EyeWorld India December 2021 Issue

REFRACTIVE EWAP DECEMBER 2021 25 Donnenfeld, MD, were performing their first cases with these lenses when EyeWorld spoke to them in June. Dr. Williamson said, overall, his procedures went great and his patients with the lens were doing “extremely well” postop. The preoperative workup for Synergy, he said, is similar to that with other diffractive IOLs. Intraoperatively, he said he was excited about the injector, which he noted is preloaded and only requires a little balanced salt solution (no viscoelastic). Inside the eye, he said you could count about 15 rings, and he thought the central button was a decent size. “It was a bit smaller than the Symfony [Johnson & Johnson Vision], but it was still easy for me to align it on the coaxial Purkinje,” Dr. Williamson said. He also implanted a couple of the toric versions of Synergy. He said the upgraded haptic arms were sticky. “It was a little hard to rotate, which was a good sign because that tells you it’s going to stay in place,” he said. Dr. Williamson described Synergy as like the baby of the ZMB00 (Johnson & Johnson Vision) and Symfony. “The reason why the ZMB00 was difficult is you had huge gaps in between. It had great near and functional distance, but it didn’t have much intermediate, so you slap an EDOF on there and you don’t have the drop-off in midrange vision,” he said, adding that he thinks Synergy will provide the best near vision on the market. He said the lens has technology that corrects for chromatic aberration, giving higher contrast in low light situations. It blocks violet light, which is a shorter wavelength. Shorter wavelengths, Dr. Williamson explained, cause more problems with light scatter. “By selectively blocking out the violet wavelength of light, they’re finding this lens performs well in low light situations,” he said. Dr. Donnenfeld said he thinks Synergy will be similar to PanOptix in many ways, though he also said Synergy appears to have a little more reading vision and better contrast sensitivity under scotopic conditions. “I think what it comes down to is it will give excellent quantity of vision. The question is going to be what is the dysphotopsia profile? We don’t have a lot of experience on what that will be like,” Dr. Donnenfeld said. Accommodating IOLs There is not yet a truly accommodating IOL available in the U.S., but Dr. Donnenfeld said Juvene (LensGen) will soon start clinical trials on its path to potentially earning FDA approval. “All lenses that give presbyopic solutions currently split light to some extent, and by doing that, they reduce contrast sensitivity. A truly accommodating lens would be a lens that would focus so that all the light would be given to the distance that you’re looking at and there would be no loss of contrast, no glare, no halo,” Dr. Donnenfeld said. This is what Juvene could achieve. Accommodating lenses from other companies are at different stages of development as well. Dr. Donnenfeld has experience with Juvene as an investigator with it for a study in Mexico. “We have a long track record with it, and what we find is that it gives a defocus curve of about 2.5 D of reading without splitting light. When patients are asked about quality of vision, they don’t complain of glare, halo, starbursts, or the dsyphotopsias that you see with a multifocal lens. … The contrast sensitivity with and without glare is the same as a monofocal lens,” he said. As a biomimetic lens, Dr. Donnenfeld said it fills the capsular bag. Going out to 5 years, capsules of eyes that have received this lens are completely clear (without opacification), and Dr. Donnenfeld said there is minimal risk for posterior vitreous detachment or floaters. “Presbyopic, accommodating lenses are the future. We’re going through a period of time now where we’ve seen dramatic improvements with multifocal lenses, but in the future, I think that accommodating lenses will replace our traditional multifocals, and the technology will continue to improve,” he said. Advice for young eye surgeons Drs. Yeu, Williamson, and Donnenfeld offered their advice to young eye surgeons on when new lens technologies become available. Dr. Yeu said surgeons should be comfortable with management of dissatisfied patients. “We have to have things in place so we can help manage those patients in the instance that we’re not able to meet their expectations,” she said. “If [a young eye surgeon is] comfortable with that, I would say talk to someone you trust in terms of technologies, especially with early adopters.” For surgeons who have some trepidation about newer technologies, Dr. Yeu said to look at lenses that have been out for longer vs. what’s brand new. These lenses, she explained, go through their own learning curve once they enter the market, with surgeons learning over time how they perform in the real world in terms of quality of vision, patient satisfaction, and side effects. The longer track record, she said, is what can give surgeons confidence with PanOptix. “There are several years of good data out there, and it performs well. If a [young eye surgeon] wanted to jump into multifocality, it’s a great time to jump into multifocal IOLs,” Dr. Yeu said.