BLOG: It’s always personal
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Key takeaways:
- The combination of a Symfony IOL and a Synergy IOL maximizes range and quality of vision.
- There have been fewer dysphotopsias complaints and a lower enhancement rate with this combination.
Personalized vision, or mixing and matching of IOLs to achieve optimal results, is a long-established practice.
Since 2005, Frank A. Bucci Jr., MD, for example, has conducted multivariate regression analyses with more than a dozen pairings of IOLs from various platforms to identify predictors of patient satisfaction. In our clinic, we have utilized a personalized approach since the introduction of low-add multifocal IOLs. Our goal has consistently been to optimize vision for each eye individually and to push the limits of optical quality, range of vision and stereoacuity for each patient.
The Tecnis Symfony IOL (Johnson & Johnson Vision), as the first extended depth of focus (EDOF) IOL, helped to define a new lens category in the U.S. While never intended to be a full range of vision IOL, this lens provides what we have always found to be a meaningful benefit in uncorrected “social” reading vision. In other words, patients are able to perform many tasks in their daily life without glasses but typically require readers or a slight myopic defocus for fine print or prolonged near activities.
The next-generation presbyopia-correcting IOL that followed, Tecnis Synergy with InteliLight technology, further expanded on the available presbyopia-correcting IOLs subcategories with the first hybrid EDOF-multifocal. It brought new advantages in terms of a closer near point — what we call “very near” vision at about 33 cm — and good reading performance in low light. Consistent with trifocal and other multifocal IOLs, this lens provides a wide range of focus but is not as refractively forgiving, in our experience, as a pure EDOF lens; however, it is more refractively forgiving than a trifocal IOL. Additionally, due to the complex optics of the Synergy lens, we recommend implantation in healthy eyes.
Based on our international colleagues’ experience with these two newer IOLs, we hypothesized that our patients might benefit from a pure EDOF lens in the dominant (or less healthy) eye, paired with a full range of vision IOL in the nondominant (or healthier) eye. This allows us to maximize contrast sensitivity and quality of vision in the distance or compromised eye while expanding the range of vision in the fellow eye for the greatest possible spectacle independence. With the introduction of Symfony OptiBlue, both of these lenses now have the InteliLight features of correcting for chromatic aberration, filtering out violet light and high-resolution lathing that all contribute to optical quality, making the matchup even more intuitive.
With this combination, we have fewer dysphotopsias complaints and a lower enhancement rate, although neither is completely zero. A great advantage is that both eyes can be targeted for distance, maximizing stereoacuity. In talking with patients, I try to have an outcomes-based discussion and avoid confusing medical terminology. If patients do notice that they see a little differently out of their two eyes, we reassure them that the difference is by design.
Our practice optically customizes the IOL choice for each eye individually and the best pair of IOLs to maximize each patient’s overall stereoacuity, range and quality of vision. With this combination of IOLs, we have been able to streamline the process.
Read more blogs from George O. Waring IV, MD, FACS, here.
Follow @georgewaring on Twitter.
References:
- Bucci FA Jr. Multivariate regression analysis to identify predictors of patient satisfaction with presbyopia-correcting IOLs. Presented at: American Society of Cataract and Refractive Surgery meeting; 2018; Washington.
- Rocha KM. J Refract Surg. 2017;doi:10.3928/1081597X-20170217-01.
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