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Friday / August 19.
HomeminewsStudy Mirrors Real World for Tecnis Synergy

Study Mirrors Real World for Tecnis Synergy

Findings from a 12 month randomised bilateral study comparing the Tecnis Synergy (Johnson & Johnson Vision [J&JV]) and PanOptix Trifocal (Alcon) presbyopia correcting intraocular lenses (IOL) have confirmed real world experience, according to lead author and ophthalmologist Dr Dean Corbett, from Auckland Eye, New Zealand.

The study, conducted across 12 sites in Singapore, Europe, the Philippines and New Zealand, reported 91% of patients implanted with either the Tecnis Synergy or PanOptix were “completely, mostly or moderately satisfied with their overall vision when not wearing glasses”.

Presented at the European Society of Cataract & Refractive Surgeons (ESCRS), the J&JV funded study reported that 93% of Tecnis Synergy versus 83% of PanOptix subjects were spectacle-independent at near, and spectacle independence was comparable for both distance and intermediate vision.

The Tecnis Synergy, which combines diffractive technology from J&JV’s Tecnis Multifocal with extended depth of focus features from Tecnis Symfony IOL, demonstrated a continuous range of vision through 33cm, with higher visual acuity and a longer binocular defocus curve than the comparator. Additionally, more Tecnis Synergy subjects achieved ‘good binocular distance corrected visual outcomes’ (76% vs 50%).

Both the Tecnis Synergy and PanOptix IOLs had a similar dsyphotopsia profile, with insignificant reports of night glare and starbursts; 37% and 39% of Tecnis Synergy and PanOptix subjects respectively, reported mild, moderate or severe haloes.

NO SURPRISES

Having implanted around 60 eyes with the Tecnis Synergy, Dr Corbett, who is paid to consult to J&JV said, “The biggest thing I notice is the broad depth of focus. Tecnis Synergy is nice because it has the greatest likelihood of generating spectacle freedom because of this range of vision – even people with short arms or challenging near tasks are going to do well.”

This was reflected in the study, where Tecnis Synergy showed an additional line of visual acuity improvement at a near distance of 33cm when compared to the PanOptix.

“The only potential issue to be aware of for synergy is the relatively steep fall off the minus side of the defocus curve. In planning refractive target it is essential to plan for a hyperopic refractive outcome – i.e. first plus in all cases, otherwise distance acuity might be compromised.

“What did surprise me was the lack of bothersome dysphotopsias across both groups. This could be because people enrolled into studies tend to give somewhat different information compared to the commercial population. That’s for several reasons – only certain personalities enrol in a randomised study. They are given a lot more information up front, warned of everything that could possibly go wrong, and tend to be more cooperative, less demanding, and less likely to report downsides.”

EDUCATION, TRANSPARENT COMMUNICATION KEY

With more IOL options presenting a broader array of potential outcomes and avenues of optimisation, Dr Corbett said a clear understanding of the patient’s vision needs and expectations is essential.

“The most suitable IOL will depend on their age, tasks, demeanour, their attitude towards night dysphotopsias, and whether they mind wearing spectacles at the moment or not – it’s a constellation.”

Ensuring patients clearly understand their long-term visual function, with or without surgical intervention, is essential. Additionally, patients should be counselled that an IOL will not replicate natural, pre-presbyopic vision and secondary intervention may be required.

“It’s inevitable that the appropriate refractive target will not be met in every case – in my practice about 6% of patients require laser vision correction to achieve maximal vision. Occasional patients will need a secondary IOL, a vitrectomy to clear vitreous debris, or even IOL explantation and replacement. “It’s up to each surgeon as to how they manage that – whether they can do this themselves or refer on, and whether they cover the cost within the initial fee or charge separately. Most importantly, patients must be thoroughly counselled and acknowledge, prior to surgery, that a secondary intervention may be required to achieve maximal vision. Additionally, surgery must be performed in such a way that the IOL can be explanted if necessary.

“Lifestyle implants are unpredictable, you’re never going to win with every patient, that’s one of the most challenging things about vision correcting surgery – you’re going to get patients with high expectations who don’t listen well, and you’re going to have to manage them.

“The great thing about the Tecnis platform, is that it is easy to implant the lens and it is also easy to explant if required… I really do believe refractive surgery is the most difficult specialty. It requires a lot of experience and surgical ability to optimise the visual outcome, as well as the psychological capacity to really understand the patient’s needs and expectations.”

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