Dual-optic IOL shows good accommodation at 5 years

No loss of accommodative ability and no posterior capsular opacification were seen with Synchrony lens.

ROME — A dual-optic accommodating IOL shows good visual acuity results with a high degree of spectacle independence, stability over time and objective evidence of accommodation at 5 years, according to studies.

In addition, because of the unique design of the Synchrony lens (Visiogen), posterior capsular opacification rate is extremely low.

“My personal experience begun more than 5 years ago, and I am continuingly impressed with how clear capsular bags look, as well as with the high rate of long-term patient satisfaction,” said Ivan L. Ossma-Gomez, MD, MPH, of Fundación Valle del Lili in Cali, Colombia.

At the winter meeting of the European Society of Cataract and Refractive Surgeons held here, Dr. Ossma-Gomez outlined the key steps of surgery for successful outcomes with the Synchrony IOL.

Centered, intact rhexis needed

Capsulorrhexis, Dr. Ossma-Gomez said, is the most important part of the procedure. To make the lens work at its best, a well-centered, intact rhexis of 4.5 mm to 5.5 mm in diameter is needed to have a perfect overlap around the 360° of the anterior lens optic.

“I use a rhexis marker when I am initiating the surgery to set the boundaries of the rhexis. I know I cannot go beyond those, and if at the end of the procedure the rhexis is too small, I can always enlarge it,” he said.

At the end of phaco, the anterior capsule must be polished thoroughly using bimanual irrigation and aspiration to remove the epithelial cells. Their presence and proliferation could, in the long run, have a negative impact on overall capsular contraction.

To implant the lens, the incision must be enlarged to 3.8 mm.

“That’s why I like to do the incision on the steepest axis to reduce the amount of induced astigmatism,” Dr. Ossma-Gomez said.

Delivery of the two optics

For ease of implantation, a pre-loaded injector system is provided. The two optics come out sequentially, posterior first and anterior after. Dr. Ossma-Gomez recommended pausing a few seconds in between the two optics’ delivery to allow the first one to unfold and settle before the second one is pushed out of the cartridge.

All viscoelastic must be accurately removed at the end, without forgetting the space between the two optics of the lens.

“As with any premium IOL technology, attention to details is important. I have so far implanted more than 350 Synchrony lenses, with very good clinical outcomes,” he said.

At the same symposium, Gerd U. Auffarth, MD, of Heidelberg University, Germany, said the dual-optic concept of this lens is “more realistic” than the single-optic system of previous accommodative IOLs.

“The two optics that move away from one another for near vision and come closer for distance vision can cover a distance that could not be achieved by a single moving lens,” Dr. Auffarth said.

In addition, objective accommodation testing using dynamic stimulation aberrometry showed that a group of six patients with 5 years of follow-up maintained 1 D of objective accommodation.

“These patients were implanted with one of the earliest prototypes of the lens. We have now gone five models further and can expect even better results,” he said.

The Dynamic Stimulation Aberrometry system (Optana), linked to the WASCA analyzer (Carl Zeiss Meditec) or to the Ocular Wavefront Analyzer (Schwind), also was used to stimulate and measure accommodation in other patients implanted with more recent models of the lens. A high response to the stimuli was reported, although no response was observed in control groups implanted with traditional monofocal lenses.

Dr. Auffarth reported no capsule fibrosis, no PCO and no intralenticular opacifications in any of the patients whom he implanted 5 years ago. The Synchrony lens fills the capsular bag almost completely and is another demonstration of “the no space, no cells concept.” The lens is perfectly clear at all time points, he said.

Worldwide, more than 1,000 eyes have been implanted with this IOL, which has received CE mark and is currently undergoing a phase 3 clinical trial in the United States. – by Michela Cimberle

• Gerd U. Auffarth, MD, can be reached at Department of Ophthalmology, University of Heidelberg, INF 400, 69120 Heidelberg, Germany; e-mail: ga@uni-hd.de. Dr. Auffarth has no direct financial interest in the products discussed in this article, nor is he a paid consultant for any companies mentioned.
• Ivan L. Ossma-Gomez, MD, MPH, can be reached at Fundación Valle del Lili, Carrera 98, No. 18-49, Cali, Colombia; e-mail: ossma@mac.com. Dr. Ossma-Gomez is a clinical investigator for Visiogen.

There is evidence of long-term accommodation and maintenance of distance, intermediate and near vision with the Synchrony dual-optic accommodating IOLs, and that these outcomes can be achieved by different surgeons. There is also objective evidence of accommodation as measured by dynamic stimulation aberrometry. Most importantly, there seems to be no reported complications or adverse effects associated with this lens.

The Synchrony dual-optic lens represents the next step in the evolution of accommodating IOLs. It will provide ophthalmologists with a superior means to improve the range of vision in patients undergoing cataract surgery.

With 5 years of follow-up, it would seem that any untoward outcomes should have occurred, but the authors report no increase in post-capsular opacification, no capsular fibrosis or intralenticular opacification.

With any innovation, it is important that it build on the current best practices. The Synchrony dual-optic lens has been found in these studies to provide best corrected distance vision similar or superior to the most widely used IOLs, including multifocals.

– George Beiko, BM, BCh, FRCSC

University of Toronto, Canada