THE RECENT FDA APPROVAL of the Tecnis Synergy Intraocular Lens (IOL) from Johnson & Johnson Vision expands the possibilities of what a presbyopia corrective lens is capable of doing for patients. Those who have utilized the lens in its clinical trial phase (and outside of the US, where it’s already been available) have seen promising results. There is excitement surrounding how this new IOL will be able to better meet patient needs on a more widespread level now that it will be available in the US.

“The Tecnis Synergy combines multifocal and extended depth of focus (EDOF) characteristics into a single presbyopia-correcting lens, creating a whole new standard for presbyopia-correcting abilities. Instead of having distinct focal points at various ranges, the advanced diffractive optics provide a continuous range of vision,” says Daniel H. Chang, MD, cataract and refractive surgeon at Empire Eye and Laser Center in Bakersfield, CA, and president and founding member of the nonprofit Advanced Center for Eyecare. Dr. Chang was a clinical investigator of the technology.

“The Tecnis Synergy provides a broad range of continuous vision, including the best near vision I’ve ever seen in a presbyopia-corrective lens,” he continues. “Patients had near vision as good as ‘high-add’ multifocals like the original Tecnis Multifocal +4 IOL with no perceivable drop-off in intermediate ranges. This means they were able to hold reading material at any range based on their preferences and comfort without being limited by their focal range.”

Many believe this ability will be a gamechanger for patient satisfaction.

“Being able to provide patients with less dependence on glasses is a huge benefit in terms of enhancing quality of life,” says Maria C. Scott, MD, founder, medical director, and cataract and refractive surgeon at Chesapeake Eye Care and Laser Center in Annapolis, MD, and also a clinical investigator.

Dr. Scott says that the ability to give patients great distance vision without compromising intermediate or reading vision is a significant milestone. In a Johnson & Johnson Vision sponsored study, nine out of 10 patients did not need glasses after surgery.

“The clarity of the lens, as well as the lack of compromise in distance vision, is impressive,” Dr. Scott continues. “Whereas we are typically used to making vision compromises or coming up with a customized solution, with this new lens, the quality of vision is maintained without the tradeoff for range.”

Dr. Chang adds, “By leveraging even greater active correction of chromatic aberration than the Tecnis Symfony, the Tecnis Synergy can provide this amazing range of vision and still deliver superior-quality vision and contrast, regardless of light conditions.”

Johnson & Johnson Vision has also announced that it will offer the Tecnis Synergy IOL on the Toric II platform to give surgeons the ability to address astigmatism at the time of surgery.

Violet Light-filtering Technology for Reduction in Halos

One of the concerns of presbyopia-correcting IOLs is dysphotopsias, such as glare, halos, and starbursts, particularly in low-light conditions.

“In general, dysphotopsia side effects have always been a challenge with IOLs. But the violet light filtering (VLF) technology provides a new range of functionality with fewer side effects,” says Dr. Scott. “This will naturally enhance patient satisfaction.”

The addition of a VLF chromophore has been shown in models to reduce halo intensity for tasks like nighttime driving; and clinical studies have shown a significantly greater proportion of patients reporting “no difficulty driving at night” and “no frustration with vision” compared to patients without the chromophore.

“For most pseudoaccommodating IOLs, the degree of low-light dysphotopsias correlates with the quality and quantity of near vision. With greater range of vision comes greater potential dysphotopsias,” says Dr. Chang. “However, the addition of a VLF, as well as manufacturing improvements such as HD-lathing, helps to mitigate the impact of these dysphotopsias. As each successive generation of Tecnis is introduced, we are seeing additional optics technology, which gives us better visual quality and range of vision while minimizing dysphotopsias. That makes the Tecnis Synergy very exciting, as it provides more range and functionality to our patients than we’ve ever been able to offer before.”

Dr. Chang says that, though this light technology will decrease the relative amount of glare, halos, and starbursts for the provided range of vision, surgeons should still be aware of their impact. Therefore, he will continue to emphasize the possibility of dysphotopsia symptoms in his preoperative risk/benefit conversation. He says that, fortunately, the full range of vision that patients experience generally makes the dysphotopsia tradeoff more acceptable.

Adapting the Patient Dialogue

Dr. Chang says that his patient conversations regarding presbyopia have always included discussion around the dangers of multifocal spectacles and potential falls in the elderly.

“My patient dialogue around presbyopia and cataract surgery has always begun with a conversation about safety,” he explains. “Though we often think of correcting presbyopia as a convenience, safety should also be at the forefront of that conversation.”

Dr. Scott adds that the Tecnis Synergy simplifies the patient conversation in that doctors will now be able to offer their patients more — with less compromise. That makes everything much easier on the patient, she says.

“Patients absolutely understand what they’re gaining, so we expect to see much higher conversion rates,” she continues. “In the past, I would often have patients tell me they would be more interested in the multifocal lenses if they were younger. But now that we have this option, I believe we’ll see higher conversion rates in older patients. What they have to gain in terms of benefits outweighs the risks.”

For older patients, Dr. Scott says it’s safe to say the lens will last their lifetime, increasing the benefits even more.

“For this generation of patients to be able to have great depth perception and see at all distances — without worrying about bifocals — is incredibly exciting,” she says. “Given my experience with the trials, I’m confident that my patients are going to be able to achieve a full range of vision, which could be life changing in many cases.”

Dr. Scott says this lens taking a tried-and-true technology, material, and platform—and improving upon it—also instills peace of mind. She says that ophthalmologists have already had good EDOF and trifocal IOLs available to them, which have demonstrated positive patient outcomes. Now, this lens advances those benefits even further.

“It’s palpable that patients are excited about their vision,” Dr. Chang adds. “With EDOF IOLs, patients do not always realize what they’ve gained in terms of range improvements, especially in low myopes. But with Tecnis Synergy, the improvements are incredibly clear. Having that full range of vision is a major gain for almost all patients — and that’s hard not to appreciate. It all adds up to meeting our patient needs and making them happy.” ■

Daniel H. Chang, MD, is a cataract and refractive surgeon at Empire Eye and Laser Center in Bakersfield, CA. A member of ASCRS’s Refractive Surgical Clinical Committee, Dr. Chang has a career focus of “conquering presbyopia.”

Maria Scott, MD, is Chief Medical Officer of Vision Innovation Partners, and Medical Director of Chesapeake Eye Care and Laser Center and Chesapeake Eye Surgery Center. She is a cataract and refractive surgeon in Annapolis, Maryland, and specializes in refractive IOLs.

Disclosures
Dr. Chang is a consultant to and has received research funding from Johnson & Johnson Vision. Dr. Scott is a consultant to Johnson & Johnson and Zeiss.