Eyeworld

EW NEWS & OPINION 30 September 2016 Chief medical editor's corner of the world by Eric Donnenfeld, MD, EyeWorld chief medical editor design correct for both spherical ab- erration and chromatic aberration. Night vision A major obstacle in the adoption of presbyopia-correcting IOLs has been the concern of visual disturbances under night vision conditions. We have been particularly conserva- tive with those patients who have a high need for good vision in dim light, such as those who drive long distances at night. Although we counseled patients in the study to expect that they might develop glare and halo, we found a very low incidence of night vision symptoms. On a non-directed symptom questionnaire, the vast majority of subjects implanted with the Symfony lens reported no halo, glare, or starbursts, and of those who did report symptoms, most experienced only mild or moderate symptoms, with less than 3% clas- sifying their symptoms as "severe" (Figure 2). We know that reading vision is always easier with good illumina- tion. But the Symfony lens functions much like a monofocal lens, with a high degree of pupil indepen- dence. In addition, the difference in contrast sensitivity (CS) with the Symfony is not clinically significant compared to CS with an aspheric monofocal IOL. In the past, we have judged presbyopia-correcting IOLs primarily by the quantity of vision or Snellen acuity they provide. Quality of vi- sion discussions were framed mostly as a negative, for example, "Can the patient tolerate the expected decrease in visual quality?" Now, we can begin to shift our thinking because we have a presbyopia-cor- recting lens that is likely to perform well for night driving and for more demanding visual tasks where CS matters more than acuity. Functionality for patients Spectacle use was sharply reduced. As I previously noted, the study subjects achieved very functional near vision and 20/20 intermediate —exactly what they need to perform most daily tasks without glasses. About 85% of the Symfony subjects reported wearing glasses "none" or "a little bit" of the time (Figure 3), and 92% said they would select the same IOL again. The weakness of Dr. Donnenfeld shares highlights of the Tecnis Symfony clinical trial results I n July, the U.S. Food and Drug Administration approved the first extended range of vision IOL, the Tecnis Symfony (Abbott Medical Optics, Abbott Park, Illinois). This lens works differ- ently from other presbyopia-correct- ing IOLs in that it provides a wide range of continuous vision while minimizing and even eliminating most of the disadvantages that have been associated with multifocal IOLs. Using diffractive echelette technology and achromatic optics, the lens spreads out light along a range, rather than splitting it be- tween two distinct points. The U.S. clinical trial for the lens was a prospective, randomized, subject- and evaluator-masked study conducted at 15 U.S. sites, including our practice. In all, 148 subjects were bilaterally implanted with the Symfony lens and 150 with the ZCB00 Tecnis monofocal lens. In reviewing the results from the clinical trial, four key features stand out to me. Quality vision at all distances The subjects implanted with the Symfony lens achieved mean binoc- ular uncorrected vision of 20/20 for intermediate distance and between 20/25 and 20/32 for near (Figure 1). But even with these gains in near vision, they still had a high quality of vision at distance. Monocular and binocular distance visual acuity were clinically comparable to that of the monofocal control group. This is better distance vision than I have observed with multifocal IOLs. At our practice, we even had a number of patients who saw better than 20/20 uncorrected at distance, which is unusual with a presbyopia- correcting IOL. I think that this high quality of vision is due in part to the fact that the lens material and New IOL provides high quality vision over extended range Figure 1. In the U.S. clinical trial, Symfony subjects achieved uncorrected binocular vision at distance and intermediate of approximately 20/20 and near vision between 20/25 and 20/32. Figure 2. Complaints of glare, halo, and starbursts were low in both the Symfony and monofocal groups. Figure 3. A statistically significantly greater proportion of Symfony subjects compared to control subjects reported wearing glasses "none/a little of the time," and a majority of Symfony subjects reported never wearing glasses. Source: U.S. Food and Drug Administration

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