She first visited us for consultation about cataract surgery with multifocal lenses because for three months her left eye had been blurry and hard to see with.
Both eyes had strong cortical cataracts with posterior subcapsular opacity, and vision in the left eye in particular had fallen considerably, to 0.06 (0.4) at distance and 0.1 (0.3) at near. Her younger sister had also had surgery at our clinic (right eye: extended depth of focus Symfony; left eye: trifocal PanOptix), and she too had wished for and been scheduled for surgery with trifocal lenses; but after she booked, early use of TECNIS Synergy, whose near focal distance is closer, became possible, so after discussing it, including its advantages (good contrast and vision even closer) and disadvantages (strong photic phenomena such as halos, glare and starbursts), the surgery was done with the continuous-focus TECNIS Synergy.
The cataract had made her left eye myopic at about −4.0 D (near distance about 25 cm), so to bring out TECNIS Synergy's characteristics and not fall far short of her preoperative focal distance, we chose a slightly myopic target refraction (prioritizing near), even at some sacrifice of distance.
The cataract was mainly cortical opacity without a very hard nucleus, so the left eye surgery was completed without problems, and postoperative uncorrected vision was very good at 1.5p distance / 1.2p near. For the left eye we had meant, on the lens's specifications, to choose a power that sees nearer at some sacrifice of distance, but as a result not only near but distance vision was good, so we chose the same power for the right eye. In the end, both eyes had good uncorrected vision of 1.5p distance / 1.2p near, and she was very satisfied.
TECNIS Synergy is a continuous-focus multifocal lens characterized by continuous vision from about 35 cm near to distance, a lens that emphasizes near more than the current trifocal lenses covered by the elective treatment system. Accordingly, shifting the target refraction toward near tends to reduce distance vision (the distance sweet spot is narrow), so the manufacturer recommends choosing a target refraction from emmetropia to slightly hyperopic. However, in our experience so far, choosing a slightly myopic power close to emmetropia tends to give higher satisfaction. Of course, for people who prioritize distance, following the manufacturer's recommendation should be fine (though people who choose TECNIS Synergy tend to prioritize near over distance in the first place). Perhaps because many of our patients are myopic before surgery, we have so far not experienced a case in which setting the target refraction on the myopic side reduced distance vision.
It is a new lens with still few cases in Japan, so useful information should accumulate, and we will update this as it does.
2021.04.29