Johnson & Johnson Vision’s (J&JV) Tecnis Synergy presbyopia-correcting intraocular lens (IOL), launched in September 2019, is living up to its promise, according to cataract surgeon Dr Rob Paul from WA Laser Eye, in Western Australia.
The IOL combines diffractive technology from J&JV’s Tecnis Multifocal and extended depth of focus features from the Tecnis Symfony IOLs to deliver continuous high-contrast vision from far through near, even in low-light conditions.1,2
Having implanted 110 lenses over 12 months, Dr Paul says his patients have been impressed with the results.
For the first time, patients are coming in and specifically asking for this IOL by name
“Patients tell me their vision is amazing – particularly for reading – they can hold their reading at any distance rather than find the sweet spot, which is something they’ve never had before. They also find that it’s very good for distance.”
Interestingly, he said, “For the first time, patients are coming in and specifically asking for this IOL by name – they have heard about Synergy, talked about it with their friends and researched it.”
Describing the technology, Dr Paul said, “It is much like the trifocal IOLs I previously used, however the main point of difference is that it offers a continuous range of vision from near to intermediate and distance with no jumps in vision.
“So you can look from your mobile or a book to the computer and into the distance without any blur.”
Of the patients he has implanted with a Synergy IOL, Dr Paul reported that 90% are getting 20/20 for distance; and 98% are getting 20/20 for intermediate and N5 or better for reading.
“I’ve been putting multifocal IOLs in since 2005 and they were very good but nothing like this. The Symfony, which was J&JV’s precursor to the Synergy, was excellent for intermediate and distance vision but patients complained that it wasn’t good enough for near; it didn’t have the reading component.
“The Synergy is an extended depth of focus IOL with excellent near vision – and that’s the game changer – otherwise it would be the same as a trifocal – the continuous vision is key.”
REDUCES GLARE AND HALOES
J&JV has reduced glare and haloes by designing the Synergy with a violet filter, which creates less light scatter on the retina.
“This design appears to reduce glare and halos by about 50%,” Dr Paul said. “I find that while about 80% of patients implanted with other presbyopic IOLs will complain of glare and haloes, only about 30% of patients implanted with a Synergy will spontaneously complain of the same. Patients who are left short sighted will typically get more glare and haloes, but the violet filter corrects for this – and reduces the number of complaints.
“Of course for almost all patients, glare and haloes dissipate after six to nine months, so it’s a case of clearly discussing this in the planning stage and reassuring them that they won’t last.”
To further reduce the chance of glare and haloes and optimise vision he recommended, “aim for slight long sightedness – about +0.25D gives you the best outcomes. If a patient ends up at -0.25D or greater, vision problems, such as glare and haloes will be magnified, and distance vision won’t be so good. It’s a very sensitive lens but if you aim for the right target, you’ll get the right results… there’s always laser vision correction as a back-up, but to date, I haven’t had to use it.”
While there is no difference in the implant procedure, he said he uses femtosecond laser for patients getting the implant for cosmetic reasons because they no longer want to wear glasses.
“Femtosecond achieves more perfect surgery in my hands, but otherwise it’s routine manual cataract surgery for patients and it takes about five minutes.”
Contraindications for the Synergy are as they would be for any multifocal IOL.
“You wouldn’t implant it in a patient with macular degeneration, significant glaucoma, terrible dry eye, corneal disease or keratoconus. And you certainly wouldn’t implant it in a patient who’d had previous radial keratotomy surgery. Any of these conditions would exclude patients,” he said.
When asked whether he would have this lens implanted in his eye, Dr Paul didn’t hesitate to respond. “Yes I would.”
Dr Paul concluded by saying that a toric version of the Synergy is “eagerly awaited” so that astigmatism can be addressed as well.
- DOF2019OTH4003 – Clinical Investigation of the Tecnis Next-Generation IOL Model ZFR00 (Tecnis Synergy IOL): 6-Month POC Data. 23 Apr 2019.
- DOF2019OTH4002 – Weeber H. MTF of the Tecnis Synergy OptiBlue IOL, and other lens models. 27 Mar 2019.