42 EyeWorld Asia-Pacific | September 2024 Introducing the Next Generation TECNIS™ Presbyopia-Correcting EDOF IOL At the 39th Asia-Pacific Academy of Ophthalmology (APAO) Congress held in conjunction with the 49th PERDAMI, or the Indonesian Ophthalmologists Association (IOA) Annual Meeting in Bali, Indonesia in February 2024, three highly regarded ophthalmologists came together to speak about the next generation presbyopia-correcting intraocular lens (PCIOL). History and Evolution of Presbyopia-Correcting IOLs (PCIOLs) Gerd Auffarth, MD, FEBO (Germany) offered a unique perspective on his experience with various PCIOLs. In terms of technology, Dr. Auffarth agrees that everything is there for the clinicians. “We just have to pick the right lens for the right patient,” he said. “The question is, what lens do we choose? In Germany, we have so many lenses. There are too many choices, and it can get very confusing.” Thinking back to the EDOF concept, the TECNIS Symfony™ IOL was one of the first EDOF lenses that was engineered with the Echelette design. Although real world data was strong for the TECNIS Symfony™ IOL, patients were still experiencing dysphotopsia, and the lens was primarily targeted for intermediate vision. “In order to get to the point where you get extremely good spectacle-free near vision, you have to have a combination of TECNIS Symfony™ with a bifocal diffractive lens,” Dr. Auffarth explained. This resulted in the TECNIS Synergy™ IOL, which creates a very flat defocus curve over a wide range of diopters while delivering continuous high contrast. “But we have to know that depth of field and dysphotopsia are directly related to one another,” Dr. Auffarth continued, “and are dependent on the technology we are using in our optics.” In a plano eye, the light rays are directly focused on the fovea. In a myopic eye, the focus is in front of the retina, and patients can experience a shine around the point source of light. Thus came the lens: the TECNIS Eyhance™ IOL, which aims for mid-range visual acuity while maintaining correction of primary spherical aberration. Similar to Dr. Auffarth’s experience, in a European Society Of Cataract & Refractive Surgeons (ESCRS) Clinical Trends Survey conducted in 2021, Tim Roberts, MBBS, MMed, FRANZCO, GAICD (Australia) saw that 66% of responding ophthalmologists were most interested in using an extended depth of focus (EDOF) intraocular lens (IOL) in their practice, more so than trifocal, shape-changing, or light-adjustable IOLs. However, the ophthalmologists’ biggest concerns and unmet needs regarding PCIOLs were night-time quality of vision and loss of contrast visual acuity. Dr. Roberts explained that the ideal EDOF IOL would provide a sharp focus over a wide range without unwanted dysphotopsia or any visual side effects. This wide range would give patients excellent distance and intermediate vision. “This ideal is theoretical,” Dr. Roberts explained, “and it doesn’t exist. You want predictable results. If you implant 100 lenses, and you get 10 or 15 patients that are thrilled, most are not happy, and you are not exactly sure which patient is going to get that result. This is a little bit of a disincentive for introducing a new lens.” J&J Introduces the Next-Generation Refractive EDOF IOL for Presbyopia Correction Nevertheless, recent technical developments have resulted in a new generation IOL: the TECNIS PureSee™ IOL. The refractive TECNIS PureSee™ IOL Supplement to EyeWorld Asia-Pacific September 2024 design of the TECNIS PureSee™ IOL is based on a continuous change in power. “What the research and development team has done is extend the wavelength so that there is progressive focusing from distance to intermediate to near vision,” Dr. Roberts said. “There is not a zone for intermediate nor for distance vision. This is a smooth, continuous, and elongated posterior surface.” The TECNIS PureSee™ IOL’s front optics compensate for the spherical aberrations of the cornea, while the posterior optics maintain a dysphotopsia profile comparable to a monofocal IOL and provide a uniform depth of field from distance to near. Comparing the TECNIS PureSee™ IOL to other EDOF IOLs, Dr. Auffarth explained that the quality of vision, the modulation transfer function (MTF), for TECNIS PureSee™ stays stable over several millimeters of aperture, while other EDOF lenses show a greater loss in MTF as pupil diameter increases. TECNIS PureSee™ IOL: What are the Clinical Merits? Clinical Outcomes with the Next-Generation Refractive EDOF IOL In the proof-of-concept study that Dr. Roberts took part in, a total of 117 patients from six sites in Australia and one site in New Zealand were evaluated. This prospective, randomized, double-blinded study analyzed 60 patients receiving the TECNIS PureSee™ IOL and 57 patients receiving the TECNIS Eyhance™ IOL, an enhanced monofocal IOL, at 6-month follow-up. Dr. Roberts stated that the results were excellent: distance vision for those implanted with the TECNIS PureSee™ IOL was statistically non-inferior to those implanted with the monofocal IOL, and 100% of TECNIS PureSee™ IOL eyes achieved 0.20 logMAR or better.1 “The take home message is that the quality of distance vision with the TECNIS PureSee™ IOL is as good as we are getting with a monofocal lens,” Dr. Roberts reiterated. Furthermore, when looking at monocular distance-corrected intermediate vision, 82% of TECNIS PureSee™ IOL eyes achieved 0.20 logMAR or better compared to only 60% of TECNIS Eyhance™ IOL eyes, a statistically significant result.1 Additionally, the monocular range of vision at 0.2 logMAR was 0.7 D larger in patients implanted with the TECNIS PureSee™ compared to those implanted with the TECNIS Eyhance™ six months after surgery. “The TECNIS PureSee™ IOL is a very good lens if you’re targeting emmetropia,” Dr. Roberts explained. “Across a cohort of patients, if your mean absolute error is a little bit plus or a little bit minus, the uncorrected quality of vision with this lens is maintained, so we’re getting a really good range across refractive errors.” For those who are concerned about moving from a monofocal to an EDOF lens, the results of the proof-of-concept study further showed that TECNIS PureSee™ provides high distance image quality comparable to a monofocal as well as more tolerance to refractive errors. From validated patient-reported questionnaires,
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