Clinical Visual Outcomes Over a Range of Vision Following Cataract Surgery with Bilateral Implantation of a Hybrid Multifocal and Extended Depth of Focus Intraocular Lens

Clinical Visual Outcomes Over a Range of Vision Following Cataract Surgery with Bilateral Implantation of a Hybrid Multifocal and Extended Depth of Focus Intraocular Lens | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article Clinical Visual Outcomes Over a Range of Vision Following Cataract Surgery with Bilateral Implantation of a Hybrid Multifocal and Extended Depth of Focus Intraocular Lens Rahul T Pandit This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-3308228/v1 This work is licensed under a CC BY 4.0 License Status: Posted Version 1 posted You are reading this latest preprint version Abstract Background: To evaluate binocular visual outcomes, with emphasis on near intermediate vision at 50 cm, in patients undergoing bilateral cataract surgery with implantation of the Synergy hybrid intraocular lens with multifocal and extended depth of focus diffractive optics. Methods: A chart review was conducted of all patients undergoing phacoemulsification by a single surgeon with bilateral implantation of a Synergy IOL from August 2021 through March 2023. Primary endpoints were Uncorrected Distance Visual Acuity (UDVA), Uncorrected and Distance-Corrected Near Visual Acuity (UNVA and DCNVA, respectively) at 33 cm, Corrected Distance Visual Acuity (CDVA), and Distance-Corrected Intermediate Visual Acuity at 50 and 66 cm (DCIVA-50 and DCIVA-66, respectively). Results: Eighty-six eyes of 43 patients (26 or 60% female, mean age 70 years) were included with a mean followup of 42 days. Mean values for binocular visual acuity were as follows: UDVA 0.01 ± 0.05 logarithm of the minimum angle of resolution (logMAR), UNVA 0.01 ± 0.03 logMAR, CDVA 0.00 ± 0.00 logMAR with a mean spherical equivalent of 0.04 diopters ± 0.22, DCNVA 0.00 ± 0.00 logMAR, DCIVA-50 0.04 ± 0.17 logMAR, and DCIVA-66 0.12 ± 0.07 logMAR. Conclusions: The Synergy hybrid IOL achieved excellent visual acuity at a distance of 50 cm, corresponding to many intermediate tasks, as well as distance, intermediate, and near visual acuity at traditionally measured ranges. Synergy multifocal EDOF hybrid IOL INTRODUCTION Presbyopia correcting intraocular lenses (IOL) continue to advance in design. While refractive technology including extended depth of focus and bifocal designs are being offered, diffractive technology remains a predominant means to offer a full range of vision to patients undergoing cataract surgery and who seek independence from corrective lens wear. The emergence of diffractive extended depth of focus (EDOF) technology has been shown to improve the depth of focus curves and subsequent continuous range of distance through intermediate vision. 1 , 2 The Tecnis Synergy IOL (Johnson & Johnson Vision) is designed as a hybrid lens that combines both EDOF as well as multifocal diffractive optics to provide a full range of vision. 3 – 5 The IOL is available in both standard and toric versions. Several published studies have demonstrated that it performs well for distance, intermediate, and near vision at various ranges. 6 – 13 These studies have reported clinical outcomes from bilateral implantation of this lens in patients at near focal points of 33, 40, 66, and 80 cm. This author’s experience with the Tecnis Symfony EDOF IOL (Johnson & Johson) 14 and its clinical results has suggested the importance of not only measuring a traditional near point of focus of 33 cm and a traditional optical intermediate focal point of 66 cm, but also a practical close intermediate focal point of 50 cm corresponding to computer use encountered in patients’ daily lives. This study was therefore designed to evaluate binocular outcomes of distance, far intermediate, near intermediate, and near vision in eyes bilaterally implanted with the Tecnis Synergy IOL by a single surgeon in a routine clinical setting. PATIENTS AND METHODS A retrospective chart review was conducted of all patients undergoing phacoemulsification by a single surgeon (RTP) with bilateral implantation of a Tecnis Synergy IOL (DFR00V) or Tecnis Synergy Toric IOL (DFW150, DFW225, DFW300, and DFW375) from August 2021 through March 2023. Exclusion criteria included prior history of keratorefractive surgery, phacoemulsification combined with other anterior segment surgeries, lack of followup beyond 21 days postoperatively, concurrent ocular conditions limiting best corrected distance visual acuity to less than or equal to 20/30 Snellen [0.18 logarithm of the minimal angle of resolution (logMAR)] in either eye, or development of visually significant posterior capsular opacification (PCO) requiring YAG laser capsulotomy within 3 months of phacoemulsification. Institutional Review Board approval was obtained by the Houston Methodist Research Institute, Houston, TX. Phacoemulsification was performed using a standard microinvasive cataract surgery technique. 