PURPOSE: Enhanced monofocal intraocular lenses (IOLs) are designed to extend depth of focus (DOF) compared to traditional monofocal lenses. The enVista ASPIRE Toric (ETA) and enVista ASPIRE (EA) IOLs are hydrophobic acrylic enhanced monofocal IOLs that have demonstrated up to 1.25 D of continuous DOF in clinical trials. This study aimed to evaluate the real-world performance and outcomes of ETA and EA IOLs.

SETTING: This was a prospective, real-world study conducted at two sites in Spain (Unidad de cirugía facorefractiva, Hospital Universitario Miguel Servet, Zaragoza and Hospital Universitario Ramón y Cajal, Madrid). Surgeries were performed by two investigators in patients between 21 January 2025 and 16 December 2025.

METHODS: Postoperative visual performance was assessed in patients implanted with EA and ETA IOLs. All procedures utilised femtosecond laser–assisted cataract surgery (Victus, Bausch & Lomb, Inc.), with consistent APEX-guided centration of the implants. Clinical outcomes included corrected and uncorrected distance visual acuity (CDVA and UDVA), uncorrected intermediate distance visual acuity (UIVA), refractive outcomes (manifest refraction spherical equivalent [MRSE], spherical equivalent [SEQ], manifest refraction cylinder), and a defocus curve. Outcomes were assessed at 4–12 weeks postoperatively. Safety was also monitored.

RESULTS: A total of 80 patients (98 eyes; 54% OD) were included; median follow-up was 34 days (n=42). Mean±standard deviation (SD) age was 69±9 years (n=33) and mean±SD SEQ target was −0.08±0.13 D (n=95). Monocular outcomes were CDVA of 0.1 logMAR or better in 99% of eyes (92/93), UDVA of 0.1 logMAR or better in 74% (69/93), and UIVA of 0.3 logMAR or better in 68% (61/90). Mean±SD MRSE was −0.18±0.38 D (n=94), mean±SD SEQ difference compared with target values was 0.11±0.38 D (n=93), and manifest refraction cylinder was −0.37±0.31 D (n=94). The defocus curve demonstrated an extended DOF, with a functional range of approximately 1.25 D at a 0.2 logMAR cutoff, reflecting good intermediate performance. No significant dysphotopsias were reported.

CONCLUSIONS: In this real-world study, EA and ETA IOLs provided high refractive accuracy and good distance and intermediate visual acuity. The defocus curve also demonstrated an extended DOF without compromising visual quality.