EyeWorld India December 2021 Issue

Complementing My Practice PCIOL Portfolio Hiroko Bissen-Miyajima, MD, Japan Presbyopia-correcting (PC) IOL usage in cataract surgery in Japan remains quite low at 5%, though Hiroko Bis- sen-Miyajima, MD reports a usage rate of 85% in her own practice. Dr. Bissen-Miyajima began using PC IOLs in the 1990s and has had experi- ence with both refractive and diffractive IOLs. Currently, the most commonly used PC IOLs are EDOF IOLs and contin- uous range of vision (CRV) IOLs. For successful implantation of PC IOLs, Dr. Bissen-Miya- jima states that it is important to “understand the patient’s expectation for vision” so as to avoid unhappy patients following implantation. In trying to understand patient expectations, Dr. Bissen-Mi- yajima conducted patient surveys through a national cohort study as well as in her own practice. The national cohort study observed patient expectations at 65 institutions across Japan, analyzing 1,384 eyes of 871 patients. Although this data is not speci c to the TECNIS Synergy™ IOL, a variety of PC IOLs were used in Dr. Bissen-Miyajima’s study, and eyes were analyzed at varying distances. Fifty-nine percent (59%) of patients were satis ed or very satis ed with their near vision, while 88% and 75% of patients were satis ed or very satis ed with their distance and inter- mediate vision, respectively. “There is still room to improve with near vision,” says Dr. Bissen-Miyajima. This con- cern is important because in the Asian population, Chinese characters need to be 1.54 times larger than the English alphabet to provide the same visual acuity, thus the need for better near vision. “Our biggest concern for selecting the correct PC IOL is with unhappy patients whose complaints are severe and who require long-time consul- tation,” says Dr. Bissen-Miya- jima. To understand patients’ postoperative satisfaction, Dr. Bissen-Miyajima conducted an evaluation of unsatis ed patients at her hospital. She was able to analyze surveys from 464 patients. From the 6.8% of patients who report- ed they were dissatis ed or extremely dissatis ed. Dr. Bissen-Miyajima was able to determine that the keys to successful PC IOL implanta- tion are to provide suf cient near vision and minimize the loss of contrast sensitivity. Dr. Bissen-Miyajima pointed out that although the TECNIS Symfony ® IOL does provide better contrast sensitivity than other bifocal IOLs, but up-close near vision still lags behind trifocal IOLs. Com- bining the TECNIS Symfony ® IOL with the technologies of the TECNIS ® Multifocal IOL, which gives good distance and near vision but lacks in contrast sensitivity, results in the TECNIS Synergy™ IOL which has the optical bene- t of both. In a retrospective study analyzing 33 eyes, the TECNIS Synergy™ IOL showed comparable UCVA to the combined distance acu- ities of TECNIS Symfony ® and TECNIS ® Multifocal IOLs. Ad- ditionally, contrast sensitivity was within normal range. In one case report, Dr. Bis- sen-Miyajima described a 69-year-old male pilot who strongly wished for spectacle independence with a high concern for glares and halos. After being told the advan- tages and disadvantages for different PC IOLs, the patient selected implantation with TECNIS Synergy™, and his surgical outcomes were excel- lent. “The patient told me that this was the best decision of his life,” said Dr. Bissen-Miy- ajima. In her practice, Dr. Bissen-Mi- yajima says CRV IOLs such as TECNIS Synergy™ and EDOFs like the TECNIS Symfony ® IOL both have a place in practice. For patients who wish for good continuous vision from distance to near, TECNIS Syn- ergy™ is a good choice. For patients who want very good contrast sensitivity and high-quality vision, yet do not mind using reading glasses for small print, TECNIS Symfo- ny ® is an option. Polished haptics The NewAge of Prebyopia Correcting IOLs “ In the Asian population, Chinese characters need to be 1.54 times larger than the English alphabet to provide the same visual acuity, thus the need for better near vision. ” Dr. Dr. Hiroko Bissen-Miyajima