Clinical Outcomes of Patients Bilaterally Implanted With the TECNIS® Symfony or TECNIS® Symfony Toric Extended Range of Vision IOL
Clinical Outcomes of Patients Bilaterally Implanted With the TECNIS® Symfony or TECNIS® Symfony Toric Extended Range of Vision IOL
In With increased patients' demand for a spectacle-free lifestyle and technological
 advancements, cataract surgery with multifocal intraocular lens (IOL) implantation has become
 an effective solution for correcting presbyopia in patients who want to maintain their full
 range of vision.

 Conventional bifocal IOLs used either refractive or diffractive optics to split the light and
 create 2 principal focal points, thus providing functional vision at distance and near. This
 simultaneous imaging principle produces a sharp image that is overlaid by a secondary blurred
 out-of focus image, so these IOLs inherently produce a deterioration in contrast sensitivity
 and unwanted photic phenomena such as glare and halos. Additionally, studies reported
 insufficient intermediate vision with bifocal IOLs.

 There is an increasing desire for spectacle independence at intermediate distance, especially
 due to the increased use of computers and smartphones. Trifocal IOLs were introduced to the
 market in 2010 and participants provide an additional, third focal point to improve
 intermediate vision without compromising distance and near vision. However, participants are
 still vulnerable to decreased contrast sensitivity and photic phenomena due to the IOL's
 mechanism of splitting the light into discrete focal points.

 An extended depth of focus (EDOF) technology was recently introduced with the aim to improve
 intermediate vision while maintaining image contrast. The diffractive echelette design,
 embedded on its posterior optical surface, extends the range of vision and the achromatic
 technology reduces corneal chromatic aberrations to enhance retinal image quality and improve
 contrast sensitivity. The elongated focus allows imaging in a continuous range of vision
 without overlapping near and far images, and therefore theoretically would provide a more
 consistent distance and intermediate vision with less dysphotopsia.

 The aim of this study was to investigate the clinical outcome of patients bilaterally
 implanted with either Tecnis Symfony or Tecnis Symfony toric extended range of vision IOLs
 (Johnson & Johnson Vision, Santa Ana, CA, USA) in terms of visual performance at different
 distances, spectacle independence, photic phenomena, and patient satisfaction.
Enrollment period : 18 months after IRB approval Participants : Patients who had
 uncomplicated cataract surgery with binocular implantation of either Symfony (ZXR00) or
 Symfony toric (ZXT) IOLs.

 Methods: The postoperative examinations were performed at 4-8 weeks, and 4-6 months
 postoperatively. Binocular corrected (CDVA) and uncorrected (UDVA) distance visual acuity was
 assessed at 4 m using a Snellen chart. Binocular uncorrected intermediate visual acuity
 (UIVA) at 70 cm and binocular uncorrected near visual acuity (UNVA) at 40 cm were assessed
 using the Rosenbaum near vision card.

 A subjective questionnaire on spectacle use, photic phenomena, and satisfaction was
 administered to all patients. Patients were asked how often (never, occasionally, 50% of the
 time, frequently) participants wear spectacles for near, intermediate, and distance
 activities. Non-directed and directed questions were used with regard to visual symptoms.
 Photic phenomena (halos, glare and starbursts) were graded as none, trace, mild, moderate, or
 severe. Patients were asked to rate their level of satisfaction with distance, intermediate,
 and near vision on a scale from 0 (completely dissatisfied) to 10 (completely satisfied).
 Additionally, participants were asked whether participants would choose the same IOL again
 and if participants would recommend the IOL to their friends and family. Surgeons were also
 asked to rate their level of satisfaction on a scale from 0 to 10 in terms of the ease of
 manipulation and implantation of the IOL and the visual performance of the IOL.
Inclusion Criteria:

 -  1. Age of 20 years or older

 -  2. Cataract

 Exclusion Criteria:

 -  1. Amblyopia

 -  2. Keratoconus

 -  3. Previous corneal or refractive surgery

 -  4. Chronic or recurrent uveitis

 -  5. Acute ocular disease

 -  6. Previous ocular surgeries

 -  7. Glaucoma

 -  8. Any ocular disease which could possible affect the postoperative visual acuity