Clinical Experiences with a New Diffractive Extended-Depth-of-Focus IOL Versus a Former-Generation Model, presented at ASCRS 2018 – by Timon Ax, D. Breyer, H. Kaymak, K. Klabe, P. Hagen, F. Kretz, G. Auffarth

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!
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