You want to see the road clearly, use a computer and check your phone. Reading glasses for small print would be acceptable. So which lens makes more sense: PureSee or Vivity?
If preserving contrast is a priority, I see good reasons to discuss PureSee first. But I would not reduce this to ‘PureSee for image quality, Vivity for reading’. Both aim to help with everyday vision, including screens. Some reading results favour Vivity; how large those differences are — and what was actually measured — matters more than the word ‘better’.
First, what are these two lenses trying to do?
A conventional monofocal lens has one main focus. PureSee and Vivity aim to extend the zone of clear vision, giving you more usable range from distance toward a computer screen. This approach is called EDOF — extended depth of focus. It does not restore the natural lens’s ability to change focus, and small-print reading can still need glasses. More about EDOF lenses.
So the choice is not “contrast with PureSee or a useful screen distance with Vivity.” Both offer an extended range. The question is how to weigh that range, image quality and the tasks you want to do without glasses.
Which lens makes reading easier: PureSee or Vivity?
In my conversations with surgeons, PureSee is often chosen for both image quality and reading. That experience matters, but it is not a controlled comparison. Different patients, working distances and planned focus can lead to different impressions. A study can test part of that experience; it cannot explain every surgeon’s results.
There is a real signal in Vivity’s favour, not a demonstrated universal winner. Koh directly compared 34 PureSee patients with 51 AcrySof Vivity patients six months after surgery. They answered questions about tasks without glasses.
| Task without glasses | PureSee | Vivity | Difference |
|---|---|---|---|
| Small print | 65.9 | 76.0 | 10.1 points |
| Newspaper or book | 80.3 | 94.8 | 14.5 points |
| Large print or telephone numbers | 79.5 | 88.0 | 8.5 points |
| Overall questionnaire | 89.3 | 92.6 | 3.3 points |
Average questionnaire scores, from 0 to 100; higher means better function without glasses. These are not percentages of patients or percentages of better vision. Koh, Table 4.
The book-reading gap is too large to dismiss casually as ‘almost nothing’. Yet the overall difference was small and not statistically significant. It also fell below the four-point difference the researchers had chosen as meaningful for the overall score. That threshold does not tell us whether each individual reading item was clinically important.
This study did not measure reading speed, endurance or how long someone could read comfortably. It records a difference in patients’ answers. It does not tell us ‘Vivity lets you read for an extra hour’.
During intermediate-vision testing, patients with Vivity could, on average, recognise smaller letters without glasses than patients with PureSee. The difference was smaller in one study and larger in the other. That is an advantage in recognising small details during a test, not an answer to how much easier it will be to read a book or work at a computer. Kang; Koh.
Koh also ran an additional test: each eye first received the spectacle correction that gave its clearest distance vision, then vision closer in was tested. Vivity also had an advantage at some distances in that test. So the result cannot simply be explained away by a difference in the small amount of short-sightedness left after surgery.
However, the study does not list the exact refraction planned for each eye — in everyday terms, whether the calculation aimed for no glasses prescription or a particular small amount of short-sightedness. There is also an inconsistency in the table of postoperative results. This finding is worth considering, but it is not a promise that everyone will find reading easier with Vivity. The testing details are below. Koh: methods and results.
There is also an early reading-speed result in the other direction, favouring PureSee, in a conference report collected by J&J. That is worth following up, but without the full protocol I would not use it to overrule these published comparisons. The figures and limitations are in the research notes below.
Checking one message and reading several pages are different tasks. For comfortable reading, the text needs to be sufficiently larger and more contrasty than what you can only just recognise. That is the reserve I explain in ‘I can read it’: the trap in judging vision. It helps explain why reading comfort is not settled by one chart result. It does not prove that either lens provides more reserve for your particular eyes. Whittaker and Lovie-Kitchin.
Contrast is about seeing details, not making the picture prettier
A black letter on a white chart is easy to separate from its background. A step in shadow is different: its edge may be only slightly darker than the surface around it. Recognising that edge depends on more than the smallest letter you can read.
Contrast sensitivity is your ability to distinguish details when the difference between light and dark is small. When it falls, an object can blend into the background. That is why a good result on the usual sight chart does not describe everything about everyday vision. I explain this in more detail in why contrast sensitivity matters.
This has practical evidence behind it. In a study of driving before and after cataract surgery, improvement in contrast sensitivity was the best predictor of improvement on the driving test. It supports the importance of contrast — not a claim that PureSee drivers outperform Vivity drivers. That was not the comparison. Wood and Carberry, 2006.
