Full Range of Vision IOLs in Australia: Clinical Outcomes, Contrast Sensitivity, and How They Work

Full range of vision intraocular lenses aim to provide functional vision across distance, intermediate, and near without glasses. They are the most technologically ambitious category of lens implant currently available, and also the most demanding for both patient selection and surgical technique. This post analyses the lenses in this category available in Australia in 2026, how each achieves its extended range optically, what the published evidence shows about visual acuity outcomes and contrast sensitivity, and what the dysphotopsia trade-offs are in clinical practice. For a broader overview of all intraocular lens options for cataract surgery, including monofocal and enhanced monofocal lenses, see the dedicated IOL guide.

How do full range of vision lenses achieve their range?

The fundamental challenge of providing vision across multiple focal distances with a fixed-focus implant is that a single lens cannot simultaneously focus light at infinity, at arm's length, and at 40 centimetres using standard optics. Full range of vision lenses solve this problem using one of two main approaches: diffractive optics that split incoming light into multiple focal zones, or refractive designs that create a continuous power gradient across the lens surface.

Diffractive lenses use concentric rings etched onto the lens surface that diffract light into two or more focal zones. The trifocal designs available in Australia including the Clareon PanOptix Pro and the TECNIS Odyssey use diffractive optics to create distinct peaks in the defocus curve at distance, intermediate, and near. The efficiency of light utilisation is a key variable in diffractive designs. The original PanOptix used 88 percent light utilisation. The PanOptix Pro with ENLIGHTEN NXT technology has improved this to 94 percent, reducing the amount of light scattered as unwanted glare.

Hybrid lenses such as the TECNIS Synergy combine diffractive echelette technology with multifocal optics to create a continuous range rather than discrete peaks. The aim is to eliminate the dip in vision between intermediate and near that first-generation multifocal lenses produced. The defocus curve of a hybrid lens typically shows a plateau from distance to near rather than distinct peaks.

Non-diffractive EDOF lenses such as the Clareon Vivity and TECNIS PureSee achieve their extended range through purely refractive means. The Vivity uses X-WAVE wavefront-shaping technology involving two smooth transition zones that shift and extend the wavefront without splitting it into discrete focal zones. The PureSee uses a continuously varying posterior curvature. Neither produces the discrete near focal point that trifocal lenses achieve, but both produce a continuous range from distance to intermediate with functional near vision in good lighting, without the optical interference that causes halos in diffractive designs.

Visual acuity outcomes: what do the data show?

The published evidence on full range of vision lenses is substantial but comparisons across studies are difficult because of differences in trial design, patient populations, and measurement methodology. The most relevant comparisons are those that directly compare lenses head to head in randomised or matched studies.

Trifocal versus EDOF: A 2023 systematic review and meta-analysis published in PubMed analysing 22 studies comprising 2,200 eyes found that trifocal IOLs provided statistically superior uncorrected near visual acuity compared with EDOF IOLs, while uncorrected distance and intermediate visual acuity were not statistically different between groups. The defocus curve favoured trifocal lenses at near vision and EDOF lenses at intermediate vision. Spectacle independence was significantly higher with trifocal IOLs. Halos and glare were not statistically different between groups in this analysis, though individual study results varied (PubMed 36736751).

Synergy versus PanOptix versus Symfony: A comparative analysis of US FDA premarket approval data published in Journal of Clinical Medicine 2023 examined outcomes across three lenses. Patients achieving 20/20 or better uncorrected binocular distance visual acuity were 67 percent for Synergy, with both Synergy and PanOptix showing statistically superior near visual acuity compared with Symfony. Halos were statistically more common in Synergy patients compared with PanOptix (p=0.0013) and Symfony (p<0.0001). Each lens outperformed its monofocal comparator for spectacle independence (Moshirfar et al., J Clin Med 2023; doi: 10.3390/jcm12134365).

PureSee versus Eyhance: A 2025 prospective multicentre randomised study of the TECNIS PureSee (ZEN00V) versus TECNIS Eyhance (ICB00) found that the PureSee group demonstrated superior uncorrected intermediate (0.11 versus 0.17 logMAR, p=0.006) and near visual acuity (0.25 versus 0.31 logMAR, p=0.023), with comparable distance visual acuity and contrast sensitivity. No significant difference in dysphotopsia profile was observed between the two groups (MDPI J Clin Med 2025; doi: 10.3390/jcm14144967).

