Rayner Sulcoflex lens: benefits, limitations and how it works
Sulcoflex is a supplementary (also known as a piggy back) intraocular lens made by Rayner. It sits behind the iris and in front of the lens already implanted during cataract surgery, so the original implant can stay in place. Depending on the model, it can correct a remaining glasses prescription, treat suitable astigmatism, or add intermediate and near focus.
The trade-off is another implant and, when added after cataract surgery, another operation. The toric option can rotate, the trifocal option can produce haloes around lights, and its hydrophilic acrylic material has a reported risk of calcification. Choosing the right model requires an assessment of both the existing implant and the rest of the eye.
What vision can each Sulcoflex model provide?
Sulcoflex is a family of lenses, not one focus design. The choice depends on what you want to change after cataract surgery.
- Aspheric: a monofocal add-on that corrects remaining short-sightedness or long-sightedness. If it is targeted for distance, reading glasses will usually still be needed.
- Toric: corrects suitable regular astigmatism as well as a spherical prescription.
- Trifocal: adds distance, intermediate and near focus to an existing implant. It aims to reduce reliance on glasses across those distances, with optical compromises.
The original lens, the chosen target and any residual prescription still influence the result. An add-on cannot correct poor vision caused by every retinal, corneal or optic nerve problem.
How does an add-on lens work?
It sits in the ciliary sulcus, just behind the iris. The original implant stays deeper in the capsular bag, the thin envelope left after the natural lens was removed. Sulcoflex is designed for this second position, rather than putting an ordinary capsular-bag lens there.
Its supporting arms, called haptics, are rounded, undulating C-loops. They angle backwards by 10°. The optic has a convex front and concave back, helping provide separation from the original implant. These design features do not eliminate the possibility of iris contact, displacement or inflammation.
The Aspheric and Toric options have an aberration-neutral optical design. The Trifocal 703F adds a diffractive pattern on its back surface: rings divide light between distance, intermediate and near focus. This is a fixed optical system; it does not restore the focusing movement of a young natural lens.
The broader guide to piggyback and add-on lens surgery explains the procedure.
What is the lens made of?
The current Sulcoflex models are single-piece, foldable implants made from Rayacryl hydrophilic acrylic, with 26% water content at equilibrium and an ultraviolet filter.
Some surgeons favour hydrophobic acrylic because calcium deposits can cloud certain hydrophilic implants. Sulcoflex calcification has been reported in older models, and a 2025 case report also documented it in a Trifocal 703F after complicated retinal surgery involving silicone oil. Reports involving hydrophilic lenses also raise concerns about later operations using air or gas, including some retinal and corneal procedures.
Lens-material clouding differs from clouding of the capsule behind the original implant. YAG laser treats capsule clouding; it cannot remove calcium deposits within a lens. Significant material clouding may require lens exchange. Read about hydrophobic versus hydrophilic acrylic lenses.
What are its technical specifications?
| Feature | Specification |
|---|---|
| Model identity | |
| Current global codes | Aspheric 700L; Toric 710T; Trifocal 703F |
| Dimensions and construction | |
| Optic / overall diameter | 6.50 mm / 14.0 mm |
| Material / water content | Rayacryl hydrophilic acrylic / 26% at equilibrium |
| Haptics / edge | Rounded undulating C-loops; 10° posterior angulation; rounded optic edge |
| Implantation position | Ciliary sulcus, in front of the original capsular-bag implant |
| Power and optical design | |
| Aspheric range, global table | −10.0 to +10.0 D; 0.5 D steps, including plano |
| Toric spherical equivalent | −7.0 to +7.0 D; 0.5 D steps |
| Toric cylinder, global table | +1.0 to +6.0 D; 0.5 D steps; reference plane not specified in table |
| Trifocal spherical range | −3.0 to +3.0 D in 0.5 D steps; −1.0 to +1.0 D also in 0.25 D steps |
| Trifocal additions, implant plane | Intermediate +1.75 D; near +3.50 D |
| Trifocal optical structure | 16 posterior diffractive steps; 4.5 mm diffractive zone |
| Material optics | |
| Refractive index / Abbe number | 1.46 / 56; index measurement conditions not stated |
| UV filter | UV-absorbing benzophenone; 10% transmission cutoff 380 nm |
Dioptres (D) describe optical power. The trifocal additions are stated at the implant plane, not as a glasses prescription.
Can Sulcoflex correct astigmatism?
Yes, the Toric version is designed for suitable regular astigmatism. Accurate corneal measurements, a stable glasses prescription and the correct planned axis matter. Irregular astigmatism may not be corrected adequately by a toric implant.
Rotation reduces its astigmatic correction and may require another procedure to reposition it. In a retrospective series of 51 eyes using the older 653T, 62% underwent repositioning. This was a selected, mixed surgical population, including eyes with corneal grafts. It is an important caution, but it is not a measured rotation or reoperation rate for the currently listed 710T.
What are the main advantages?