What happened when researchers tested patients?
Two direct patient comparisons favour PureSee for contrast; a third found no significant difference. This is a reason to consider PureSee beyond the laboratory graph. These were small, non-randomised studies, so the result is not a promise for every eye. Koh, Kang, Jeong. Study sizes and testing conditions are below. The reporting limits discussed below also matter when interpreting Koh’s contrast finding; they are not reasons to scrutinise only the reading result.
What about halos and glare?
In Koh’s study, strongly bothersome light effects were reported by 0 of 34 PureSee patients and 10 of 51 Vivity patients. “Strongly bothersome” meant scoring at least one effect at 50 or more out of 100. Zero reports in a small group does not mean zero risk. Koh.
Nor was that pattern universal: Kang’s study did not confirm a significant PureSee advantage for halos or glare; the numerical trend went the other way. Kang.
Also, fewer halos and glare and better contrast are different outcomes. A lens can have relatively few obvious rings around lights while still reducing the ability to distinguish faint details.
An important detail in the official safety information
Alcon’s US safety information warns of reduced contrast sensitivity with Clareon Vivity compared with a monofocal lens and advises caution in dim light. In the FDA-reviewed PureSee trial, extra intermediate vision did not come with a contrast reduction exceeding the study’s chosen threshold. That supports taking contrast seriously when considering PureSee, but these were not the same trial or a direct comparison of the two lenses. Alcon; FDA, Table 21. The full qualifications are below.
What does the laboratory comparison add?
Before interpreting the table, one term: MTF measures how well optics preserve contrast in a test pattern. It is not a patient’s percentage of vision. A laboratory measures the lens; clinical contrast testing measures a person’s visual system. Edmund Optics explanation.
At the distance focus
PureSee had higher MTF in this experiment:
| Test aperture | PureSee | Vivity |
|---|---|---|
| 3.0 mm | 0.28 | 0.24 |
| 4.5 mm | 0.27 | 0.21 |
A laboratory measurement of lenses, not patients’ vision. The aperture is the test opening; 3 mm and 4.5 mm do not directly mean “day” and “night”. Full test conditions are below. Niknahad, 2025; Alcon grant disclosed.
At an intermediate focus
Around the focus modelling 67 cm, Vivity preserved more contrast in one test setting. That also matters. But neither this result nor PureSee’s higher distance-focus values alone proves better everyday vision. Figure 1.
The practical message is simple: one distance-focus number cannot describe the whole lens. For the testing method, see how IOLs are tested in the laboratory and this technical methods paper.
How I would use this when choosing
If your priority is image quality and contrast, you want useful distance-to-screen vision, and glasses for small print are acceptable, I would start the discussion with PureSee. Its clinical contrast results give that preference a basis beyond the bench. This is my interpretation of the evidence, not a promise that your eye will reproduce a group average.
For reading, I would not decide from ‘Vivity is better’ or from a surgeon’s favourable impression of PureSee alone. Ask what either claim means for your own text size, distance and light. Vivity’s questionnaire advantage is worth keeping in the discussion; it does not establish better sustained reading for everyone. Nor do PureSee’s contrast results alone establish that it is the better reading lens.
I would not describe this as practical vision versus abstract contrast. Contrast is part of practical vision. What is still missing is a reliable answer to how much these measured differences change everyday tasks for an individual patient. The condition of your eyes and the planned focus remain essential to the choice.
Three questions for your surgeon
- Given my eyes, which lens would you favour for image quality, and why?
- What focus will you aim for in each eye, and what should I expect at my usual screen distance without glasses?
- What would you expect in dim light, and for which tasks should I plan to use glasses?
If you already have a shortlist but are unsure how it fits your life, an IOL consultation can help you organise your priorities and questions. Your surgeon determines medical suitability after examining your eyes.
Research details, funding and further reading
Refraction: what Koh did and did not report
Sections 2.3–2.4 describe IOLMaster 700 measurements, the Barrett Universal II calculation and lens factors of 2.04 for PureSee and 1.99 for Vivity. The authors state that they selected the first available negative-power option within the calculated range. In context, this appears to mean the first predicted slightly myopic result; the wording about IOL power is imprecise. It is not a per-eye numerical target table, but neither does it describe choosing a second minus for Vivity and a first minus or zero for PureSee. The actual target distributions and the implanted power versus predicted postoperative refraction for each eye are not provided.
