Cataract surgeons in the United States have long been envious of the IOL options available to their international colleagues. Finally, in 2016, American ophthalmologists gained access to some novel IOLs such as the Tecnis Symfony Extended Range of Vision IOL and the Tecnis Symfony Toric IOL (Abbott) that were approved by the FDA. According to leading cataract surgeons who spoke to Ophthalmology Times, these simultaneous approvals rank as the biggest cataract surgery news story of the year.
“The approval of the Symfony and Symfony Toric IOLs was an important event because these implants represent a whole new class of presbyopia-correcting lens technology, and it is also exciting because the Symfony Toric is the first toric non-accommodating presbyopia-correcting IOL,” said Dr. Donnenfeld, clinical professor of ophthalmology, New York University, New York, and founding partner, Ophthalmic Consultants of Long Island and Connecticut, Garden City, NY.
The Symfony IOLs have several appealing features and he predicted their availability would lead to a significant increase in uptake of advanced technology IOLs.
“In the FDA trials and in my clinical experience, problems with glare and halo are minimal with the Symfony IOLs and are much less than previous generation multifocal IOLs, and that reduces the risk of patient dissatisfaction. In addition, the Symfony IOLs are easy to implant and very forgiving of residual cylinder and hyperopia in terms of providing excellent distance vision,” Dr. Donnenfeld said.
Mark Packer, MD, offered similar thoughts. “The Symfony IOLs are associated with less halos and glare than the progenitor platform, the Tecnis Multifocal IOL (Abbott), and they can provide 20/20 UCVA at distance and J1 at 16 to 18 inches, which is pretty strong in terms of presbyopia correction,” he said.
However, Dr. Packer pointed out that the Symfony IOLs perform less well for providing excellent uncorrected near vision, and that the technology does not completely eliminate dysphotopsias. Therefore, surgeons must be careful to mention the risk when counseling patients.
“Twenty years ago when the Array multifocal IOL (Abbott) was introduced, some surgeons were telling patients they would not experience any visual disturbances with the lens. I hope we have learned a lot since then because any optic that features a diffractive element has the potential to cause halos and glare. When people are forewarned and anticipate a possible problem, they are more likely to accept it and remain satisfied than if it comes as an unanticipated surprised,” said Dr. Packer, clinical associate professor of ophthalmology, Oregon Health & Science University, Portland.
He noted that cataract surgeons outside of the United States may prefer trifocal IOLs over the Symfony implants because the trifocals provide better near vision. The only presbyopia-correcting toric competitor for the Symfony Toric IOL in the United States is the Trulign Toric IOL (Bausch + Lomb). However, its performance also falls off at near. And compared with the Symfony, surgeons need to pay a little more attention to detail when implanting the Trulign and provide closer follow-up to monitor for capsular contraction.
“The Trulign gives great distance and intermediate correction, and near vision performance can be optimized by using monovision or a modified monovision approach. Otherwise, J5 is the average UCVA at near with the Trulign, which means near vision is worse than that in half of people who are implanted with the lens,” Dr. Packer said.
“In addition, tilting, or the so-called Z-syndrome, remains a nagging concern with this lens, and many surgeons are performing anterior capsulotomy early to avoid that problem,” Dr. Packer said.