Contrast sensitivity: the underreported outcome

Visual acuity measured with high-contrast optotype charts does not capture the full clinical picture of visual quality after IOL implantation. Contrast sensitivity, which measures the ability to detect low-contrast targets across a range of spatial frequencies, is a more sensitive measure of real-world visual performance particularly in low-light conditions such as night driving.

Diffractive lenses including trifocals and diffractive EDOF designs split incoming light across multiple focal zones. By definition, this means that less light is directed to any single focal point compared with a monofocal lens. The result is a measurable reduction in contrast sensitivity compared with monofocal lenses, particularly at high spatial frequencies and in mesopic conditions. The clinical significance of this reduction varies between patients. Most patients with healthy maculas adapt well and the reduction in contrast sensitivity does not translate into subjectively poor vision in daily life. However, patients with pre-existing reductions in macular function, including early age-related macular degeneration or epiretinal membrane, are at greater risk of symptomatic contrast reduction with diffractive lenses.

Non-diffractive EDOF lenses show the most favourable contrast sensitivity profiles in the full range of vision category. The TECNIS PureSee pivotal trial demonstrated mesopic contrast sensitivity comparable to the enhanced monofocal TECNIS Eyhance within 0.11 log units across all measured spatial frequencies (PMC11080637). The Clareon Vivity has similarly demonstrated contrast sensitivity approaching monofocal equivalence in multiple studies. This is the principal advantage of non-diffractive EDOF designs over trifocal lenses: they provide extended range with a contrast sensitivity profile that does not compromise night driving performance in the way that diffractive lenses can.

Dysphotopsia profiles: halos, glare, and starbursts

Dysphotopsias are the visual disturbances most commonly reported by patients with premium lens implants. They are caused by the optical interference inherent in diffractive designs and are experienced as halos around lights, glare, and starbursts, typically most noticeable in dark environments with point light sources.

The dysphotopsia profile of a lens is one of the most important factors in patient selection and preoperative counselling. The hierarchy from most to least dysphotopsia-prone in the full range of vision category is approximately as follows based on published data:

Hybrid full range of vision lenses including TECNIS Synergy have the highest reported halo rates. In the Synergy FDA pivotal trial, halos were statistically more common compared with both PanOptix and Symfony. This reflects the combination of diffractive echelette and multifocal optics which creates more complex light interactions than a single diffractive design.

Trifocal lenses including Clareon PanOptix Pro and BVI FineVision produce moderate halos in the majority of patients during the neuroadaptation period of three to six months. The PanOptix Pro with ENLIGHTEN NXT technology has improved light utilisation from 88 to 94 percent, reducing the halo intensity compared with the original design. Studies report that 69 to 80 percent of PanOptix patients report little to no halos at six months as neuroadaptation occurs.

Non-diffractive EDOF lenses produce the lowest dysphotopsia rates in the full range of vision category. The Clareon Vivity shows halo rates approaching monofocal equivalence in mesopic conditions. The TECNIS PureSee demonstrated in its pivotal trial that 91.7 percent of patients reported no or minimal halos, 95 percent reported no or minimal starbursts, and 95 percent reported no or minimal glare (PMC11080637).

The practical implication is that non-diffractive EDOF lenses are the most appropriate full range of vision option for patients with high night-driving demands, occupational night vision requirements, or documented sensitivity to halos and glare preoperatively.

The neuroadaptation period

A concept that is essential to discuss with patients considering diffractive full range of vision lenses is neuroadaptation. The visual cortex has a remarkable ability to suppress dysphotopsias over time as it learns to interpret the complex optical signal from a diffractive lens. The neuroadaptation period for trifocal and hybrid lenses is typically three to six months. During this period, halos are at their most noticeable. By six to twelve months, the majority of patients report that halos have become less bothersome even if they remain objectively present.

