Eyeworld

62 | EYEWORLD | SEPTEMBER 2021 R EFRACTIVE Relevant disclosures Donnenfeld: Alcon, LensGen, Johnson & Johnson Vision Williamson: Johnson & Johnson Vision Yeu: Alcon, Johnson & Johnson Vision "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 cor- rects 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 wave- length 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. Accom- modating 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 who are younger and 20/20 with mild cataracts complaining of glare would give her pause with PanOptix alone, Dr. Yeu said, but coupling it with Vivity in the dominant eye mitigates the dysphotopsia profile of PanOptix in the non-dominant eye. "Patients have loved that," she said. "It's not my go-to, but it has expanded who I am able to offer it to." Overall, Dr. Yeu said there is a high level of satisfaction among patients and surgeons with PanOptix. "This lens technology has created that easy button. It allows for it to be an easier conversa- tion that we can have our counselors partake in. It helps to enable proper education and expecta- tions for the patient, and it meets those expecta- tions, even exceeds them," she said. Combination multifocal-EDOF TECNIS Synergy (Johnson & Johnson Vision), which combines multifocal diffractive and extended depth of focus technology, received FDA approval in May. Blake Williamson, MD, and Eric 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 ver- sions 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. continued from page 60

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