In the past year, Matossian Eye Associates added a new category of presbyopia-correcting IOLs to the practice: the extended depth of focus (EDOF) IOL. The first IOL in this category is the Tecnis Symfony (Johnson & Johnson Vision). EDOF lenses from other manufacturers are in clinical trials, so it behooves the cataract surgeon to better understand how these lenses work.
Unlike the distinct single or dual foci of a monofocal or multifocal IOL, the EDOF lens has an elongated area of focus (Figure 1) that provides high-quality vision over a continuous range. This is the kind of vision that patients want from a presbyopia-correcting IOL.Matossian Eye Associates conducted a retrospective analysis of 1-month results of all EDOF lenses implanted in the first 3 months that the practice began using the Symfony lenses. The data set includes all patients–eyes implanted with all 4 toric EDOF powers, post-LASIK eyes, and some patients with mild pathology, including epiretinal membrane, corneal epitheliopathy, elevated intraocular pressure (with normal optic nerve and no history of glaucoma) and macular drusen.
Importantly, these types of eyes no longer have to be excluded from consideration for a presbyopia-correcting IOL.
A toric EDOF was implanted in over half of the cases (55%). I do not like to make large arcuate incisions, so in the past I would not have considered these patients as good candidates for a presbyopia-correcting IOL.
It is an advantage to have toric EDOF lenses, as well as toric multifocal IOLs. Of the spherical implants in this data set, nearly half of patients (44%) also had limbal relaxing incisions (LRIs) for correction of low astigmatism (<1 D).