Neuroadaptation does not occur universally. A minority of patients do not adapt adequately and continue to experience bothersome dysphotopsias beyond twelve months. The factors associated with poor neuroadaptation include high pre-operative anxiety, dry eye disease affecting optical quality, large mesopic pupils, pre-existing macular pathology, and unrealistic expectations about the adaptation process. These factors should be assessed preoperatively. Patients who express high concern about night vision disturbance before surgery are at elevated risk of post-operative dissatisfaction with a diffractive lens and should be counselled toward a non-diffractive EDOF or a monofocal lens instead.

Clinical comparison: which lens for which patient?

The choice between lens types within the full range of vision category depends on the patient's visual priorities, ocular health, pupil size, macular status, and tolerance for an adaptation period.

Patients who prioritise near reading independence and are prepared to accept a neuroadaptation period of three to six months are the best candidates for trifocal lenses such as Clareon PanOptix Pro or TECNIS Odyssey. These lenses provide the highest levels of spectacle independence across all three distances in clinical studies. They are not appropriate for patients with macular pathology, irregular corneas, or significant pre-existing contrast sensitivity loss.

Patients who drive frequently at night, who have occupational requirements for optimal low-light vision, or who express concern about halos before surgery are better suited to a non-diffractive EDOF lens such as Clareon Vivity or TECNIS PureSee. These lenses sacrifice some near independence compared with trifocal lenses but provide a dysphotopsia profile approaching monofocal equivalence.

Patients who want a compromise between the near independence of a trifocal and the dysphotopsia profile of a non-diffractive EDOF can be considered for a mix-and-match approach, with a non-diffractive EDOF in the dominant eye and a trifocal in the non-dominant eye. However, as discussed in the premium IOL guide covering all lenses available in Australia, the mix-and-match approach is not yet supported by high-quality randomised trial data and should be presented to patients as a strategy based on clinical experience rather than an established standard of care.

For a detailed guide to how specific activities and occupations influence lens selection, see the post on choosing a lens to suit your lifestyle.

What full range of vision lenses cannot do

No currently available full range of vision lens fully replicates the accommodative range of the young phakic eye. Patients should understand before surgery that:

Near vision with trifocal lenses is functional rather than optimal in all conditions. Fine print in dim lighting, prolonged reading of very small text, and sustained near tasks in low ambient light may still require reading glasses even with a trifocal lens. The range of vision provided depends on ambient lighting, pupil size, and individual neural processing.

Distance vision with some trifocal designs may show a marginal reduction in contrast-weighted acuity compared with a high-quality monofocal lens. For patients for whom absolute distance optical quality is the primary priority, a monofocal lens remains the most optically efficient choice.

The full range of vision achieved binocularly is greater than the range achieved monocularly. The brain integrates visual information from both eyes and the binocular defocus curve is typically broader than the monocular curve. This means that patients trialling one eye first before the second eye surgery may experience less range than they will ultimately achieve with both eyes implanted.

For information on cataract surgery in Melbourne and what to expect from the surgical process, see the dedicated guide. Optometrists referring patients for premium IOL assessment can find referral information on the referral information for optometrists page.

References

1. Moshirfar M, et al. Assessing Visual Outcomes: A Comparative Study of US-FDA Premarket Approval Data for Multifocal and EDOF Lens Implants in Cataract Surgery. J Clin Med. 2023;12(13):4365. https://pubmed.ncbi.nlm.nih.gov/37445400/
2. Wan KH, et al. Extended Depth of Focus Versus Trifocal for Intraocular Lens Implantation: An Updated Systematic Review and Meta-Analysis. PubMed 36736751. https://pubmed.ncbi.nlm.nih.gov/36736751/
3. TECNIS PureSee (ZEN00V) vs TECNIS Eyhance (ICB00): Comparative Visual Performance. MDPI J Clin Med 2025;14(14):4967. https://www.mdpi.com/2077-0383/14/14/4967
4. Quality of vision clinical outcomes for a new fully-refractive extended depth of focus Intraocular Lens. PMC11080637. https://pmc.ncbi.nlm.nih.gov/articles/PMC11080637/
5. Comparison of Outcomes of Non-diffractive Extended Depth of Focus Intraocular Lens and Diffractive Extended Depth of Focus Intraocular Lens. PMC12487963. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12487963/