New Diffractive Extended-Depth-of-Focus IOL Versus a Former-Generation Model
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The study compares a new diffractive extended-depth-of-focus (EDOF) intraocular lens (IOL) with a former-generation model, Tecniss Symfony, finding no significant differences in key metrics such as predictability, distance-corrected visual acuity (CDVA), and defocus curves at three months postoperative. Both EDOF IOL models demonstrated similar performance in contrast sensitivity and halo & glare effects. The results suggest that while the two lenses are comparable, the neuroadaptation period may vary for patients receiving multifocal or EDOF lenses.
![Materials and Methods: Preoperative Patient Data
Mean ± Standard deviation
TECNIS
Symfony
AT LARA 829
# eyes 54 22
M:F [%] 52:48 59:41
Age [years] 70 ± 9 67 ± 10
Spherical Equivalent (SE) [D] 0.0 ± 2.7 0.9 ± 1.7
Cylinder [D] -0.6 ± 0.6 -0.8 ± 0.9
CDVA [logMAR] 0.2 ± 0.2 0.1 ± 0.2
UDVA [logMAR] 0.6 ± 0.4 0.3 ± 0.3
IOL SE power [D] 22.5 ± 3.0 22.1 ± 3.1
Significant (p<0.05) difference in
preoperative UDVA
Retrospective
analysis of
consecutive cases](https://image.slidesharecdn.com/larasymfonyascrs20180309-180626140945/85/New-Diffractive-Extended-Depth-of-Focus-IOL-Versus-a-Former-Generation-Model-5-320.jpg)
![0%
25%
50%
75%
100%
(-oo, -1) [-1, -0.5) [-0.5, 0.5] (0.5, 1] (1, oo)
Percentageofeyes[%]
∆SE [D]
Predictability: SE(post) - SE(target)
Results (3M postop.):
Predictability: ΔSE = SE(post) – SE(target)
EDOF # eyes
ΔSE = SE(post) – SE(target) [D]
mean ± SD
|∆SE| ≤ x [%]
0.5 D 1.0 D
Symfony 54 -0.11 ± 0.57 79.6 92.6
LARA 22 -0.18 ± 0.51 72.7 95.5
• Small deviation from target refraction
• No significant (p<0.05) difference
between mean ∆SE
• CDVA-plateau of EDOF IOLs can make
precise measurement of manifest
refraction harder in daily routine](https://image.slidesharecdn.com/larasymfonyascrs20180309-180626140945/85/New-Diffractive-Extended-Depth-of-Focus-IOL-Versus-a-Former-Generation-Model-6-320.jpg)
![Results (3M postop.):
Monocular UDVA
0%
25%
50%
75%
100%
20/12.5
20/16
20/20
20/25
20/32
20/40
20/63
Percentageofeyes[%]
Cumulative UDVA (x or better)
Cumulative UDVA EDOF # eyes
UDVA
[logMAR]
Cumulative UDVA (20/x or better) [%]
mean ± SD 12.5 16 20 25 32 40 63
Symfony 51 0.10 ± 0.13 2.0 5.9 45.1 66.7 82.4 96.1 100.0
LARA 18 0.05 ± 0.12 0.0 27.8 50.0 77.8 94.4 100.0 100.0
• Consider emmetropic subgroup
(predicted target refraction from IOL-Master +
Haigis-formula within [-0.5 D, +0.5 D])
• LARA with slightly (2-3 letters) better
results but difference is not significant
(p<0.05)
• 1 Symfony eye received add-on after 8
months](https://image.slidesharecdn.com/larasymfonyascrs20180309-180626140945/85/New-Diffractive-Extended-Depth-of-Focus-IOL-Versus-a-Former-Generation-Model-7-320.jpg)
![Results (3M postop.):
Monocular Distance-Corrected Defocus Curves
Monofocal IOL (mon, cc)
Lara 829 (mon, cc, n=24)
Symfony (mon, cc, n=36)
Reference Curve VA=1,0 (mon, sc)
0.00
0.25
0.50
0.75
1.00
1.25
-3.0
-2.5
-2.0
-1.5
-1.0
-0.5
0.0
DecimalVA
Defocus [D]
43%
69%
100%
75%
n = number of eyes
mon = monocular
bin = binocular
sc = uncorrected
cc = distance-corrected
EV = emmetropic vision
% = MIOL capacity
(area under curve)
• Almost identical curves with
good intermediate VA
• Only significant (p<0.05)
difference at -1.0 D defocus](https://image.slidesharecdn.com/larasymfonyascrs20180309-180626140945/85/New-Diffractive-Extended-Depth-of-Focus-IOL-Versus-a-Former-Generation-Model-8-320.jpg)