15 Both manual as well as femtosecond laser-assisted cataract surgery (FLACS) cases were included. Visual acuity was reported at the first postoperative visit after phacoemulsification when eyes were considered stable (no concurrent postoperative ocular conditions affecting visual acuity including unresolved iritis, cystoid macular edema, and keratitis sicca). Near visual acuity was measured using a lighted card on a phoropter rod with the patient’s distance refraction placed in the phoropter. Primary endpoints were Uncorrected Distance Visual Acuity (UDVA), Uncorrected Near Visual Acuity (UNVA), Corrected Distance Visual Acuity (CDVA), Distance-Corrected Near Visual Acuity at 33 cm (DCNVA), and Distance-Corrected Intermediate Visual Acuity at 50 and 66 cm (DCIVA-50 and DCIVA-66, respectively). These distances were based on the average focal distance to laptop and desktop computer screen monitors and reading materials per patient preferences, as well as the bench optical properties of the Synergy IOL. 3 All measurements were binocular. Statistical Analysis Data analysis was performed using Microsoft Excel for Microsoft 365 (Version 2306 Build 16.0.16529.20164, Microsoft Inc, WA). Snellen visual acuities were converted to logMAR for calculation of mean and standard deviation values. Statistical significance was performed with two-tailed T-test. RESULTS A total of 86 eyes of 43 patients were identified that met inclusion and exclusion criteria. Eighty-two (95%) of eyes underwent FLACS. Fifty-eight eyes (67%) were implanted with a Synergy IOL, and the remaining 28 eyes with a Synergy Toric IOL. Mean age of patients was 70 ± 5.8 years (range 54–82). Mean followup period was 42 ± 18 days (range 23–100; Table 1 ). Mean preoperative CDVA was 0.06 ± 0.07 logMAR with a mean spherical equivalent refraction of -1.47 ± 3.39 diopters. Mean postoperative CDVA improved to 0.00 ± 0.00 logMAR (p < 0.0001) with an improvement in postoperative spherical equivalent refraction to 0.04 ± 0.22 diopters (P < 0.0001). There was also a significant improvement from the preoperative CDVA to the postoperative UDVA of 0.01 ± 0.05 logMAR (p < 0.001). Mean values for postoperative UDVA, UNVA, CDVA, DCNVA, DCIVA-50, and DCIVA-66 are reported in Table 1 . All patients achieved a binocular CDVA 20/20 or better (1.0 logMAR), binocular DCNVA of 20/20 or better (1.0 logMAR), binocular DCIVA-50 of 20/25 (0.1 logMAR) or better, and binocular DCIVA-66 of 20/40 (0.30 logMAR) or better. Table 1 Mean Binocular Outcomes Mean Values Standard Deviation SD Range Low SD Range High Ave Days Postop 42 18 24 60 LogMAR UDVA 0.01 0.05 -0.04 0.05 Snellen UDVA (20/-) 20.23 18.22 22.47 LogMAR UNVA 0.01 0.03 -0.02 0.04 Snellen UNVA (20/-) 20.40 18.91 22.01 LogMAR CDVA 0.00 0.00 0.00 0.00 Snellen CDVA (20/-) 20.00 20.00 20.00 LogMAR DCNVA 0.00 0.00 0.00 0.00 Snellen DCNVA (20/-) 20.00 20.00 20.00 LogMAR DCIVA-50 0.02 0.04 -0.02 0.06 Snellen DCIVA-50 (20/-) 20.96 19.14 22.95 LogMAR DCIVA-66 0.12 0.07 0.05 0.19 Snellen DCIVA-66 26.28 22.48 30.73 UDVA = uncorrected distance visual acuity UNVA = uncorrected near visual acuity CDVA = corrected distance visual acuity DCNVA = distance corrected near visual acuity DCIVA-50 = distance corrected intermediate visual acuity at 50 cm DCIVA-66 = distance corrected intermediate visual acuity at 66 cm SD = standard deviation All distances measured in centimeters (cm) DISCUSSION The Synergy IOL employs a hybrid technology that provides both multifocal and EDOF diffractive optics. Theoretically and clinically this range should be more complete than traditional trifocal or EDOF-only technologies. Benchmark testing of this lens suggests that it can achieve a high level of visual acuity over a range of vision. 3 To achieve a high quality of visual functioning over a range of vision, the optics of the Synergy IOL, similar to its predecessor EDOF-only Symfony IOL, correct for different types of aberration, including chromatic and spherical, providing an extremely high peak in its defocus curve. 6 The clinical trials used for FDA approval for this lens reported results of monocular and binocular acuity at 40 cm (primary endpoint), as well as 33 and 66 cm, in addition to distance (secondary endpoints). Other studies have evaluated two and up to three near focal lengths. This study included an intermediate target of 50 cm instead of 40 cm, which the study author’s clinical experience has been more representative of required distance for intermediate vision tasks, especially in the use of a laptop computer or desktop monitor in the daily lives of many patients. This study demonstrated that patients achieved an excellent level of DCIVA at 50 cm, along with excellent near, distance, and traditional 66 cm intermediate vision as shown in past studies. The FDA clinical trial results measured near and intermediate visual acuity up to the 20/40 level—beyond that, eyes were grouped together. The author’s experience is consistent with 20/40 (0.30 logMAR), or J3 on a near card, as a suitable target size of print to satisfy most daily intermediate tasks including computer screen work. This study is limited by its retrospective nature and the lack of a control group. All surgeries, however, were performed by one surgeon and techniques for measuring visual outcomes in the clinic were standardized between the surgeon and the chief technician performing visual and refractive assessments. As such, it is felt that the retrospective design does not significantly impact the nature of visual outcomes reported here. One limitation of this study is that the use of a near acuity card in ideal lighting conditions may overestimate outcomes in patients who are subject to extended periods of reading or for reading in non-ideal conditions. This method of testing of near vision, however, is consistent with that employed by most clinicians when measuring patient outcomes in a normal clinical setting. Furthermore, the Synergy IOL has demonstrated that, with similar visual acuity outcomes as seen in this study, good real world reading outcomes are experienced. 