- Preserving the original implant: a suitable, stable lens can stay in its capsular bag, avoiding the need to remove it solely to change optical power.
- Choosing the type of correction: monofocal, toric and trifocal options address different goals.
- Planning after the first result is known: a later add-on can use the healed eye’s measured prescription. Some surgeons also use a planned two-lens system during the original operation.
- Potential removal or exchange: the add-on can be surgically removed if needed. This requires another operation and does not reverse cataract surgery or restore the natural lens.
Preserving the original lens can be valuable when removing it would be complex. It does not make add-on surgery risk-free or prove it is preferable to exchange in every eye.
What are the main limitations?
An extra lens cannot guarantee glasses-free vision. Residual prescription, ocular disease, reading distance and lighting all affect what you can see. A monofocal add-on generally retains the need for near glasses when targeted for distance.
The Trifocal splits light between several focus distances. Haloes, glare or starbursts around lights can occur, and dim-light contrast may be less comfortable than with a monofocal approach. These effects matter particularly for night driving. Adaptation varies; persistent symptoms deserve assessment.
An add-on is not a reliable solution for every problem caused by an existing multifocal lens. If that lens itself is producing unacceptable optical effects, retaining it may retain the cause. Discuss exchange and other options before deciding.
What do clinical studies show?
The direct 703F evidence supports useful vision across several distances, but is mainly short-term and without an implanted comparison group.
A prospective study of 40 eyes in 20 patients assessed bilateral sequential monofocal-plus-703F implantation at 6 months. It reported good binocular distance, intermediate and near vision; all 20 patients reported complete spectacle independence.
A 2022 retrospective report involving 25 patients also found improved distance vision and useful intermediate and near performance at 3 months. A 2025 series followed 80 eyes in 40 patients, including selected mild eye conditions, for 3 months after simultaneous two-lens implantation. One patient required add-on exchange for a myopic result, and one had cystoid macular oedema that resolved.
Who might be a suitable candidate?
An add-on may be considered when the original implant is stable and appropriately positioned, the eye has healed, and a measurable optical problem remains. Assessment includes the original lens, iris and sulcus anatomy, cornea, tear film, pressure, retina and optic nerve.
For a trifocal, the priority is whether the eye can use the additional focus comfortably. Significant macular disease, glaucoma, irregular corneal optics or strong night-driving demands may favour a more conservative choice. Mild conditions in one small study do not establish suitability for every stage of those diseases.
A separate use is treatment of selected negative dysphotopsia, a dark peripheral shadow after cataract surgery. A small series using the older Aspheric 653L reported complete resolution in six of nine eyes and partial improvement in one; two did not improve, and one implant was removed. This use requires its own diagnosis and discussion.
Right eye · outer right sideThe slider changes how dark the shadow is. Illustration only.
Video of Dr Chen implanting a Sulcoflex lens for the treatment of negative-dysphotopsia.
Watch on YouTube →What are the alternatives?
Glasses or contact lenses may correct the remaining prescription without another intraocular operation. In suitable eyes, corneal laser treatment is another option.
Lens exchange removes and replaces the original implant. It may address its power, position or optical design, but can become more complex as the capsule adheres to the implant, particularly after a YAG capsulotomy. The lens-exchange guide explains that balance.
If the aim is fewer reading glasses, compare an add-on with using reading glasses, carefully selected monovision, or exchanging the original lens for an appropriate alternative. The best plan depends on the reason for dissatisfaction, not just the desire for another focal point.
What are the risks of Sulcoflex implantation surgery?
Add-on surgery can cause infection, inflammation, pressure changes, bleeding, retinal problems or an inaccurate final prescription. The additional implant can contact the iris, become displaced or rotate; toric rotation is particularly relevant to its correction. Occasionally further surgery is needed.
When should I seek urgent advice after surgery?
Contact your surgeon urgently for sudden or worsening vision loss, increasing pain or redness, new flashes or a sudden shower of floaters, or a curtain or shadow in vision. Do not wait for your scheduled review or assume these changes are adaptation to the new implant. If your surgeon cannot be reached, seek urgent ophthalmic or emergency care.
Sources and further reading
- Rayner: current Sulcoflex Aspheric specifications →
- Rayner: current Sulcoflex Toric specifications →
- Rayner: Sulcoflex Trifocal 703F specifications →
- Rayner: Australian patient brochure, November 2021 →
- Australian government: July 2026 Prescribed List →
- McLintock and colleagues: legacy 653T toric outcomes, 2019 →
- Kahraman and colleagues: sequential bilateral 703F outcomes, 2021 →
- Baur and colleagues: supplementary trifocal outcomes, 2022 →
- Brunner and colleagues: simultaneous duet implantation, 2025 →
- Yildirim and colleagues: calcification in eyes with two implants, 2020 →
- Mackenbrock and colleagues: 703F calcification case, 2025 →
- Makhotkina and colleagues: selected negative dysphotopsia cases, 2015 →