In early May, Johnson & Johnson Vision announced U.S. Food and Drug Administration approval of its new presbyopia-correcting Tecnis Synergy and Tecnis Synergy Toric II IOLs. (The Synergy IOL has been available outside of the U.S. since 2019; all of the Tecnis Synergy IOLs are expected to be available in the United States and Canada this summer.) 

According to the company, the Synergy IOLs are based on the existing Tecnis lens platform. The company says the Tecnis lenses use a proprietary combination of materials and design that results in very good visual clarity, lower light dispersion, a very low level of chromatic aberration and extremely low spherical aberration—as well as very good contrast under all light conditions. 

Ike K. Ahmed, MD, FRCSC, a professor of ophthalmology at the University of Utah and assistant professor at the University of Toronto, says he’s had about a year of experience with the Synergy lens in Canada. (Dr. Ahmed is a consultant for Johnson & Johnson Vision.) “We’ve implanted them in about 100 patients,” he says. “I’ve been doing an evaluation of these lenses, and the experience has been good.

“Most multifocals have a very good range of vision, but these have the best I’ve seen,” he explains. “They combine a multifocal design with extended depth-of-focus design. They have diffractive rings, some of which split the incoming light to different focal points, while others stretch the light between focal points. It’s kind of like a mix between the Symfony and the Tecnis multifocal. This combination gives patients a true continuous range of vision, as shown by both the defocus curve and what we see clinically. Patients are able to see well from 30 cm all the way out to 80 cm.” (In a study sponsored by the company, nine out of 10 patients receiving these lenses didn’t need glasses after the surgery.)

“The Synergy lens also has the closest near point of any multifocal I’ve had experience with,” Dr. Ahmed adds. “It’s at least 10 or 15 cm closer than others I’ve used. This lets patients bring things closer and see them clearly without any visual tradeoff.” 

Dr. Ahmed says it helps that the Tecnis platform uses materials and design that may limit the loss of contrast sensitivity associated with multifocal technology. “These lenses use [what the company calls] Chrom­Align technology to correct chromatic aberration, plus a little violet filtering which may reduce some of the dysphotopsia from LED lights,” he explains. “I do ask my patients about their night vision, and they seem to be happy with it.”

 Dr. Ahmed admits that there are still issues to consider. “This is a diffractive design, so there’s a risk of haloes,” he says. “I always warn my patients about this, although anecdotally, those receiving the lens seem to be happy with their night vision. Also, compared to a monofocal lens, there will always be some contrast loss. So you have to be mindful of patients who may be at risk for quality-of-vision issues, whether because of comorbidities, work-related issues or lifestyle. Furthermore, it’s important to hit the refractive mark. These lenses are very sensitive to refractive errors, so the surgeon needs to hit that plano mark and minimize astigmatism as much as possible.

“Overall, these lenses have been an excellent choice for our patients,” he concludes. “We’ve been very happy with our results using the Synergy lens.”

A Breakthrough in Sickle Cell Retinopathy Management

Ophthalmologists at New York Eye and Ear Infirmary of Mount Sinai have developed a new way to evaluate patients with sickle cell retinopathy and assess the disease earlier than previously possible, using optical coherence tomography angiography. In sickle cell disease, abnormally folded hemoglobin distorts the shape of red blood cells, causing them to clump and block blood flow. The resulting capillary damage that may occur in the retina can cause bleeding, retinal detachment and vision loss. 

Using sequential OCTA images of blood flow in the retina has allowed the researchers to assess both disease progression and the impact of treatment on the disease. The more the blood flow fluctuates between images, the higher the risk of a permanent blockage. The study authors note that without this technique, it’s impossible to judge disease status in the retina until patients report vision loss.

In a small study conducted at Mount Sinai, 13 patients with sickle cell disease—some being treated for the disease, others not—were compared to 14 controls. All subjects were imaged 10 times in a row using OCTA over a 10-minute period; this was repeated an hour later. Sickle cell disease causes vessels to open and close—or “flicker”—so the researchers counted the number of flickers between scans for each patient. They found that patients with no disease had minimal or no flickering, indicating consistent blood flow. Sickle cell patients not receiving treatment had substantially more flickering than patients on treatment, indicating that the treatment was having a beneficial effect. (The study was published in the online May issue of Biomedical Optics Express.) 

The researchers have used the measurements of flicker frequency and location to develop a computer algorithm that can assess the risk of retinal blood blockages in sickle cell patients. For more information, visit mountsinai.org.