16 This study was not designed to capture side effects such as positive dysphotopsias or overall satisfaction rates of patients undergoing phacoemulsification with the Synergy IOL since detailed questionnaires are not routinely administered in our setting. Nevertheless, a review of all clinic notes revealed that, even though some patients did report glare or haloes on their final postop visit, no patient was dissatisfied with their IOL or required additional followup visits to manage persistent dysphotopsias. The Synergy IOL is designed with a proprietary violet light-filtering chromophore that reduces transmittance of violet wavelengths of light, which may contribute to an improved rate of dysphotopsias compared to similar IOLs without this reduction in transmission of shorter wavelength violet light. 17 CONCLUSION This study demonstrates that the Synergy IOL achieves an excellent level of intermediate visual acuity at a distance of 50 cm, corresponding to many intermediate tasks, as well as distance, intermediate, and near visual acuity at traditionally measured ranges. Declarations DATA AVAILABILITY The Excel spreadsheet including data and table used to support the findings of this study are available from the corresponding author upon request. ACKNOWLEDGEMENTS The author would like to acknowledge Cynthia Pratt for her assistance in data collection. Ethics approval and consent to participate: This retrospective study is IRB approved and requirement for informed consent is waived. All experimental protocols were approved by the Houston Methodist Research Institute Institutional Review Board. All methods were carried out in accordance with relevant guidelines and regulations. Consent for publication: I consent to publication of this submission. Availability of data and materials: The Excel spreadsheet including data and table used to support the findings of this study are available from the corresponding author upon request. Competing interests: The author has the following financial disclosures: Consultant and Speaker’s bureau: Johnson and Johnson Vision, Bausch & Lomb. Funding: The author received no funding for this study. Author’s contributions: Rahul T Pandit, MD was responsible for the conception, design, data acquisition, analysis, interpretation, manuscript writing, and submission of the work. References Gatinel D, Loicq J. Clinically Relevant Optical Properties of Bifocal, Trifocal, and Extended Depth of Focus Intraocular Lenses. J Refract Surg 2016; 32 : 273-80 Weeber HA, Meijer ST, Piers PA. Extending the range of vision using diffractive intraocular lens technology. J Cataract Refract Surg 2015; 41 : 2746–2754 Yan W, Łabuz G, Khoramnia R, Auffarth GU. Trifocal Intraocular Lens Selection: Predicting Visual Function From Optical Quality Measurements. J Refract Surg. 2023 Feb;39(2):111-118. doi: 10.3928/1081597X-20221207-02. Epub 2023 Feb 1. PMID: 36779464. Ribeiro FJ, Ferreira TB, Silva D, Matos AC, Gaspar S. Visual outcomes and patient satisfaction after implantation of a presbyopia-correcting intraocular lens that combines extended depth-of-focus and multifocal profiles. J Cataract Refract Surg. 2021 Nov 1;47(11):1448-1453. Gabrić N, Gabrić I, Gabrić K, Biščević A, Piñero DP, Bohač M. Clinical Outcomes With a New Continuous Range of Vision Presbyopia-Correcting Intraocular Lens. J Refract Surg. 2021 Apr;37(4):256-262. Chang DH, Hu JG, Lehmann RP, Thompson VM, Tsai LH, Thomas EK. Clinical performance of a hybrid presbyopia-correcting intraocular lens in patients undergoing cataract surgery in a multicenter trial. J Cataract Refract Surg. 2023 Aug 1;49(8):840-847. Ozturkmen C, Kesim C, Karadeniz PG, Sahin A. Visual acuity, defocus curve and patient satisfaction of a new hybrid EDOF-multifocal diffractive intraocular lens. European Journal of Ophthalmology. 2022;32(5):2988-2993. Shin DE, Lee H, Kim TI, Koh K. Comparison of visual results and optical quality of two presbyopia-correcting intraocular lenses: TECNIS symfony versus TECNIS synergy. Eur J Ophthalmol. 2022 Nov;32(6):3461-3469. Shin DE, Lee H, Koh K. Comparative analysis of a presbyopia-correcting intraocular lens that combines extended depth-of-focus and bifocal profiles with a standard monofocal intraocular lens. BMC Ophthalmol. 2022 Jul 14;22(1):302. Moshirfar M, Stapley SR, Corbin WM, Bundogji N, Conley M, Darquea IM, Ronquillo YC, Hoopes PC. Comparative Visual Outcome Analysis of a Diffractive Multifocal Intraocular Lens and a New Diffractive Multifocal Lens with Extended Depth of Focus. J Clin Med. 2022 Dec 12;11(24):7374. doi: 10.3390/jcm11247374. PMID: 36555990; PMCID: PMC9781237. Ferreira TB, Ribeiro FJ, Silva D, Matos AC, Gaspar S, Almeida S. Comparison of refractive and visual outcomes of 3 presbyopia-correcting intraocular lenses. J Cataract Refract Surg. 2022 Mar 1;48(3):280-287. Dick HB, Ang RE, Corbett D, Hoffmann P, Tetz M, Villarrubia A, Palomino C, Castillo-Gomez A, Tsai L, Thomas EK, Janakiraman P. Comparison of 3-month visual outcomes of a new multifocal intraocular lens vs a trifocal intraocular lens. J Cataract Refract Surg. 2022 Nov 1;48(11):1270-1276. De Rojas JO, Sandoval HP, Potvin R, Solomon KD. Visual Outcomes, Quality of Vision, Patient Satisfaction and Spectacle Independence After Bilateral Implantation of the Synergy™ Intraocular Lens. Clin Ophthalmol. 2023 Aug 9;17:2277-2285. Pandit RT. Monocular Clinical Outcomes and Range of Near Vision following Cataract Surgery with Implantation of an Extended Depth of Focus Intraocular Lens. J Ophthalmol. 2018 Dec 13;2018:8205824. doi: 10.1155/2018/8205824. Pandit, RT. Combo-chop nuclear disassembly. J Cat Refract Surg 2007; 33 :2155. Baur ID, Auffarth GU, Łabuz G, Stengele A, Hallak MK, Khoramnia R. Clinical Evaluation of Reading Performance in Refractive Lens Exchange With a Diffractive Continuous-Range-of-Vision Intraocular Lens. Am J Ophthalmol. 2023 Jun;250:25-37. van der Mooren M, Alarcon A, Jenkins Sanchez MD, Chang DH. Effect of Violet Light-Filtering and Manufacturing Improvements in an Extended Depth-of-Focus Intraocular Lens on Visual Performance. Clin Ophthalmol. 