Presbyopia-correcting IOL improves vision for patients

Reviewed by Eric D. Donnenfeld, MD

The Tecnis Synergy and Tecnis Synergy Toric II IOLs (Johnson & Johnson Vision) received FDA clearance in early May 2021 and are now commercially available in the United States.

As an early adopter of these new implants, which are designed to provide a continuous range of vision, Eric D. Donnenfeld, MD, said that he is extremely pleased with the outcomes he has achieved during his initial experience.

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“The optic of the Synergy IOLs is very interesting, as it combines trifocal and extended depth-of-focus [EDOF] designs and brings the benefits of both technologies to give patients a full range of quality vision,” he said. “In particular, the Synergy IOLs stand out for providing an improved level of near vision.”

Overall, Donnenfeld said the IOLs seem to give the highest likelihood of achieving spectacle independence of any currently available presbyopia-correcting IOLs.

“I have had the opportunity to use the Synergy IOLs for about 1 month, and I am looking forward to gaining more experience and seeing the outcomes in a larger group of patients and after longer follow-up,” he said.

Functional performance
The near vision benefit of the Synergy IOLs is particularly impressive, according to Donnenfeld, founding partner of Ophthalmic Consultants of Long Island and Ophthalmic Consultants of Connecticut, Garden City, New York, and clinical professor of ophthalmology at New York University Medical Center, New York.

“Patients [in whom] I have implanted the Synergy IOL are reading J1 effortlessly, even in situations with moderate lighting,” he noted. “Achieving that level of near vision with other IOLs usually requires an abundance of light.”

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Distance vision with the Synergy IOL is comparable to that of trifocal IOLs, and with the Synergy IOL there is no drop-off in visual acuity or quality in the intermediate range.

“Patients implanted with the Synergy IOL have experienced no problems with driving nor concerns with driving at night,” Donnenfeld said. “They still may notice some halos around lights, which would be expected with any diffractive trifocal design, but the halos are not bothersome. I have not had any patient complain.”

The novel optic design of the Synergy IOL also seems to explain another interesting feature of the lens that sets it apart from other IOLs.

“Results from bench testing showed that contrast sensitivity performance was better with a large aperture and dim illumination than in bright light with a smaller aperture size,” Donnenfeld explained.

The Synergy IOLs incorporate technologies for violet light–filtering and chromatic aberration improvement that may reduce dysphotopsias and improve contrast and visual clarity.

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Donnenfeld observed that the features of the Tecnis Synergy IOL optic suggest that the visual outcome should be forgiving to small amounts of decentration or residual refractive error.

Familiar features

The Tecnis Synergy IOLs are made of the same hydrophobic acrylic material found in other Tecnis lenses and have the same A-constant as the Tecnis monofocal (ZCB00) and Tecnis Eyhance IOLs.

“The Tecnis IOL hydrophobic acrylic material is glistening free and provides crisp quality vision," Donnenfeld said.

Donnenfeld said he expects that the Tecnis Synergy IOLs will be an extremely valuable addition to existing presbyopia-correcting IOL options. He noted he has also been very happy with the Tecnis Eyhance IOL (Johnson & Johnson Vision) and the AcrySof Vivity IQ (Alcon) IOLs that are now available.

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“Both of these IOLs give patients some improved near vision without compromising the quality of distance vision because there is no loss of contrast at distance,” he said.

Donnenfeld said he is still fastidious about selecting appropriate candidates for a trifocal IOL.

“I am very comfortable recommending the Synergy IOL to a broader pool of patients, but at the same time, I am still very careful about evaluating patients for conditions that can affect the outcome, such as significant dry eye disease and macular pathology,” he explained.

Trifocal and EDOF IOLs available in Europe are expected to enter the US market. However, the next big advance in presbyopia-correcting IOLs will come with the approval of an accommodating IOL, Donnenfeld said. The Juvene (LensGen) may begin investigation in a phase 3 trial in 2021.

“I had the opportunity to implant this fluid-optic IOL in Mexico and was impressed by the quality of vision it provides,” he concluded. The Juvene IOL gives true spectacle independence without light splitting. It offers the range of vision of a trifocal IOL with the contrast sensitivity of a monofocal lens,” he said.

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Eric D. Donnenfeld, MD
E: ericdonnenfeld@gmail.com
Donnenfeld is a consultant for Alcon, Johnson & Johnson, and LensGen.