OASC | IOL TECHNOLOGY of field,” he explains. “Because it does not cause much nighttime dysphotop-sia, it’s a good choice for surgeons with limited premium lens experience. If the lens falls short at near, I target near-sightedness, in the -0.75D range on the second eye.” The Tecnis Synergy (Johnson & Johnson Vision), a lens currently avail-able outside the United States, combines multifocal and EDOF characteristics into a single presbyopia-correcting lens—virtually a new category, accord-ing to Dr. Hamilton. “The lens combines the great extended range of the Symfony lens and the multifocality of the higher add power of Tecnis Multifocal to give a full range of unaided vision,” he says. “I look forward to using this promising new technology as soon as it is available in the United States.” Dr. Chang, who has been a clinical investigator of the technology, observes: “The Tecnis Synergy IOL leverages an even greater correction of chromatic aberration to provide the fullest range of any IOL that I have ever used—all while maintaining excellent visual qual-ity. In my experience, patients had near vision as good as high-add multifocals with no perceivable drop-off anywhere in intermediate vision. I look forward to having this lens option when it becomes available in this country.” IQ PanOptix Trifocal IOL The first trifocal lens to be available to the U.S. market is the AcrySof IQ PanOptix Trifocal (Alcon)—and the excitement is not lost on Drs. Hamilton and Thompson. “I’m always re-evaluating my go-to lens when new technologies arrive, and the PanOptix is my current choice for patients desiring spectacle indepen-dence with otherwise healthy eyes,” says 10 AcrySof Dr. Hamilton. “In my experience, it pro-vides the best level of uncorrected near vision of any current lens. It does cre-ate night dysphotopsia and have some dropout at the 1 meter range, but over-all it’s an excellent lens because it gives patients a full range of vision.” Dr. Thompson has found that suc-cess is very high with the PanOptix lens—with the right patients. “It’s up to us surgeons to match the proper implant to the proper patient, and I’m looking for corneas that are optically clean with a healthy tear film,” he says. “We also need to bring our ‘A’ game in analyzing the eye preopera-tively, particularly analyzing the cornea for optical irregularities and quantify-ing the high-order aberrations, which can rule out a multifocal if they are too numerous. I also check for a healthy macula and optic nerve and look for posterior capsule opacification, which will reduce the image quality of the multifocal implant.” The result is many happy patients, Dr. Thompson says. “In the FDA-monitored trial, 99.2% of patients said they’d get the same lens again. 1 That’s just amazing patient satisfaction! We see it in practice, too. If we put the PanOptix implant in healthy eyes, the chance of patient satisfaction is very high.” Light Filtering Tecnis Symfony OptiBlue Blue-light filtering has been available in IOLs for some time, with a goal of protecting the retina and perhaps improving the quality of vision by reducing the dispersion of light. But there are drawbacks. The new Tecnis Symfony OptiBlue (Johnson & Johnson Vision) lens is designed to avoid some of those drawbacks, while offering some specific advantages. THE OPHTHALMIC ASC | MAY 2021 “The issue with filtering blue light is that wavelengths in the blue spectrum are responsible for a larger proportion of vision in dim light than in bright light, so filtering it, particularly in a multifocal platform, can compromise dim light near vision,” Dr. Hamilton explains. “The Tecnis OptiBlue filters out violet light, the shortest wavelengths of visible light, to reduce chromatic aberration without compromising near vision in dim light.” Adds Dr. Chang: “This technol-ogy has existed for years, and now it is finally becoming available in this coun-try. The lens filters very specific, high-energy violet wavelengths that cause phototoxicity, free radical formation, and dysphotopsia while maintaining the blue light required for scotopic vision. It also preserves circadian rhythm entrainment, for which blue light must reach intrinsically photosensitive retinal ganglion cells (ipRGCs).” TIPS FOR GETTING STARTED WITH NEW LENSES “I find online forums incredibly useful when learning about new IOL tech-nologies, particularly in the COVID era when in-person meetings are not available,” Dr. Hamilton says. “I check the online forums for the Refractive Surgery Alliance as well as Cedars Aspens Society, and ask overseas col-leagues what they’re seeing. It’s very important for me to learn what benefits my patients will get from the new lens.” Once surgeons are convinced by the data and their peers to try a new lens, they tend to feel comfortable with the procedure. Of the new lenses discussed here, the exception to this rule is the RxSight Light Adjustable Lens, which requires both a hardware investment and schedule adjustment. Violet
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