2023 Mar 1;17:701-709. Additional Declarations Competing interest reported. The author RTP is a consultant and on the speaker’s bureau for Johnson and Johnson Vision. The author received no financial or other support from Johnson and Johnson Vision for this study. Cite Share Download PDF Status: Posted Version 1 posted You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. We do this by developing innovative software and high quality services for the global research community. Our growing team is made up of researchers and industry professionals working together to solve the most critical problems facing scientific publishing. Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-3308228","acceptedTermsAndConditions":true,"allowDirectSubmit":true,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":230722269,"identity":"4b19e788-c100-40fa-9512-2ed64d26dc0e","order_by":0,"name":"Rahul T Pandit","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAABIUlEQVRIie2RMUvEMBiGUwK9JV7Xr/T+glApxIMr9K+0BDKVQxA6djnwlhPXgoP/onsp1OW8uXKCguBc0aHiYpJbPC69WTDPEJoveXjJW4QMhj+LDciBX1s1Gb69U8At5EcsF7xTyHEFgd/uK2hQOb+7rj4usmkebBeN+9WH89PlTfPSZdMoQrh5/zxUJs2YecUGgD413CMxv6TrenQmJskK2ex2cqiATXzv5EoobUo9FNdJ2TJbTmKCSIA1LQgl+JZKUKTU7aXy/KqU6IhCVYoPKQWiUrBSrJVQrE6nzPmMbETHLWczwnlSrhl11Vtqm2FNY4Af6i3JcscpWPXYh2FS3ldv0GV5NFouaqvX1Tz4x5CIwNrTYUWgTzEYDIZ/xg+ynlgy+9a/fQAAAABJRU5ErkJggg==","orcid":"","institution":"Blanton Eye Institute, Houston Methodist Hospital","correspondingAuthor":true,"submittingAuthor":false,"prefix":"","firstName":"Rahul","middleName":"T","lastName":"Pandit","suffix":""}],"badges":[],"createdAt":"2023-08-30 00:29:13","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-3308228/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-3308228/v1","draftVersion":[],"editorialEvents":[],"editorialNote":"","failedWorkflow":false,"files":[{"id":45914065,"identity":"819e7b68-e649-451b-a52d-21e2856f5c54","added_by":"auto","created_at":"2023-11-06 06:52:44","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":259719,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-3308228/v1/272f1867-a573-4302-ad5d-c853cf61b112.pdf"}],"financialInterests":"Competing interest reported. The author RTP is a consultant and on the speaker’s bureau for Johnson and Johnson Vision. The author received no financial or other support from Johnson and Johnson Vision for this study.","formattedTitle":"Clinical Visual Outcomes Over a Range of Vision Following Cataract Surgery with Bilateral Implantation of a Hybrid Multifocal and Extended Depth of Focus Intraocular Lens","fulltext":[{"header":"INTRODUCTION","content":"\u003cp\u003ePresbyopia correcting intraocular lenses (IOL) continue to advance in design. While refractive technology including extended depth of focus and bifocal designs are being offered, diffractive technology remains a predominant means to offer a full range of vision to patients undergoing cataract surgery and who seek independence from corrective lens wear. The emergence of diffractive extended depth of focus (EDOF) technology has been shown to improve the depth of focus curves and subsequent continuous range of distance through intermediate vision.\u003csup\u003e\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e,\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e\u003c/sup\u003e The Tecnis Synergy IOL (Johnson \u0026amp; Johnson Vision) is designed as a hybrid lens that combines both EDOF as well as multifocal diffractive optics to provide a full range of vision.\u003csup\u003e\u003cspan additionalcitationids=\"CR4\" citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e\u003c/sup\u003e The IOL is available in both standard and toric versions. Several published studies have demonstrated that it performs well for distance, intermediate, and near vision at various ranges.\u003csup\u003e\u003cspan additionalcitationids=\"CR7 CR8 CR9 CR10 CR11 CR12\" citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e\u003c/sup\u003e These studies have reported clinical outcomes from bilateral implantation of this lens in patients at near focal points of 33, 40, 66, and 80 cm. This author\u0026rsquo;s experience with the Tecnis Symfony EDOF IOL (Johnson \u0026amp; Johson)\u003csup\u003e\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e\u003c/sup\u003e and its clinical results has suggested the importance of not only measuring a traditional near point of focus of 33 cm and a traditional optical intermediate focal point of 66 cm, but also a practical close intermediate focal point of 50 cm corresponding to computer use encountered in patients\u0026rsquo; daily lives. This study was therefore designed to evaluate binocular outcomes of distance, far intermediate, near intermediate, and near vision in eyes bilaterally implanted with the Tecnis Synergy IOL by a single surgeon in a routine clinical setting.\u003c/p\u003e"},{"header":"PATIENTS AND METHODS","content":"\u003cp\u003eA retrospective chart review was conducted of all patients undergoing phacoemulsification by a single surgeon (RTP) with bilateral implantation of a Tecnis Synergy IOL (DFR00V) or Tecnis Synergy Toric IOL (DFW150, DFW225, DFW300, and DFW375) from August 2021 through March 2023. Exclusion criteria included prior history of keratorefractive surgery, phacoemulsification combined with other anterior segment surgeries, lack of followup beyond 21 days postoperatively, concurrent ocular conditions limiting best corrected distance visual acuity to less than or equal to 20/30 Snellen [0.18 logarithm of the minimal angle of resolution (logMAR)] in either eye, or development of visually significant posterior capsular opacification (PCO) requiring YAG laser capsulotomy within 3 months of phacoemulsification. Institutional Review Board approval was obtained by the Houston Methodist Research Institute, Houston, TX. Phacoemulsification was performed using a standard microinvasive cataract surgery technique.