We have recently had the opportunity to evaluate a new presbyopia-correcting intraocular lens (IOL) that is available in the United States on a limited market release. The TECNIS Odyssey IOL (Johnson & Johnson Vision) was designed to provide an optimized full range of continuous vision. In developing this lens, additional goals were to achieve excellent contrast sensitivity (CS), tolerance to refractive error, and minimal dysphotopsias. We had the unique opportunity to serve as the second site globally to implant the TECNIS Odyssey lens and participate as 1 of 4 sites in the prospective, open-label study to evaluate performance and patient outcomes. We have recently analyzed our first 100 cases with promising results.

 At the 2024 annual meeting of the American Society of Cataract and Refractive Surgery (ASCRS) in Boston, I presented some of the first clinical results of this lens, from the aforementioned prospective, open-label, multicenter study conducted at 4 U.S. clinical sites.¹ Patients were bilaterally implanted with the TECNIS Odyssey IOL with the target of emmetropia in both eyes. To be eligible to participate in the study, participants had to have healthy eyes (other than cataract) with no history of corneal or refractive surgery. Preoperative biometry and ocular surface evaluations were meticulous, with close attention to appropriate refractive targeting and full correction of astigmatism. We chose the lens power predicted to provide the postoperative refraction closest to plano, with a preference for the first minus if the first plus and first minus refractions were equal.

Expand

Study Results

At 1 month postoperatively, 54 eyes of 27 patients were available for assessment. The monocular defocus curve (Figure 1) is very broad, showing that the TECNIS Odyssey IOL provides monocular mean acuity of 0.2 logMAR (20/32) or better across a wide range, from plano to -2.50 D. Binocular vision is even better: Mean binocular uncorrected distance visual acuity (UCDVA) was -0.04 ± 0.08 logMAR or 20/20+2; mean binocular uncorrected intermediate vision (UCIVA) at 66 cm was 0.05 ± 0.07 or 20/20-2; and mean binocular uncorrected near (UCNVA) at 40 cm was 0.13 ± 0.12 or 20/25-1 (Figure 2). The study is ongoing, with 3-month data to be presented soon.

Expand

Because of this full range of continuous vision, the TECNIS Odyssey lens is categorized under the updated International Organization for Standardization (ISO) standard 11979-7:2024 as a full visual range (FVR) IOL, distinct from both multifocal and extended depth of focus (EDOF) IOLs, which are the 3 types of simultaneous vision IOLs recognized by the standards body. The hybrid EDOF-diffractive multifocal TECNIS Synergy (Johnson & Johnson Vision) and the Clareon PanOptix trifocal (Alcon) are also categorized as FVR lenses. 

IOL Design

To design the TECNIS Odyssey lens, optical scientists began with an optimized monofocal and used advanced optical modeling and artificial intelligence to guide the presbyopia-correcting features of the lens, including a novel free form nonparabolic diffractive profile (Figure 3), meaning a nonuniform distribution of refractive echelettes. Historically, diffractive optics have used a uniform distribution of echelettes and a predetermined distribution of light and add power and contrast sensitivity to specific focal points. The unique design of the TECNIS Odyssey lens more evenly distributes light to maximize CS function, including—for the first time in a diffractive IOL—maximizing CS function in areas of out-of-focus light. This ability allows the lens to achieve a level of visual acuity that, in my experience, we have not previously been able to achieve with an FVR lens due to limitations in CS function. Furthermore, the extension of CS function into areas of unfocused light also improves tolerance for residual refractive error.² Even with our best modern IOL power calculation formulas and even with meticulous planning and surgical techniques, we still cannot predict effective lens position or guarantee a perfectly emmetropic result in 100% of eyes, so some built-in tolerance of refractive error over time is critical to achieving high rates of patient satisfaction with any presbyopia-correcting IOL. 

High-resolution lathing was employed not only in the manufacturing of the TECNIS Odyssey IOL but also in the creation of its diffractive design features, such as the echelettes, which have smoother, more rounded edges (Figure 3), which are intended to further reduce light scatter and dysphotopsia. In my experience thus far, the result is a decrease in the positive dysphotopsias that have been observed previously with other FVR IOLs. Bench testing has shown that the TECNIS Odyssey IOL provides best-in-category contrast and low-light performance thanks to these advanced optical features.

The Odyssey IOL also has all the characteristics we have come to expect of the TECNIS platform, including the highest available spherical aberration correction, a high Abbe number for minimal internal reflections, and both active and passive control of chromatic aberration. The A-constant, preloaded injector, and ease of handling will all be familiar to users of other TECNIS IOLs. 

 Patient-reported Outcomes

Patients in our open-label study also completed the Patient-Reported Spectacle Independence Questionnaire at 1 month. The results showed a high rate of satisfaction with overall vision (93%) and a high rate of spectacle independence, with 89% of patients saying they used glasses “none of the time” or only “a little of the time.” Reports of dysphotopsias were low. Although patients may still notice visual symptoms at night, they seemed to resolve quickly and be minimally bothersome. In particular, in this study and in the global multicenter study, there have been notably fewer reports of starbursts than observed with other presbyopia-correcting IOLs we have implanted.

Although these are still early data, I am highly encouraged by the optimized, full range of continuous, high-quality vision. Anecdotally, our very first patient implanted with the lens was 20/10 and J1 on postoperative day 1, which is not something we have observed with previous FVR lenses due to limitations in CS function. We have since analyzed our first 100 Odyssey IOLs implanted and found mean monocular UCDVA and UCNVA of eyes available for postoperative analysis 20/18 and J1, respectively. Although we have typically employed a mix-and-match or personalized vision approach, combining an EDOF and hybrid EDOF-multifocal with great success,³ we are now primarily using bilateral TECNIS Odyssey IOLs for my refractive lens surgery patients who are candidates. I find this IOL to be one of the best-balanced presbyopia-correcting lenses that we have used to date.  

References

1. Waring GO IV, De Jesus M, Muenz D, Weeber H. Depth of focus and spectacle independence 1-month outcomes for a new full vision range IOL. Paper presented at: Annual meeting of the American Society of Cataract and Refractive Surgeons; April 5-8, 2024; Boston MA.

2. Chang D. Clinical evaluation of tolerance to residual refractive errors following implantation with new diffractive presbyopia-correcting IOL. Paper presented at: Annual meeting of the American Society of Cataract and Refractive Surgeons; April 5-8, 2024; Boston MA.

3. Waring GO IV, van den Berg R, van den Berg A, Rocha KM. Combining an EDOF and hybrid EDOF-multifocal IOL for presbyopia correction: clinical & patient-reported outcomes. Poster presented at: Annual meeting of the American Academy of Ophthalmology; November 3-6, 2023; San Francisco, CA.

Disclosure

Dr. Waring is a consultant for Johnson & Johnson Vision, which funded the study discussed in this article.

George O. Waring IV, MD, FACS is the founder and medical director of the Waring Vision Institute in Mt. Pleasant, SC; director of refractive surgery at the Medical University of South Carolina, Storm Eye Institute; and medical director at Magill Vision Center.