ASCRS 2025: Visual and patient-reported outcomes following bilateral Odyssey implantation

Precise surgical technique and patient selection were key factors contributing to positive visual outcomes with a full-range IOL in a recent clinical study. (Image credit: AdobeStock/Roman)

With growing interest in full-range IOLs, clinical data are helping to clarify how these technologies perform in real-world settings. At this year’s annual meeting of the American Society of Cataract and Refractive Surgery in Los Angeles, California, I shared early clinical outcomes and patient feedback from our experience with a next-generation full visual range IOL.¹ We conducted an ambispective study evaluating visual outcomes after successful cataract surgery in our practice with bilateral implantation of the device (TECNIS Odyssey IOL; Johnson and Johnson Vision), which purports to offer a continuous range of vision and high rates of spectacle independence.

A total of 80 eyes of 40 subjects treated at a single clinical site were evaluated. All subjects had already undergone uncomplicated bilateral cataract surgery with implantation of either the DRN00V or DRTxxx model. Patients with significant ocular comorbidities were excluded. After enrolling in the study, extensive visual acuity measurements (including photopic and mesopic, monocular and binocular, and uncorrected, corrected, and distance corrected acuities at various distances) were obtained at the 3-month visit. Additionally, patients also completed the Assessment of IntraOcular Lens Implant Symptoms (AIOLIS) questionnaire, a new assessment tool that has been validated by the FDA and American Academy of Ophthalmology for use in patients undergoing presbyopia-correcting IOL surgery.

Study results

Excellent refractive accuracy was achieved. The mean manifest refraction spherical equivalent (MRSE) in the study was -0.02 D, with 99% of eyes within 0.50 D of emmetropia. Mean residual astigmatism was -0.12 D, and nearly all eyes (96%) had 0.50 D of astigmatism or less postoperatively.

Patients achieved excellent vision at all distances (Table). Under photopic conditions, the mean uncorrected distance visual acuity (UDVA) was 20/20 (0.00 logMAR) monocularly and 20/17 (-0.07 logMAR) binocularly. Under mesopic conditions, tested at 3 lumens, mean monocular UDVA was 20/21 (0.02 logMAR) and binocular UDVA was 20/18 (-0.04 logMAR).

Intermediate and near visual acuity was measured at 66 cm (intermediate), 40 cm (near) and 33 cm (very near), under both photopic and mesopic conditions. In bright light, all of the mean monocular near and intermediate acuity measures were J1 to J2 (0.00 to 0.10 logMAR). With both eyes open, subjects could see J2+ to J1+(-0.02 to 0.03 logMAR) on all the near/intermediate measures. Even in dim light, the mean intermediate and near visual acuities were all better than J3 monocularly and better than J2 binocularly. We know that near vision in dim light is among the most challenging situations for presbyopia-correcting IOLs, so these findings are quite impressive.

On the AIOLIS questionnaire, 93% of patients said they never wore glasses or wore them “only a little” of the time. Patients rated their vision very highly, with 100% of the 40 subjects saying their vision was “excellent” or “very good” at distance, 88% at intermediate, and 77% at near. Most visual disturbances were rated “not at all” bothersome. Night glare, halo and rings/spiderwebs were the symptoms most likely to be rated as somewhat bothersome.

Pearls for success

With all presbyopia-correcting IOLs, it is important to select patients with healthy eyes. Ocular surface problems should be treated prior to surgery in order to achieve optimal biometry and other preoperative measurements. Patients must be counseled that no artificial optical system—no matter how good—will be as perfect as their own eyes in youth.

I tell patients that with good light they can expect very functional vision. In other words, they should be able to see their phone, the dashboard, or a menu without glasses, but I don’t overpromise. I tell them they might need glasses to perform tasks like fixing a watch battery or reading a medicine bottle. That way, if they do achieve J1 vision (as many do), they are pleasantly surprised.

I prefer to use a femtosecond laser (Catalys; Johnson and Johnson Vision) to create the capsulorrhexis in all premium lens cases because it offers a perfectly round and centered capsular opening that can be made very quickly. I also like to use a surgical planning platform (Veracity; Zeiss) for all my premium lens cases. In particular, I value the nomogram tools it offers for calculating the length, depth, and optical zone for relaxing incisions.

To achieve the best visual results, surgeons have to be aggressive about correcting astigmatism with toric IOLs and/or relaxing incisions. Patients tend to drift about 0.25 D more against-the-rule (ATR) per decade, so I always think it is better to flip the axis to slightly with-the-rule (WTR) rather than leave any ATR astigmatism. This approach will help to protect the longevity of the patient’s uncorrected distance acuity results.

During surgery, I try to thoroughly remove any lens epithelial cells from the anterior lens capsule using a sweeping instrument and then use a silicone squeegee to buff the posterior capsule to try to prevent early posterior capsular opacification. These steps, which are helpful with any premium lens, really help to give patients great vision as early as day 1.

With this lens in particular, I aim for the “first minus” refractive target or even for -0.25 D or slightly more myopic. I find the lens to be very forgiving at distance, so this targeting helps to achieve the near vision that patients want without any negative impact on distance acuity. Additionally, the high quality of the material and edge design of this family of IOLs helps to improve visual quality and reduce dysphotopsia.

Although the present study reports on 3-month outcomes, I am now beginning to see patients who have reached 1-year post-implantation with these lenses and they are extremely happy with the results. One patient, for example, had been an emmetrope with 20/15 vision his whole life. Presbyopia hits these patients hard because suddenly they can’t see up close, and then that is compounded by the development of cataract. Cataract surgeons sort of dread these patients because it is difficult to satisfy their expectations of the perfect vision they used to have at all distances. After surgery with these lenses, this patient was ecstatic because his distance vision was excellent, and he could see well enough near to tie on his fly-fishing lures without glasses.

So many of our patients desire full spectacle independence, and we are fortunate to have many advanced IOLs to offer. However, the majority of these lenses have come with tradeoffs such as visual disturbances at night or have not offered good enough vision at near. This IOL has certainly become a lens that I don’t hesitate to use in plano presbyopes and others who want full spectacle independence. As the results of this small study demonstrate, we can achieve excellent visual acuity at all distances with this lens, even in mesopic conditions. Of course, I still discuss the limitations of any diffractive optic, the need for good light, and the potential for dysphotopsias at night, but in general I find that patients are very satisfied with the quality of their vision with this IOL.

Alex Hacopian, MD
E: alex.hacopian@manneye.com
Alex Hacopian, MD, is in practice at Mann Eye Institute in Houston, Texas. The study discussed here was funded by a research grant from Johnson and Johnson Vision. The author has no other relevant financial interests to disclose.

Reference

1. Hacopian A, Brunson P, et al. Patient reported outcomes and visual acuity after bilateral implantation of a next generation presbyopia correcting intraocular lens. Paper presented at: American Society of Cataract and Refractive Surgery 2025; April 25-28, 2025; Los Angeles, California.