\u003csup\u003e\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e\u003c/sup\u003e Both manual as well as femtosecond laser-assisted cataract surgery (FLACS) cases were included.\u003c/p\u003e \u003cp\u003eVisual acuity was reported at the first postoperative visit after phacoemulsification when eyes were considered stable (no concurrent postoperative ocular conditions affecting visual acuity including unresolved iritis, cystoid macular edema, and keratitis sicca). Near visual acuity was measured using a lighted card on a phoropter rod with the patient\u0026rsquo;s distance refraction placed in the phoropter.\u003c/p\u003e \u003cp\u003ePrimary endpoints were Uncorrected Distance Visual Acuity (UDVA), Uncorrected Near Visual Acuity (UNVA), Corrected Distance Visual Acuity (CDVA), Distance-Corrected Near Visual Acuity at 33 cm (DCNVA), and Distance-Corrected Intermediate Visual Acuity at 50 and 66 cm (DCIVA-50 and DCIVA-66, respectively). These distances were based on the average focal distance to laptop and desktop computer screen monitors and reading materials per patient preferences, as well as the bench optical properties of the Synergy IOL.\u003csup\u003e\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e\u003c/sup\u003e All measurements were binocular.\u003c/p\u003e \u003cdiv id=\"Sec3\" class=\"Section2\"\u003e \u003ch2\u003eStatistical Analysis\u003c/h2\u003e \u003cp\u003eData analysis was performed using Microsoft Excel for Microsoft 365 (Version 2306 Build 16.0.16529.20164, Microsoft Inc, WA). Snellen visual acuities were converted to logMAR for calculation of mean and standard deviation values. Statistical significance was performed with two-tailed T-test.\u003c/p\u003e \u003c/div\u003e"},{"header":"RESULTS","content":"\u003cp\u003eA total of 86 eyes of 43 patients were identified that met inclusion and exclusion criteria.\u003c/p\u003e \u003cp\u003eEighty-two (95%) of eyes underwent FLACS. Fifty-eight eyes (67%) were implanted with a Synergy IOL, and the remaining 28 eyes with a Synergy Toric IOL. Mean age of patients was 70\u0026thinsp;\u0026plusmn;\u0026thinsp;5.8 years (range 54\u0026ndash;82). Mean followup period was 42\u0026thinsp;\u0026plusmn;\u0026thinsp;18 days (range 23\u0026ndash;100; Table\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e). Mean preoperative CDVA was 0.06\u0026thinsp;\u0026plusmn;\u0026thinsp;0.07 logMAR with a mean spherical equivalent refraction of -1.47\u0026thinsp;\u0026plusmn;\u0026thinsp;3.39 diopters. Mean postoperative CDVA improved to 0.00\u0026thinsp;\u0026plusmn;\u0026thinsp;0.00 logMAR (p\u0026thinsp;\u0026lt;\u0026thinsp;0.0001) with an improvement in postoperative spherical equivalent refraction to 0.04\u0026thinsp;\u0026plusmn;\u0026thinsp;0.22 diopters (P\u0026thinsp;\u0026lt;\u0026thinsp;0.0001). There was also a significant improvement from the preoperative CDVA to the postoperative UDVA of 0.01\u0026thinsp;\u0026plusmn;\u0026thinsp;0.05 logMAR (p\u0026thinsp;\u0026lt;\u0026thinsp;0.001). Mean values for postoperative UDVA, UNVA, CDVA, DCNVA, DCIVA-50, and DCIVA-66 are reported in Table\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e. All patients achieved a binocular CDVA 20/20 or better (1.0 logMAR), binocular DCNVA of 20/20 or better (1.0 logMAR), binocular DCIVA-50 of 20/25 (0.1 logMAR) or better, and binocular DCIVA-66 of 20/40 (0.30 logMAR) or better.\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab1\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 1\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eMean Binocular Outcomes\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"5\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eMean Values\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eStandard Deviation\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003eSD Range Low\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e \u003cp\u003eSD Range High\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eAve Days Postop\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e42\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e18\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e24\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e60\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eLogMAR UDVA\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0.01\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.05\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e-0.04\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.05\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eSnellen UDVA (20/-)\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u003cb\u003e20.23\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u003cb\u003e18.22\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e\u003cb\u003e22.47\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eLogMAR UNVA\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0.01\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.03\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e-0.02\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.04\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eSnellen UNVA (20/-)\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u003cb\u003e20.40\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u003cb\u003e18.91\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e\u003cb\u003e22.01\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eLogMAR