At the 2025 Congress of the European Society of Cataract & Refractive Surgeons (ESCRS), I reported on interim results of a multicenter study evaluating the results of bilateral implantation of a purely refractive extended depth of field (EDF) lens, the TECNIS PureSee IOL (1). This real-world, observational study enrolled 476 eyes of 238 subjects at 17 clinical sites in Europe, Australia, and India. All patients had previously been implanted bilaterally with the TECNIS PureSee lens and were followed at a single three-month visit.
Binocular uncorrected visual acuity was -0.02 logMAR at distance, 0.12 at intermediate, and 0.25 at near. Distance-corrected binocular acuity was -0.05, 0.11, and 0.22 logMAR, respectively. All patients achieved distance-corrected vision of 0.20 logMAR or better at distance, 92% at intermediate, and 54% at near (Figure 1). The near vision results were surprisingly good, with three-quarters of patients seeing 0.30 logMAR or better, and about half seeing 0.20 logMAR or better at 40 cm even with distance correction. In good light, that is a decent level of near vision and better than we might have expected from this type of IOL. In practice, I typically give patients 0.50 D to 0.75 D of mini-monovision to further improve near vision. Occasionally, in a patient who is already accustomed to contact lens monovision, I’ll target as much as a 1.25-D offset for the near eye.
The frequency of spectacle wear in the multicenter study was low, with 85% of patients reporting that they wore glasses only “a little” or “none” of the time overall, and mostly for near tasks (Fig. 2). Again, it was somewhat surprising to me that more than 60% of patients reported needing spectacles none or very little of the time even for near. This is an excellent outcome for an IOL that is not expected to provide a full range of vision.
We assessed patient satisfaction at various distances. Overall satisfaction was very high at 95%, and 73% were satisfied with near vision. Nearly all (96%) said they would recommend the same IOL to family and friends – a good indicator of lens performance. Dr. Oege Goslings reported on dysphotopsia symptoms from the same study. A very small proportion of patients said they were very bothered by glare (3%), halo (1%) or starbursts (3%), while the vast majority reported not experiencing these dysphotopsia symptoms or being only a little bothered by them (2).
Where this lens fits
In the evidence-based functional classification of IOLs developed by ESCRS, simultaneous vision (SV) IOLs are classified as either partial or full depth of field (DOFi) (3, 4). Among the partial DOFi IOLs, the TECNIS PureSee fits best into the “extended” category. Cluster analysis showed that this category has a pooled mean uncorrected binocular visual acuity of 0.07 at intermediate (66 cm) and 0.18 at near (40 cm), and an approximately 90% chance of spectacle independence at intermediate and approximately 65% chance at near. The ESCRS classification is helpful to cut through marketing claims or arbitrary categories based on reimbursement levels and understand what our patients are likely to achieve with SV lenses.
All SVIOLs have inherent tradeoffs, including some degree of compromise in visual quality in order to expand visual function. From my clinical experience implanting the TECNIS PureSee lens over the past two years, I think it does a better job of balancing visual quality and visual function than previous IOLs in this category, which either had high rates of dysphotopsia or lacked crisp distance vision. The PureSee IOL has purely refractive optics and a continuous change in power on the posterior surface of the IOL, with no sharp or abrupt changes in elevation. These features diminish the chance of visual symptoms such as glare, halos, and starbursts. Thus far, I have had few patient complaints about night vision and have not had to explant the lens in a single patient.
However, we still do not have rigorous methods for comparing dysphotopsia and contrast sensitivity profiles across lenses or manufacturers because different scales and questionnaires have been used in clinical trials. For the future it will be important to find common ground on acceptable methods of evaluating contrast sensitivity and dysphotopsia.
In my practice, the PureSee IOL has become my go-to lens for patients who want greater spectacle independence. However, I always tell patients before surgery that they will need reading glasses after surgery for prolonged reading, small print, or poor illumination. Poor lighting can be a problem with all SVIOLs, so the need for glasses or a light in a dim restaurant isn’t a major deterrent, in my opinion. Overall, I am implanting fewer full visual range or full DOFi lenses, especially in low to moderate myopes who are accustomed to high quality near vision without glasses. I reserve the full DOFi lenses now mainly for hyperopic patients who, in my experience, have the highest tolerance for dysphotopsia, and for patients with a very strong desire to be spectacle independent at near.
I find the TECNIS PureSee lens to be very forgiving. We can expect that patients implanted with this lens will have functional near vision, even if they need glasses for some tasks. Most importantly, they are very unlikely to be disturbed by any kind of dysphotopsia.
References
- O Findl O, D Cheng, “Spectacle Independence and Visual Outcomes in Patients Bilaterally Implanted with a Purely Refractive Extended Depth of Focus Presbyopia Correcting IOL. A Multicentre Observational Study,” ESCRS Annual Congress, September 2025, Copenhagen, Denmark.
- O Goslings et al., “Quality of vision in patients bilaterally implanted with a purely refractive extended depth of focus presbyopia correcting intraocular lens. A multicentre observational study,” ESCRS Annual Congress, September 2025, Copenhagen, Denmark.
- J Fernández et al., “Navigating the lens labyrinth: A practical approach to intraocular lens classification and selection,” Ophthalmol Ther, 14:2313 (2025).
- F Ribeiro et al., “Evidence‑based functional classification of simultaneous vision intraocular lenses: Seeking a global consensus by the ESCRS Functional Vision Working Group,” J Cataract Refract Surg. 50:794 (2024).
