EyeWorld Asia-Pacific September 2019 Issue

A t this lunch symposium sponsored by Johnson & Johnson (Japan), Choi Chul Young, MD , PhD , said a “mix and match” approach with extended depth of focus (EDOF) and bifocal intraocular lenses (IOLs) may be a better option than bilateral implantation of a trifocal IOL. In his first study, he compared the Tecnis Symfony ZXR00 for dominant eyes and the Tecnis ZLB00 (+3.25 add) for non-dominant eyes to the Symfony alone. In that comparison, mix and match produced “much better outcomes” than the Symfony alone. “This mix-and-match could be an effective individualized option,” he said. Also, because Japanese, Korean, and Chinese letters have a much more complicated design, patients prefer more precise near vision. Oliver Findl, MD, MBA , spoke about the Tecnis Eyhance, which uses a monofocal base (the Tecnis platform) to provide multifocal vision. This lens provides equivalent modulation transfer function (MTF) at distance than other aspheric monofocal IOLs in photopic conditions and better MTF in mesopic conditions compared to other lenses. “The Tecnis Eyhance delivers intermediate vision with monofocal optics for the first time,” Dr. Findl said, and provides “statistically significant improvement in monocular intermediate vision at 66 cm” when compared to the Tecnis 1-piece IOL. This lens also provides surgeons with a “larger sweet spot,” he said. In fact, “we use the lens as our standard lens since about May. It has a larger landing zone, and fewer patients are unhappy than with a regular monofocal.” When asked how he explains the technology to patients, Dr. Findl said he doesn’t. “If you tell patients they’ll have better intermediate vision, you’ve oversold. They just get the lens. We over-deliver,” he said. “The Eyhance is not a replacement for multifocals, it’s a step forward for replacing monofocal lens.” Targeting slight myopia with the Symfony via bilateral implantation should be a consideration, said Kunihiko Nakamura, MD, PhD . In a comparison to the PanOptix lens, he said the Symfony “might be better than the PanOptix at intermediate vision during monocular distance corrected but the PanOptix might be better than the Symfony at near distance.” In a comparison of binocular implantation with the Symfony targeting emmetropia and slight myopia (–0.5 D) and the PanOptix, the slight myopia was significantly better than the emmetropia at 50 cm distance, but there were no differences in log contrast sensitivities at all spatial frequencies. “Bilateral implantation of the Symfony targeting –0.5 D would expand the working distance and improve spectacle independence without aggravating uncorrected far vision,” he said. He recommends staged implantation, with the Symfony in the first eye and if the patient is satisfied with near vision, implanting the Symfony in the second eye. If the patient is unsatisfied for near vision, implant the second eye with a Tecnis multifocal. Innovations in Technology Supported by an educational grant from