Table 2 reports −0.04 ± 0.22 D for PureSee and −0.04 ± 0.21 D for Vivity in a row labelled ‘Absolute refractive error in SE’ (p=0.914). An absolute value cannot be negative. These may be signed spherical-equivalent refractions, but the paper does not clarify the mismatch; I have not silently relabelled them as verified signed refractions. Reported refractive cylinder is 0.22 ± 0.20 D versus 0.15 ± 0.20 D (p=0.101). The values are similar on the reported group summaries, not proof of equivalence or identical two-eye distributions. Postoperative Table 2 uses one randomly selected eye per patient, whereas the reading questionnaire concerns the person using both eyes. The study excluded patients if either eye met the stated >0.50 D absolute-refractive-error criterion.
Distance vision was compared: uncorrected distance acuity was 0.01 ± 0.03 versus 0.01 ± 0.02 logMAR, PureSee first (p=0.254); corrected distance acuity was 0.00 ± 0.01 versus 0.00 ± 0.00 (p=0.184). No significant group difference was found. The exact working distances for the separate uncorrected intermediate/near chart tests are not specified in section 2.4, unlike the four-metre distance test; do not silently assign Koh the 66 cm used by Kang.
Figure 1 is a clinical distance-corrected defocus curve, not the optical-bench MTF curve discussed later in this article. The researchers optimised each eye’s distance correction before adding test lenses. At −1.50 D, mean acuity was 0.28 for PureSee versus 0.22 for Vivity (p=0.025): a 0.06 logMAR difference, about 0.6 standard chart line. At −2.00 D it was 0.45 versus 0.36 (p=0.043): 0.09 logMAR, about 0.9 line. This argues against attributing all nearer-range differences solely to uncorrected residual refraction. It still does not establish sustained reading comfort, or isolate a causal lens-design effect in this non-randomised study. The uncorrected 1.4-line result and these corrected differences are not interchangeable tests; subtracting them would not quantify a refractive contribution.
At zero defocus both groups averaged 0.01 logMAR. PureSee’s advantage at positive defocus does not establish sharper vision at the correctly focused distance point. Separately, the contrast-test paragraph names the CGT-2000 and lighting conditions but does not explicitly state the refractive-correction condition. That reporting limitation applies to interpreting the favourable PureSee contrast finding too, not just to Vivity’s reading results. Full source, sections 2.2–2.6 and 3.1.
Constants and experience with each model. Lens Factors 2.04 and 1.99 are stated, but their source, surgeon-specific optimisation, numbers of previous cases per lens and a separate analysis of early PureSee experience are not described. Vivity was used earlier; PureSee became available from March 2024. The authors explicitly say that PureSee counselling relied on its design and early reports rather than their own clinical experience. This does not prove that every included PureSee case was performed without any preceding PureSee implantations: the complete case sequence is not reported. Unequal experience is a possible influence, not a measured explanation of the observed gap. Different model-specific constants alone do not establish different refractive targets.
Reading: measurements and limits
Koh’s individual reading-item p-values were 0.046, <0.001 and 0.030; the overall result was p=0.115. The prespecified four-point threshold concerned the overall score, not a validated minimum important difference for each item. The paper does not describe a multiple-comparison correction for the individual questionnaire items. Patients chose their lens, and the two lenses were available over different periods. The main cohort also excluded residual refractive error greater than 0.50 D. These limits matter when generalising the result.
Koh: uncorrected intermediate acuity was 0.22 versus 0.08 logMAR, and near acuity 0.28 versus 0.21, PureSee first. Kang: intermediate acuity at 66 cm was 0.21 versus 0.16. The chart-line comparisons above use 0.10 logMAR per standard line. They are explanations of acuity differences, not a conversion into reading time or comfort. The groups were not the same: Koh used AcrySof Vivity; Kang used Clareon Vivity.
The Galan conference comparison reported mean reading speeds of 166.4 versus 128.1 words/minute, PureSee first, at 0.45 logRAD print size, with 20 bilaterally implanted patients per group. It is a conference summary in the manufacturer’s compendium, not a fully checked independent journal comparison. The complete reading protocol, including distance and correction conditions, was unavailable. These missing details prevent a like-for-like comparison with Koh. A favourable early result is a reason to seek the full paper, not to proclaim a reading-speed winner.
The background terms retained from the previous version are acuity reserve (text size relative to the recognition threshold) and contrast reserve (text contrast relative to the threshold). Neither can be calculated for a particular patient from the lens MTF alone.
