This document summarizes a clinical study comparing two extended depth of focus (EDOF) intraocular lens (IOL) models: the AT LARA 829 and the TECNIS Symfony. The study found that at 3 months post-operation, both IOLs produced good results in terms of predictability, visual acuity, defocus curves, contrast sensitivity, and halo/glare, with no significant differences between them. The document concludes that based on this retrospective analysis, the AT LARA 829 and TECNIS Symfony are very similar EDOF IOL options that provide good visual outcomes after several months of neuroadaptation.

1. 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
Clinical Experiences with a New Diffractive Extended-Depth-of-
Focus IOL Versus a Former-Generation Model.
T. Ax, D. Breyer, H. Kaymak, K. Klabe, P. Hagen, F. Kretz, G. Auffarth
Breyer, Kaymak & Klabe Eye Surgery and Premium Eyes are Consulting, Study Center & MAB for:
Abott, Alcon, AlimeraSciences, Allergan, Bayer, Carl Zeiss Meditec, Ellex, Fluoron, Geuder,
iOptics, Johnson&Johnson, LensAR, Medicem, Novartis, Oculentis, Oertli, Revision Optics,
Santen, Staar Surgical, Sifi Medtech, Thea, Topcon, Visufarma, Ziemer

2. AT LARA 829 (Carl Zeiss Meditec)
In vivo
• Anterior:
diffractive optic
• Pupil-independent
distribution of light
• Continuous focus (EDOF)
• New EDOF IOL
(so far only a few publications)
plate haptics

3. TECNIS Symfony (J&J)
• 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

4. 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

5. 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

6. 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

7. 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
5.0
1.5 6.0
Log10(CS)
Spatial frequency [cpd]
Contrast Sensitivity
(mesopic)
ref. area
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)

8. 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“

9. 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)

10. 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

11. Thank you very much for your attention!
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