Eyeworld Supplements

EWAP WIN 2018 - Sponsored by Johnson & Johnson Vision

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Delivering the next generation of outcomes with new lens and corneal refractive technology Supplement to EyeWorld Asia-Pacific Winter 2018 Y ao Ke, MD, Hangzhou, China, and Ronald Yeoh, MD, Singapore, led a symposium during the 2017 Asia-Pacific Association of Cataract & Refractive Surgeons (APACRS) meeting in Hangzhou, China on optimizing outcomes with currently available premium lens and corneal refractive technologies. The faculty included Fam Han Bor, MD, Singapore, Edward Manche, MD, Palo Alto, California, and He Tian Geng, MD, Tianjin, China. Extended range of vision for presbyopia after cataract surgery Dr. Yao presented on extended depth of focus (EDOF) IOLs for presbyopia after cataract surgery, reviewing the various options available for patients. In 1958, monovision was introduced. This option offers better intermediate vision compared to standard multi- focal IOLs, and there is good contrast sensitivity. Disad- vantages, however, include anisometropia, compromised stereopsis, and inconsistent reading ability. In 1987, bifocal IOLs began to be used, which offer optimal distance and near vision, but also have contrast sensitivity loss, light energy loss, and visual interference. Accommodative IOLs have been an option since 2003. These have the advantages of good intermediate vision, less photic phenomena, and good contrast, however, they have a limited accommodation range, difficulty with effective lens position (ELP) assessment, and reduction of accommoda- tion by capsular contraction and fibrosis. Trifocal IOLs became an option in 2010, and these offer a full range of good vision and high rate of spectacle indepen- dence. But Dr. Yao noted that there are three co-existing foci that are perceived by the visual cortex, and there could be more photic phenomena. Dr. Yao then spoke about the Symfony (Johnson & Johnson Vision, Santa Ana, California), an extended range of vision IOL, which offers extended depth of focus; a continuous range of near, far, and intermediate vision; a bigger central optic area, which can ensure far vision if the IOL is decentered; and fewer diffractive rings for less visual interference. It also offers a pattern of light diffraction that elongates the focus of the eye resulting in about 1.5 D of extended range of vision. The Symfony has nine diffractive rings of echelette design on the posterior surface, Dr. Yao said, and a 1.7 mm diameter of the center refrac- tive optic. Dr. Yao described several studies using EDOF lenses. In one study by Pedrotti et al., 1 the Symfony was compared to the monofocal Tecnis ZCB00 IOL (Johnson & Johnson Vision), with 50 eyes of 25 patients with the Symfony and 15 eyes of 30 patients with the Tecnis. It was determined that the Symfony displayed smooth defocus curves, without loss of distance vision or decrease in optical quality analysis param- eters. Dr. Yao also referenced a study by Hamid et al. 2 that compared the Symfony lens to trifocal options. Conclusions from the study were that the Symfony has advantages in distance and intermediate vision as well as in contrast sensitivity and photic phenom- ena control. The study found that near vision, defocus curve between –1.5 D to –3.0 D, and spectacle independence were better with the trifocal options. Dr. Yao discussed a study at his center that was conduct- ed from August 2016 to March 2017 in 27 eyes of 18 patients. Several factors were exam- ined, including visual acuities at different distances, defocus curve, near contrast sensi- tivity, aberration, modulation transfer function (MTF) graph, and photic phenomena. The study found that the Symfony continued on page 2 Dr. Yao described studies comparing the Symfony IOL and the ZMB00 IOL. A study at his center found that the Symfony lens provided better uncorrected and distance corrected intermediate vision and also had excellent contrast sensitivity. Source: Yao Ke, MD Sponsored by Johnson & Johnson Vision ZXR00 Symfony IOL ZMB00 Multifocal IOL The news magazine of the Asia-Pacific Association of Cataract & Refractive Surgeons APACRS

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