![0.0
0.5
1.0
1.5
2.0
2.5
1.5 3.0 6.0 12.0
Log10(CS)
Spatial frequency [cpd]
Contrast Sensitivity (photopic)
ref. area
juvenile eyes (mon, cc)
Symfony (bin, cc, n=10)
Lara (bin, cc, n=6)
0.0
0.5
1.0
1.5
2.0
2.5
1.5 3.0 6.0 12.0Log10(CS)
Spatial frequency [cpd]
Contrast Sensitivity (mesopic)
ref. area
juvenile eyes (mon,
cc)
Symfony (mon, cc,
n=22)
Results (3M postop.):
Contrast Sensitivity
• Very similar curves (no significant differences)
• Typical drop at 6 cpd under mesopic light conditions
• Mora data needed for LARA
0.0
0.5
1.0
1.5
2.0
2.5
1.5 3.0 6.0 12.0
Log10(CS)
Spatial frequency [cpd]
Contrast Sensitivity (mesopic)
ref. area
juvenile eyes (mon, cc)
Symfony (bin, cc, n=10)
Lara (bin, cc, n=6)](https://image.slidesharecdn.com/larasymfonyascrs20180309-180626140945/85/New-Diffractive-Extended-Depth-of-Focus-IOL-Versus-a-Former-Generation-Model-9-320.jpg)
![Results (3M postop.):
Halo & Glare Simulator
0%
25%
50%
75%
100%
"none" "mild" "moderate" "severe"
PercentageofEyes[%]
Strength of Halo&Glare
Halo & Glare Simulator
• Symfony EV and LARA EV with
slightly higher values compared
to phakic eyes
(1 “severe“ case in each group)
• Differences in mean values not
significant
Implantation # eyes
Halo&Glare strength [%]
mean ± SD min median max
Phakic eyes 126 30 ± 16 0 31 67
Symfony EV 16 46 ± 27 5 41 90
LARA EV 20 32 ± 28 0 31 85
EV = Emmetropic Vision; phakic eyes = employees (18 to 60 years)](https://image.slidesharecdn.com/larasymfonyascrs20180309-180626140945/85/New-Diffractive-Extended-Depth-of-Focus-IOL-Versus-a-Former-Generation-Model-11-320.jpg)
New Diffractive Extended-Depth-of-Focus IOL Versus a Former-Generation Model
- 1. Clinical Experiences with a New Diffractive Extended-Depth- of-Focus IOL Versus a Former-Generation Model Timon Ax, D. Breyer, H. Kaymak, K. Klabe, P. Hagen, F. Kretz, G. Auffarth
- 2. Financial Disclosure Breyer, Kaymak & Klabe Eye Surgery and Premium Eyes are Consulting, Study Center & MAB for: Abott, Alcon, AlimeraSciences, Allergan, AMO, Bayer, Carl Zeiss Meditec, Ellex, Fluoron, Geuder, iOptics, LensAR, Medicem, Novartis, Oculentis, Oertli, Revision Optics, Santen, Staar Surgical, Sifi Medtech, Thea, Topcon, Visufarma, Ziemer
- 3. AT LARA 829 (Carl Zeiss Meditec) In vivo• Anterior: diffractive optic • Pupil-independent distribution of light • Continuous focus (EDOF) • New EDOF IOL (so far no publications) plate haptics
- 4. TECNIS Symfony (AMO) • Posterior: diffractive optic with specific ring design • Reduced chromatic aberration: Improved contrast sensitivity • Continuous focus (EDOF) • Multiple publications on (clinical) data, e.g.: In vivo C-loop haptics
- 5. Materials and Methods: Preoperative Patient Data Mean ± Standard deviation TECNIS Symfony AT LARA 829 # eyes 54 22 M:F [%] 52:48 59:41 Age [years] 70 ± 9 67 ± 10 Spherical Equivalent (SE) [D] 0.0 ± 2.7 0.9 ± 1.7 Cylinder [D] -0.6 ± 0.6 -0.8 ± 0.9 CDVA [logMAR] 0.2 ± 0.2 0.1 ± 0.2 UDVA [logMAR] 0.6 ± 0.4 0.3 ± 0.3 IOL SE power [D] 22.5 ± 3.0 22.1 ± 3.1 Significant (p<0.05) difference in preoperative UDVA Retrospective analysis of consecutive cases