CDVA\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0.00\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.00\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.00\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.00\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eSnellen CDVA (20/-)\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u003cb\u003e20.00\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u003cb\u003e20.00\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e\u003cb\u003e20.00\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eLogMAR DCNVA\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0.00\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.00\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.00\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.00\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eSnellen DCNVA (20/-)\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u003cb\u003e20.00\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u003cb\u003e20.00\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e\u003cb\u003e20.00\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eLogMAR DCIVA-50\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0.02\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.04\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e-0.02\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.06\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eSnellen DCIVA-50 (20/-)\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u003cb\u003e20.96\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u003cb\u003e19.14\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e\u003cb\u003e22.95\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eLogMAR DCIVA-66\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0.12\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.07\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.05\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.19\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eSnellen DCIVA-66\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u003cb\u003e26.28\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u003cb\u003e22.48\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e\u003cb\u003e30.73\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003ctfoot\u003e \u003ctr\u003e\u003ctd colspan=\"5\"\u003eUDVA\u0026thinsp;=\u0026thinsp;uncorrected distance visual acuity\u003c/td\u003e\u003c/tr\u003e \u003ctr\u003e\u003ctd colspan=\"5\"\u003eUNVA\u0026thinsp;=\u0026thinsp;uncorrected near visual acuity\u003c/td\u003e\u003c/tr\u003e \u003ctr\u003e\u003ctd colspan=\"5\"\u003eCDVA\u0026thinsp;=\u0026thinsp;corrected distance visual acuity\u003c/td\u003e\u003c/tr\u003e \u003ctr\u003e\u003ctd colspan=\"5\"\u003eDCNVA\u0026thinsp;=\u0026thinsp;distance corrected near visual acuity\u003c/td\u003e\u003c/tr\u003e \u003ctr\u003e\u003ctd colspan=\"5\"\u003eDCIVA-50\u0026thinsp;=\u0026thinsp;distance corrected intermediate visual acuity at 50 cm\u003c/td\u003e\u003c/tr\u003e \u003ctr\u003e\u003ctd colspan=\"5\"\u003eDCIVA-66\u0026thinsp;=\u0026thinsp;distance corrected intermediate visual acuity at 66 cm\u003c/td\u003e\u003c/tr\u003e \u003ctr\u003e\u003ctd colspan=\"5\"\u003eSD\u0026thinsp;=\u0026thinsp;standard deviation\u003c/td\u003e\u003c/tr\u003e \u003ctr\u003e\u003ctd colspan=\"5\"\u003eAll distances measured in centimeters (cm)\u003c/td\u003e\u003c/tr\u003e \u003c/tfoot\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e"},{"header":"DISCUSSION","content":"\u003cp\u003eThe Synergy IOL employs a hybrid technology that provides both multifocal and EDOF diffractive optics. Theoretically and clinically this range should be more complete than traditional trifocal or EDOF-only technologies. Benchmark testing of this lens suggests that it can achieve a high level of visual acuity over a range of vision.\u003csup\u003e\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e\u003c/sup\u003e To achieve a high quality of visual functioning over a range of vision, the optics of the Synergy IOL, similar to its predecessor EDOF-only Symfony IOL, correct for different types of aberration, including chromatic and spherical, providing an extremely high peak in its defocus curve.\u003csup\u003e\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e\u003c/sup\u003e The clinical trials used for FDA approval for this lens reported results of monocular and binocular acuity at 40 cm (primary endpoint), as well as 33 and 66 cm, in addition to distance (secondary endpoints). Other studies have evaluated two and up to three near focal lengths. This study included an intermediate target of 50 cm instead of 40 cm, which the study author\u0026rsquo;s clinical experience has been more representative of required distance for intermediate vision tasks, especially in the use of a laptop computer or desktop monitor in the daily lives of many patients.\u003c/p\u003e \u003cp\u003eThis study demonstrated that patients achieved an excellent level of DCIVA at 50 cm, along with excellent near, distance, and traditional 66 cm intermediate vision as shown in past studies. The FDA clinical trial results measured near and intermediate visual acuity up to the 20/40 level\u0026mdash;beyond that, eyes were grouped together. The author\u0026rsquo;s experience is consistent with 20/40 (0.30 logMAR), or J3 on a near card, as a suitable target size of print to satisfy most daily intermediate tasks including computer screen work.