Update on the Synergy IOL

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This month, News in Review highlights selected papers from the original papers sessions at AAO 2021. Each was chosen by the session chairs because it presents important news or illustrates a trend in the field. Only four subspecialties are included here; papers sessions also will be held in five other fields. For up-to-date information, check the Mobile Meeting Guide (aao.org/mobile).

In a six-month study, the Tecnis Synergy IOL provided extensive range of vision and spectacle indepen­dence in the vast majority of patients with presbyopia.

The Synergy is a hybrid model that combines both multifocal and extended-depth-of-focus (EDOF) tech­nologies. It provides excellent near vision and a wide range of continuous vision, said Daniel H. Chang, MD, at Empire Eye & Laser Center in Bakersfield, California.

Clinical trial. Dr. Chang was a principal investigator for the prospective study, which compared the Tecnis Synergy (model ZFR00V) and a monofocal control (model ZCB00) in 272 patients at 15 sites. Johnson & Johnson Surgical Vision developed both lens models.

In the study, the Synergy maintained a range of about 3.5 D, which was 2.3 D greater than the monofocal con­trol lens. “Patients achieved good quality of vision from near to far, and they did not have to search for a ‘sweet spot’ to hold reading material,” said Dr. Chang.

Spectacle wear. At six months, nearly 88% of the Synergy subjects reported needing spectacles “none of the time” on a 5-point scale at all queried distances (far, intermediate, near, and overall). This was an 85%-point difference in spectacle independence at all distances compared to the control lens. On a 2-point scale, at least 91% of the Synergy subjects reported “no need for glasses” for distance, intermediate, and near vision.

Challenges and trade-offs. The challenge of pres­byopia-correcting lenses is the need to balance visual quality, depth of field, and dyphotopsias, said Dr. Chang. Given the depth of field provided by the Syn­ergy lens, it is understandable that a small percentage of patients had early complaints about uncorrected distance vision, he said. Many of these complaints were related to refractive error and improved with time, but this stresses the importance of hitting the refractive target. “Unlike an EDOF lens like the Tecnis Symfony, which provides some tolerance to refractive error, you really need to nail the refractive target with the Tecnis Synergy,” said Dr. Chang. “If you do miss, it is actually better to be slightly hyperopic than myopic.”

In low light, he said, Synergy recipients may get more halos and starbursts compared to lenses that provide less depth of field. However, Johnson & John­son incorporated both a violet light filter and new high-definition lathing technology to help mitigate these symptoms, Dr. Chang said. And, of course, coun­seling patients ahead of time can go a long way toward improving patient satisfaction, he added.

—Annie Stuart

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Relevant financial disclosures—Dr. Chang: Johnson & Johnson Surgical Vision: C,L,S.

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