aspire Toric eyes achieved monocular CDVA of 20/25 or better.
For UCDVA:
- 71.3% of enVista Aspire eyes achieved 20/25 or better.
- 84.9% of enVista Aspire Toric eyes achieved 20/25 or better
However, the intermediate results are particularly relevant to the lens design.
Tell me.
Monocular UIVA of 20/32 or better was achieved by:
- 76.6% of enVista Aspire eyes
- 93% of enVista Aspire Toric eyes
Binocularly: Every patient with available data in both groups achieved UIVA of 20/32 or better.
What about refractive outcomes and safety?
The refractive outcomes also landed close to target.
Mean postoperative spherical equivalent was −0.06 ± 0.30 D with enVista Aspire and 0.00 ± 0.32 D with enVista Aspire Toric.
For the toric group: The mean absolute residual refractive cylinder was 0.31 ± 0.28 D, suggesting effective astigmatic correction in the available real-world cases.
Safety findings were similarly reassuring, although they should be interpreted within the limitations of retrospective chart review.
No serious adverse events were documented in the available records. The researchers also reported no glistenings—although glistenings weren't a prespecified assessment and would only have been captured if clinicians documented them spontaneously.
Gotcha. Let’s circle back to those limitations you mentioned.
There were several.
First, this was a retrospective convenience sample with no control or comparator group. There was also no requirement that surgeons submit consecutive cases, opening the possibility of selection bias.
Follow-up wasn't standardized either. Among eyes with available information, the last postoperative assessment ranged from roughly days 1 to 6 after surgery through 4 months, and follow-up timing was missing for a substantial number of cases.
Clinical testing procedures also weren't standardized across centers, missing data weren't imputed, and the researchers didn't adjust for potential confounding.
And what did the researchers have to say about this?
Lead author Eric Donnenfeld, MD, noted that the findings help fill a gap between previous clinical research and what surgeons are seeing in practice.
- “The results of clinical studies involving enVista Aspire lenses have been clear, but real-world data has thus far been limited,” he stated.
According to Donnenfeld, the outcomes mirror his own clinical experience and provide additional evidence that the lens's intermediate-optimized optic is producing its intended effect in routine practice.
Anything else from the surgeons themselves?
The researchers also surveyed the six participating surgeons about their experiences with the lenses.
Satisfaction was high. Five of six surgeons rated their overall satisfaction with enVista Aspire at 9 or 10 on a 10-point scale. All five surgeons who had implanted enVista Aspire Toric gave its overall performance a 9 or 10.
Meanwhile, median satisfaction scores for lens qualities and outcomes were 10/10 for both lenses—and all participating surgeons said they would recommend the IOLs in appropriate clinical situations.
An important disclosure is also worth keeping in mind: The study was funded by Bausch + Lomb, which contributed to study design, data interpretation and manuscript review.
- Plus, all six study authors also disclosed consulting or other financial relationships with Bausch + Lomb.
Take home.
The significance of this study isn't that it establishes enVista Aspire's intermediate performance for the first time, as previous prospective research had already shown strong distance acuity alongside useful intermediate vision.
Instead, these findings—while early real-world evidence, not comparative proof—suggest that those outcomes can carry over into routine clinical practice.
And for clinicians considering an enhanced monofocal option for patients who prioritize distance vision while also wanting more functional intermediate range, the results add another layer to the existing enVista Aspire evidence base.