Direct clinical contrast comparisons
Three direct clinical comparisons give us a more useful picture than the bench alone:
- Koh, 2026: among 85 patients assessed at six months, the PureSee group performed better on contrast testing in both bright and dim light. Study.
- Kang, 2026: among 102 patients assessed at two months, PureSee performed better for some finer test patterns, not across the whole contrast test. Study.
- Jeong, 2026: among 72 patients, contrast testing at one month found no statistically significant difference. Study.
Two comparisons favour PureSee for contrast; one does not show a difference. These were not randomised comparisons. Differences in patient selection could affect the results. Nevertheless, this is a clinical argument worth discussing, not just a theoretical optical advantage.
An important detail in the official safety information
Alcon’s current US safety information for Clareon Vivity warns that most patients are likely to lose significant contrast sensitivity compared with a monofocal lens. It advises caution in dim light, including night driving. This is not a driving ban or a prediction that every patient will struggle. But “few halos” does not settle the contrast question. Alcon safety information.
There is also useful evidence for PureSee. In the manufacturer’s randomised study reviewed by the FDA, the US PureSee model DEN00V improved intermediate vision compared with a monofocal lens. Contrast differences in dim light stayed within the study’s limit for clinical significance.
In plain language: the extra intermediate range did not come with a contrast reduction exceeding that study’s threshold. Some average contrast scores were lower, so this does not mean “nothing changed at all.” FDA dossier, Table 21.
These documents help explain why preserving contrast is a reasonable reason to favour PureSee. They are not a head-to-head trial, however: the FDA comparison was with TECNIS DCB00, not Vivity. Nor do they prove a PureSee advantage in actual night driving.
How strong is the comparison?
The three direct clinical comparisons were retrospective, not randomised. Follow-up and tests differed. Koh used AcrySof Vivity; Kang used Clareon Vivity. Results from different platforms and testing conditions should not be treated as identical.
Koh reported foundation/HUS funding; one author disclosed advisory work for Alcon. Kang reported Korean government funding; one author disclosed speaking for Alcon and J&J. Jeong declared no financial conflicts. These disclosures do not invalidate the findings, but “completely independent evidence” would be too strong a description.
Kang and Jeong contain inconsistencies between some statistical statements and their tables. This article does not use the disputed results to establish a winner. Jeong’s contrast result was a bright-light test at one month, not a long-term assessment of daily comfort.
What else was found in the PureSee material?
The J&J PureSee compendium, Galan conference summary reports faster reading with PureSee than Vivity in a small early comparison. The full reading protocol and independent confirmation were not available for this review; it is not the basis of the recommendation above.
The Corbett and Black papers are additional PureSee research, but their comparison lens is Eyhance, not Vivity; their patient groups also overlap. They should not be counted as two further independent wins over Vivity.
Manufacturer conference announcements are useful leads, not substitutes for a full report. Accordingly, unverified spectacle-independence percentages from the ASCRS 2026 announcement have not been used here.
Optical-method and reading references
The published Niknahad study is the source of the MTF table, not inaccessible manufacturer “data on file.” In the J&J source list, DOF2023CT4025 concerns MTF and DOF2023CT4028 concerns simulated visual acuity. The full internal protocols were not available for verification. The separately cited DOF2020CT4011 concerns the Symfony OptiBlue light-filtering context, not this PureSee/Vivity MTF experiment; see the original J&J announcement.
For additional research on reading and contrast, the previously collected 2009 paper and 2012 paper remain available as background, not comparisons of these two IOLs.
Full measurement explanations
What about the eye chart? In Kang’s study the difference at 66 cm was about half a chart line on average. Koh found a larger intermediate-distance difference — about 1.4 lines — and about 0.7 of a line at near. So the size of the advantage was not consistent across studies. A small average chart difference can still matter for a particular task; it is not automatically a noticeable benefit for everyone. Kang; Koh.
MTF at 50 line pairs/mm. Two +20 D samples per model; polychromatic light; model cornea with +0.27 μm spherical aberration at 5.15 mm. The aperture is the opening used on the test bench, not a direct label for day or night vision. Niknahad and colleagues, 2025; Alcon grant disclosed.
At a focus modelling roughly 67 cm, with a 3 mm aperture, Vivity preserved more contrast. That result deserves the same respect — and the same limit: neither finding alone proves better everyday vision. This is an optical measurement through different focus positions, not a clinical visual-acuity defocus curve. Study, Figure 1.