Weighing Multifocal IOL Options for Presbyopia Correction

Sumit (Sam) Garg, MD


February 12, 2020

Patients now have several exciting—although not yet perfect—multifocal intraocular lenses (IOLs) for presbyopia correction from which to choose. Currently in the United States, the recently approved trifocal IOL PanOptix (Alcon; Fort Worth, Texas) and the extended-depth-of-focus IOL Symfony (Johnson & Johnson Vision; Santa Ana, California) are two of the most popular presbyopia-correcting lenses.

In a prospective study, Monaco and colleagues compared the visual performance of patients undergoing bilateral cataract surgery with PanOptix, Symfony, or a monofocal IOL (ie, SN60WF [Alcon]). Twenty patients were in each arm.

Both presbyopia-correcting lenses worked as expected, with the PanOptix providing slightly better (P = .005) near visual acuity than the Symfony at 4 months. The distance and intermediate visual acuities with both platforms were statistically equivalent.

The dependence on spectacles was equivalent in both the PanOptix and Symfony groups.

In addition, both presbyopia-correcting options had more aberrations and loss of contrast than the monofocal control, with the PanOptix having more aberrations than the Symfony.

Key Takeaways

This study presents several interesting findings for me.

First, although both PanOptix and Symfony use different light-splitting optics to achieve spectacle independence, the overall optical "quality" was similar.

Second, the trifocal Panoptix proved superior to the Symfony for near vision, which is unsurprising when you consider the effective add power offered by each IOL. However, the dependence on spectacles was equivalent between the two groups. I often use a mix-and-match approach to patients to capitalize on the different "sweet spots" for various lens platforms to try and minimize spectacle dependence.

Finally, although we have certainly come a long way with respect to refining presbyopia-correcting IOLs, there are still many drawbacks with light-splitting optics that require additional chair time and patient selection considerations.

I am confident that the future of presbyopia-correcting IOLs is a non–light-splitting accommodating IOL that allows for a full range of vision without several of the visual side effects with which we currently must contend. In the meantime, I continue to offer these platforms to my patients (with proper discussion), and look forward to further advances in these IOLs.

Sumit (Sam) Garg, MD, is the vice chair of clinical ophthalmology and an associate professor in the Department of Ophthalmology at the Gavin Herbert Eye Institute, University of California, Irvine. He specializes in corneal and cataract surgery, as well as laser refractive surgery.

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