EyeWorld India June 2015 Issue

21 June 2015 EWAP FEATURE distances (Figure 1), including key activities without glasses (Figure 2). Nearly all (98%) said they would recommend the TECNIS Symfony IOL to family and friends. Satisfaction has been high, even among the CLE subjects, who are generally regarded as more difficult to satisfy because they have good vision before surgery. Very high percentages—98% to 99%—say they do not have any severe halo, glare, or starbursts, a rate that is comparable to what we see with monofocal IOLs. Of the limited number of subjects (7) that I enrolled in the study and have personally followed, none is wearing glasses at any distance. These are promising interim results, and I look forward to the final results once all the subjects have reached 1-month follow-up. Finding its place At Goes Eye Centre, we have implanted nearly every presbyopia- correcting lens on the market over the past 15 years, and we regularly recommend multifocal IOLs. However, there are two major disadvantages of the classic multifocal IOLs. The first is that intermediate vision is weaker than we would like. This is especially true with the older bifocal multifocal lenses, which have excellent distance and near vision, but a weaker intermediate distance. In my experience, patients often complain about this gap. We know that intermediate vision is critical for spectacle-free functioning. We use intermediate vision to cook, see the food on our plates, read labels in a store or supermarket, and work on a tablet or computer. True near tasks such as reading a newspaper or book have been declining in importance for many people. Instead, we read books and newspapers on a tablet or a desktop computer. The second disadvantage of multifocal IOLs is the potential for glare, halo, or other unwanted visual effects. Although these are usually mild and improve with neuroadaptation, many patients are afraid of these side effects and unwilling to risk the chance that they might experience more severe glare and halo. I think the fact that the extended range of vision lens provides a substantial improvement in the range of vision while still minimizing undesired halos or glare will make it appealing to patients. Of course, the Tecnis Symfony also has limitations. With this lens, I cannot promise patients 100% reading capability without glasses because it does not extend the range of 20/20 vision all the way to the traditional reading distance of 40–45 cm. However, it extends the range of vision by about 1.0 D throughout the entire defocus curve, from near to far, providing mean acuity of 20/40 or better all the way to 40 cm. To improve a patient’s near acuity, we have the option of micro- monovision. I like to correct the dominate eye for emmetropia and the nondominant eye for –0.50 D. This small gap is easily tolerated and does not cause the problems we typically associate with monovision, but it is just enough to improve visual acuity in the near range and allow most patients to read without spectacles. Just like multifocal IOLs, the quality of vision with extended range of vision lenses will suffer if there is residual astigmatism or residual sphere in the dominant distance eye, so it is important to have a plan for correcting corneal astigmatism. Ultimately, I think extended range of vision IOLs will prove to be an excellent option for our patients who want natural feeling, continuous vision, and who want to avoid visual side effects. EWAP Editors’ note: Dr. Goes is medical director of the Goes Eye Centre in Antwerp, Belgium. He has no financial interests related to this article. Contact information Goes: frankjr@goes.be Advantages, caveats Dr. Koch would like to see peer- reviewed study data to substantiate the results from the AMO studies. Nonetheless, he is excited about the possibilities with these technologies. “I am so impressed by the enthusiasm of the surgeons who have used this lens. This offers the option of micro monovision, giving patients an excellent range of vision without true monovision or other significant visual compromise,” he said. As with any IOL, patients need to meet their refractive targets, and surgeons need to control for astigmatism, Dr. Donnenfeld said. Still, the lens has a built-in advantage for surgeons. “If you’re off by half a diopter, you can still get 20/20 vision because you’re in that sweet spot of 2 diopters. So, if you’re off a little refractively, there aren’t significant refractive concerns like with a multifocal IOL,” he said. Another advantage of the lens for surgeons is that there is no change to the existing surgical technique that they use for IOLs, Dr. Donnenfeld said. “My impression is the same as physicians internationally. Patients are enjoying the lens with minimal refractive complaints,” Dr. Donnenfeld said. EWAP Editors’ note: Dr. Donnenfeld has financial interests with Alcon (Fort Worth, Texas) and Bausch + Lomb (Bridgewater, NJ). Dr. Holladay has financial interests with the Holladay IOL Consultant, Alcon, and AMO. Dr. Koch has financial interests with Alcon, AMO, and Ziemer (Port, Switzerland). Contact information Donnenfeld: ericdonnenfeld@gmail.com Holladay: holladay@docholladay.com Koch: dkoch@bcm.edu