\u003c/p\u003e \u003cp\u003eThis study is limited by its retrospective nature and the lack of a control group. All surgeries, however, were performed by one surgeon and techniques for measuring visual outcomes in the clinic were standardized between the surgeon and the chief technician performing visual and refractive assessments. As such, it is felt that the retrospective design does not significantly impact the nature of visual outcomes reported here. One limitation of this study is that the use of a near acuity card in ideal lighting conditions may overestimate outcomes in patients who are subject to extended periods of reading or for reading in non-ideal conditions. This method of testing of near vision, however, is consistent with that employed by most clinicians when measuring patient outcomes in a normal clinical setting. Furthermore, the Synergy IOL has demonstrated that, with similar visual acuity outcomes as seen in this study, good real world reading outcomes are experienced.\u003csup\u003e\u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e\u003c/sup\u003e\u003c/p\u003e \u003cp\u003eThis study was not designed to capture side effects such as positive dysphotopsias or overall satisfaction rates of patients undergoing phacoemulsification with the Synergy IOL since detailed questionnaires are not routinely administered in our setting. Nevertheless, a review of all clinic notes revealed that, even though some patients did report glare or haloes on their final postop visit, no patient was dissatisfied with their IOL or required additional followup visits to manage persistent dysphotopsias. The Synergy IOL is designed with a proprietary violet light-filtering chromophore that reduces transmittance of violet wavelengths of light, which may contribute to an improved rate of dysphotopsias compared to similar IOLs without this reduction in transmission of shorter wavelength violet light.\u003csup\u003e\u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e\u003c/sup\u003e\u003c/p\u003e"},{"header":"CONCLUSION","content":"\u003cp\u003eThis study demonstrates that the Synergy IOL achieves an excellent level of intermediate visual acuity at a distance of 50 cm, corresponding to many intermediate tasks, as well as distance, intermediate, and near visual acuity at traditionally measured ranges.\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eDATA AVAILABILITY\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe Excel spreadsheet including data and table used to support the findings of this study are available from the corresponding author upon request.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eACKNOWLEDGEMENTS\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe author would like to acknowledge Cynthia Pratt for her assistance in data collection.\u003c/p\u003e\n\u003cp\u003eEthics approval and consent to participate: This retrospective study is IRB approved and requirement for informed consent is waived. All experimental protocols were approved by the Houston Methodist Research Institute Institutional Review Board. All methods were carried out in accordance with relevant guidelines and regulations.\u003c/p\u003e\n\u003cp\u003eConsent for publication: I consent to publication of this submission.\u003c/p\u003e\n\u003cp\u003eAvailability of data and materials: The Excel spreadsheet including data and table used to support the findings of this study are available from the corresponding author upon request.\u003c/p\u003e\n\u003cp\u003eCompeting interests: The author has the following financial disclosures: Consultant and Speaker\u0026rsquo;s bureau: Johnson and Johnson Vision, Bausch \u0026amp; Lomb.\u003c/p\u003e\n\u003cp\u003eFunding: The author received no funding for this study.\u003c/p\u003e\n\u003cp\u003eAuthor\u0026rsquo;s contributions: Rahul T Pandit, MD was responsible for the conception, design, data acquisition, analysis, interpretation, manuscript writing, and submission of the work.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\n\u003cli\u003eGatinel D, Loicq J. Clinically Relevant Optical Properties of Bifocal, Trifocal, and Extended Depth of Focus Intraocular Lenses. \u003cem\u003eJ Refract Surg\u003c/em\u003e 2016; \u003cstrong\u003e32\u003c/strong\u003e: 273-80\u003c/li\u003e\n\u003cli\u003eWeeber HA, Meijer ST, Piers PA. Extending the range of vision using diffractive intraocular lens technology. \u003cem\u003eJ Cataract Refract Surg\u003c/em\u003e 2015; \u003cstrong\u003e41\u003c/strong\u003e: 2746\u0026ndash;2754\u003c/li\u003e\n\u003cli\u003eYan W, Łabuz G, Khoramnia R, Auffarth GU. Trifocal Intraocular Lens Selection: Predicting Visual Function From Optical Quality Measurements. J Refract Surg. 2023 Feb;39(2):111-118. doi: 10.3928/1081597X-20221207-02. Epub 2023 Feb 1. PMID: 36779464.\u003c/li\u003e\n\u003cli\u003eRibeiro FJ, Ferreira TB, Silva D, Matos AC, Gaspar S. Visual outcomes and patient satisfaction after implantation of a presbyopia-correcting intraocular lens that combines extended depth-of-focus and multifocal profiles. J Cataract Refract Surg. 2021 Nov 1;47(11):1448-1453.\u003c/li\u003e\n\u003cli\u003eGabrić N, Gabrić I, Gabrić K, Bi\u0026scaron;čević A, Pi\u0026ntilde;ero DP, Bohač M. Clinical Outcomes With a New Continuous Range of Vision Presbyopia-Correcting Intraocular Lens. J Refract Surg. 2021 Apr;37(4):256-262. \u003c/li\u003e\n\u003cli\u003eChang DH, Hu JG, Lehmann RP, Thompson VM, Tsai LH, Thomas EK. Clinical performance of a hybrid presbyopia-correcting intraocular lens in patients undergoing cataract surgery in a multicenter trial. J Cataract Refract Surg. 2023 Aug 1;49(8):840-847.\u003c/li\u003e\n\u003cli\u003eOzturkmen C, Kesim C, Karadeniz PG, Sahin A. Visual acuity, defocus curve and patient satisfaction of a new hybrid EDOF-multifocal diffractive intraocular lens. European Journal of Ophthalmology. 2022;32(5):2988-2993.\u003c/li\u003e\n\u003cli\u003eShin DE, Lee H, Kim TI, Koh K. Comparison of visual results and optical quality of two presbyopia-correcting intraocular lenses: TECNIS symfony versus TECNIS synergy. Eur J Ophthalmol. 