- 6. 0% 25% 50% 75% 100% (-oo, -1) [-1, -0.5) [-0.5, 0.5] (0.5, 1] (1, oo) Percentageofeyes[%] ∆SE [D] Predictability: SE(post) - SE(target) Results (3M postop.): Predictability: ΔSE = SE(post) – SE(target) EDOF # eyes ΔSE = SE(post) – SE(target) [D] mean ± SD |∆SE| ≤ x [%] 0.5 D 1.0 D Symfony 54 -0.11 ± 0.57 79.6 92.6 LARA 22 -0.18 ± 0.51 72.7 95.5 • Small deviation from target refraction • No significant (p<0.05) difference between mean ∆SE • CDVA-plateau of EDOF IOLs can make precise measurement of manifest refraction harder in daily routine
- 7. Results (3M postop.): Monocular UDVA 0% 25% 50% 75% 100% 20/12.5 20/16 20/20 20/25 20/32 20/40 20/63 Percentageofeyes[%] Cumulative UDVA (x or better) Cumulative UDVA EDOF # eyes UDVA [logMAR] Cumulative UDVA (20/x or better) [%] mean ± SD 12.5 16 20 25 32 40 63 Symfony 51 0.10 ± 0.13 2.0 5.9 45.1 66.7 82.4 96.1 100.0 LARA 18 0.05 ± 0.12 0.0 27.8 50.0 77.8 94.4 100.0 100.0 • Consider emmetropic subgroup (predicted target refraction from IOL-Master + Haigis-formula within [-0.5 D, +0.5 D]) • LARA with slightly (2-3 letters) better results but difference is not significant (p<0.05) • 1 Symfony eye received add-on after 8 months
- 8. Results (3M postop.): Monocular Distance-Corrected Defocus Curves Monofocal IOL (mon, cc) Lara 829 (mon, cc, n=24) Symfony (mon, cc, n=36) Reference Curve VA=1,0 (mon, sc) 0.00 0.25 0.50 0.75 1.00 1.25 -3.0 -2.5 -2.0 -1.5 -1.0 -0.5 0.0 DecimalVA Defocus [D] 43% 69% 100% 75% n = number of eyes mon = monocular bin = binocular sc = uncorrected cc = distance-corrected EV = emmetropic vision % = MIOL capacity (area under curve) • Almost identical curves with good intermediate VA • Only significant (p<0.05) difference at -1.0 D defocus
- 9. 0.0 0.5 1.0 1.5 2.0 2.5 1.5 3.0 6.0 12.0 Log10(CS) Spatial frequency [cpd] Contrast Sensitivity (photopic) ref. area juvenile eyes (mon, cc) Symfony (bin, cc, n=10) Lara (bin, cc, n=6) 0.0 0.5 1.0 1.5 2.0 2.5 1.5 3.0 6.0 12.0Log10(CS) Spatial frequency [cpd] Contrast Sensitivity (mesopic) ref. area juvenile eyes (mon, cc) Symfony (mon, cc, n=22) Results (3M postop.): Contrast Sensitivity • Very similar curves (no significant differences) • Typical drop at 6 cpd under mesopic light conditions • Mora data needed for LARA 0.0 0.5 1.0 1.5 2.0 2.5 1.5 3.0 6.0 12.0 Log10(CS) Spatial frequency [cpd] Contrast Sensitivity (mesopic) ref. area juvenile eyes (mon, cc) Symfony (bin, cc, n=10) Lara (bin, cc, n=6)
- 10. Halo & Glare Simulator Simulation software from CZM: • Subjective matching of patient‘s photopsia via a graphic user interface • Binocular and uncorrected • 4 categories: „none“ „severe“„moderate“ „mild“
- 11. Results (3M postop.): Halo & Glare Simulator 0% 25% 50% 75% 100% "none" "mild" "moderate" "severe" PercentageofEyes[%] Strength of Halo&Glare Halo & Glare Simulator • Symfony EV and LARA EV with slightly higher values compared to phakic eyes (1 “severe“ case in each group) • Differences in mean values not significant Implantation # eyes Halo&Glare strength [%] mean ± SD min median max Phakic eyes 126 30 ± 16 0 31 67 Symfony EV 16 46 ± 27 5 41 90 LARA EV 20 32 ± 28 0 31 85 EV = Emmetropic Vision; phakic eyes = employees (18 to 60 years)
- 12. Summary: AT LARA 829 vs. TECNIS Symfony • At 3 months postop: Good results in terms of: • Predictability • CDVA and UDVA • defocus curves • contrast sensitivity • halo & glare • No relevant significant differences found so far From our retrospective analysis of clinical data: LARA and Symfony are very similar EDOF IOLs • Important in case of MIOL/EDOF lenses: Period of several months (postoperative) for satisfying neuroadaption
- 13. Thank you very much for your attention! Partner of