2022 Nov;32(6):3461-3469.\u003c/li\u003e\n\u003cli\u003eShin DE, Lee H, Koh K. Comparative analysis of a presbyopia-correcting intraocular lens that combines extended depth-of-focus and bifocal profiles with a standard monofocal intraocular lens. BMC Ophthalmol. 2022 Jul 14;22(1):302. \u003c/li\u003e\n\u003cli\u003eMoshirfar M, Stapley SR, Corbin WM, Bundogji N, Conley M, Darquea IM, Ronquillo YC, Hoopes PC. Comparative Visual Outcome Analysis of a Diffractive Multifocal Intraocular Lens and a New Diffractive Multifocal Lens with Extended Depth of Focus. J Clin Med. 2022 Dec 12;11(24):7374. doi: 10.3390/jcm11247374. PMID: 36555990; PMCID: PMC9781237.\u003c/li\u003e\n\u003cli\u003eFerreira TB, Ribeiro FJ, Silva D, Matos AC, Gaspar S, Almeida S. Comparison of refractive and visual outcomes of 3 presbyopia-correcting intraocular lenses. J Cataract Refract Surg. 2022 Mar 1;48(3):280-287.\u003c/li\u003e\n\u003cli\u003eDick HB, Ang RE, Corbett D, Hoffmann P, Tetz M, Villarrubia A, Palomino C, Castillo-Gomez A, Tsai L, Thomas EK, Janakiraman P. Comparison of 3-month visual outcomes of a new multifocal intraocular lens vs a trifocal intraocular lens. J Cataract Refract Surg. 2022 Nov 1;48(11):1270-1276. \u003c/li\u003e\n\u003cli\u003eDe Rojas JO, Sandoval HP, Potvin R, Solomon KD. Visual Outcomes, Quality of Vision, Patient Satisfaction and Spectacle Independence After Bilateral Implantation of the Synergy\u0026trade; Intraocular Lens. Clin Ophthalmol. 2023 Aug 9;17:2277-2285.\u003c/li\u003e\n\u003cli\u003ePandit RT. Monocular Clinical Outcomes and Range of Near Vision following Cataract Surgery with Implantation of an Extended Depth of Focus Intraocular Lens. J Ophthalmol. 2018 Dec 13;2018:8205824. doi: 10.1155/2018/8205824.\u003c/li\u003e\n\u003cli\u003ePandit, RT. Combo-chop nuclear disassembly. \u003cem\u003eJ Cat Refract Surg\u003c/em\u003e 2007; \u003cstrong\u003e33\u003c/strong\u003e:2155.\u003c/li\u003e\n\u003cli\u003eBaur ID, Auffarth GU, Łabuz G, Stengele A, Hallak MK, Khoramnia R. Clinical Evaluation of Reading Performance in Refractive Lens Exchange With a Diffractive Continuous-Range-of-Vision Intraocular Lens. Am J Ophthalmol. 2023 Jun;250:25-37.\u003c/li\u003e\n\u003cli\u003evan der Mooren M, Alarcon A, Jenkins Sanchez MD, Chang DH. Effect of Violet Light-Filtering and Manufacturing Improvements in an Extended Depth-of-Focus Intraocular Lens on Visual Performance. Clin Ophthalmol. 2023 Mar 1;17:701-709.\u003c/li\u003e\n\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":true,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true},"keywords":"Synergy, multifocal, EDOF, hybrid IOL","lastPublishedDoi":"10.21203/rs.3.rs-3308228/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-3308228/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003ch2\u003eBackground:\u003c/h2\u003e \u003cp\u003eTo evaluate binocular visual outcomes, with emphasis on near intermediate vision at 50 cm, in patients undergoing bilateral cataract surgery with implantation of the Synergy hybrid intraocular lens with multifocal and extended depth of focus diffractive optics.\u003c/p\u003e\u003ch2\u003eMethods:\u003c/h2\u003e \u003cp\u003eA chart review was conducted of all patients undergoing phacoemulsification by a single surgeon with bilateral implantation of a Synergy IOL from August 2021 through March 2023. Primary endpoints were Uncorrected Distance Visual Acuity (UDVA), Uncorrected and Distance-Corrected Near Visual Acuity (UNVA and DCNVA, respectively) at 33 cm, Corrected Distance Visual Acuity (CDVA), and Distance-Corrected Intermediate Visual Acuity at 50 and 66 cm (DCIVA-50 and DCIVA-66, respectively).\u003c/p\u003e\u003ch2\u003eResults:\u003c/h2\u003e \u003cp\u003eEighty-six eyes of 43 patients (26 or 60% female, mean age 70 years) were included with a mean followup of 42 days. Mean values for binocular visual acuity were as follows: UDVA 0.01\u0026thinsp;\u0026plusmn;\u0026thinsp;0.05 logarithm of the minimum angle of resolution (logMAR), UNVA 0.01\u0026thinsp;\u0026plusmn;\u0026thinsp;0.03 logMAR, CDVA 0.00\u0026thinsp;\u0026plusmn;\u0026thinsp;0.00 logMAR with a mean spherical equivalent of 0.04 diopters\u0026thinsp;\u0026plusmn;\u0026thinsp;0.22, DCNVA 0.00\u0026thinsp;\u0026plusmn;\u0026thinsp;0.00 logMAR, DCIVA-50 0.04\u0026thinsp;\u0026plusmn;\u0026thinsp;0.17 logMAR, and DCIVA-66 0.12\u0026thinsp;\u0026plusmn;\u0026thinsp;0.07 logMAR.\u003c/p\u003e\u003ch2\u003eConclusions:\u003c/h2\u003e \u003cp\u003eThe Synergy hybrid IOL achieved excellent visual acuity at a distance of 50 cm, corresponding to many intermediate tasks, as well as distance, intermediate, and near visual acuity at traditionally measured ranges.\u003c/p\u003e","manuscriptTitle":"Clinical Visual Outcomes Over a Range of Vision Following Cataract Surgery with Bilateral Implantation of a Hybrid Multifocal and Extended Depth of Focus Intraocular Lens","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2023-09-07 12:39:22","doi":"10.21203/rs.3.rs-3308228/v1","editorialEvents":[{"type":"communityComments","content":0}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"33cc6e98-9420-4361-b383-6f4c6d8bb397","owner":[],"postedDate":"September 7th, 2023","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"posted","subjectAreas":[],"tags":[],"updatedAt":"2023-11-06T06:44:32+00:00","versionOfRecord":[],"versionCreatedAt":"2023-09-07 12:39:22","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-3308228","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-3308228","identity":"rs-3308228","version":["v1"]},"buildId":"7rjqhiLT3MXkJMwkYKINL","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}