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Symfony IOL: Lens Guide and Comparison

Home / Intraocular Lens (IOL) / What Is the Symfony IOL

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The Symfony lens was the first FDA-approved intraocular lens (IOL) to provide an extended depth of focus (EDOF). With new and improved IOL options in the market, exploring how the Symfony performs against other lenses is important to determine if this is the best lens for you, or if you would be better off with an alternative.

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What is the Symfony IOL?

The Symfony IOL is an EDOF lens. This means that this lens uses special technology to manipulate light and create a single, elongated focal point of clear vision. Clear vision is continuous across the range.

The Symfony lens is a well-known EDOF IOL, and the first of its kind to obtain FDA approval, which it gained in 2016 was the first FDA approved EDOF IOL. FDA approval for this lens was obtained in 2016.1

The lens was originally developed by Abbott Medical Optics, Inc., but is now manufactured and available through Johnson & Johnson Vision, leader in the field of IOL technology. Clarity of vision with this lens is often excellent for mid-range (for example 26 inches or “computer distance”) and far away targets. However, near objects may be challenging to see as clearly without eyeglasses.

How does the TECNIS Symfony IOL work?

The TECNIS Symfony EDOF IOL uses a diffractive echelette or “ladder” design to provide a continuous range of vision. In 2022, Johnson & Johnson upgraded this lens, renaming it the TECNIS Symfony OptiBlue IOL. This new version is powered by InteliLight, a combination of three key technologies:2

  • Violet-Light Filter: Blocks the shortest wavelengths of light that helps to mitigate halo, glare, and starbursts and minimize visual disturbances when driving at night.
  • Upgraded Echelette Design: Helps reduce light scattering and halos which may allow more comfortable viewing of computer screens
  • Achromatic Technology: Corrects chromatic aberration for better contrast day and night.

Symfony Toric IOL

The Symfony lens also comes in an astigmatism-correcting or “toric” version. 

Astigmatism is a vision error that causes blurry vision at all distances. It is caused by an irregularly shaped cornea, lens or a combination of both eye structures. IOLs won’t correct astigmatism won’t correct astigmatism unless they incorporate a special shape into their design to compensate for this irregularity. This is why most IOL models come with a toric alternative. The TECNIS Symfony OptiBlue Toric II is the most current astigmatism-correcting version of this lens.3

Pros and Cons of the Symfony Lens

The advantages of the Symfony lens are: 

  • Improves visual acuity at close, intermediate and far ranges
  • May reduce the need for patients to wear contact lenses or glasses after cataract surgery
  • Provides clear, sharp distance vision comparable to a monofocal IOL
  • Tends to create less halos, glare and distortions than a trifocal IOL

The disadvantages of the Symfony lens are:

  • Near vision may not be as clear as trifocal IOLs (e.g. the PanOptix trifocal IOL)6
  • Eyeglasses for very close range seeing may be needed
  •  The FDA noted that this lens may cause reduced contrast sensitivity that becomes worse under poor visibility conditions such as dim light or fog1
  • Some patients may experience visual halos, glare or starbursts in their vision1

Symfony IOL vs Other IOLs

Symfony IOL vs PanOptix IOL

The PanOptix IOL is a trifocal IOL. Like the Symfony, this lens provides a broad range of clear vision by manipulating light, but it does so in a different way. The PanOptix creates clear vision at multiple focal points (near, intermediate and distance) by splitting light using 26 diffractive rings. This lens then creates zones of clear vision at different distances instead of having one big zone of clear vision. 

While both the PanOptix and the Symfony provide great visual outcomes, each lens tends to perform better at a specific range:

  • The PanOptix tends to perform better with near vision tasks and is a great fit for people with very active lifestyles, as it’s associated with greater spectacle independence.
  • The Symfony lens tends to be better at intermediate vision and is a good choice for people who do a lot of computer work, and for activities like crafts and cooking.

Symfony Lens vs Crystalens

The Crystalens and its toric-correcting alternative (Trulign Toric) are the only accommodating IOLs available in the market. These lenses provide an extended range of clear vision, just like EDOF and Trifocal lenses. However, they achieve this with a unique mechanism: accommodation.

Accommodation refers to the natural way that the eye focuses on objects. This is achieved by the lens of the eye, which alters its shape when we want to focus on an object. There is a muscle in the eye called the ciliary muscle which contracts or relaxes to allow the lens to change shape to focus on objects at different distances.

The Crystalens mimics the natural accommodation process. The haptics (“little arms”) that hold the lens in shape are flexible so they can respond to the movement of the ciliary muscles. As a result, vision with this lens feels more natural.

Although the Crystlens tends to give good quality vision, there is some unpredictability in terms of the final visual outcomes, which is heavily reliant of the condition of the ciliary muscles and other eye particles they connect to.13 Some patients may still need to wear reading glasses especially in dimly lit environments.13

The Symfony lens, by contrast, provides more reliable results, as it uses a different mechanism to achieve clear vision at a wide range.

Symfony Lens vs Vivity IOL

The Vivity IOL (made by Alcon) is an EDOF IOL, just like the Symfony. This lens was FDA approved in 2020 and is the first non-diffractive extended depth-of-focus (EDOF) lens.14 

The non-diffractive design of the lens reduces nighttime glare associated with prior models like the Symfony. In a study comparing the two, more patients reported symptoms of starbursts and glare in the Symfony group than the Vivity group.15 Distance vision without eyeglasses is comparable to that of a monofocal distance IOL, but near vision is less sharp.14

Symfony IOL Cost

The Symfony IOL is a premium lens and comes with a higher price than basic monofocal IOLs. Cataract surgery or RLE with Symfony lenses can cost $8000 or more.

While most insurance plans offer coverage for cataract surgery, this only includes a monofocal lens. If the patient wants any other lens, they will have to pay out of pocket. The same goes for any advanced technology during surgery, which are not included in the covered standard procedure.

Refractive lens exchange is not covered by insurance, so both the procedure and the Symfony lens will have to be paid out of pocket.

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Patients looking for a wide range of clear vision with more seamless transitions after are great candidates for an EDOF lens like the Symfony. This premium lens delivers excellent distance vision, improved intermediate vision and functional near vision. As is the case with most premium lenses, visual disturbances like glare or halo are common for most patients, but usually very manageable.

Premium alternatives to the Symfony lens that provide a clear range of extended vision with similar or better results include the PanOptix Trifocal Lens and the Vivity Lens. These Alcon lenses are available at NVISION Centers for your cataract or RLE procedure.

Other IOL Options

Two other types of IOLs represent an alternative to the Symfony with: monofocal lenses and light adjustable lenses. These lenses provide clear vision at only one point, but with excellent results. They cannot offer spectacle independence unless a monovision procedure is performed, in which one lens is adjusted for near vision and the other for distance.

Monofocal IOL

Monofocal lenses are standard lenses used in cataract surgery, and the only lens covered by insurance for this procedure. They are also the most affordable option for people without health insurance. Clarity of vision with this lens is excellent, although limited to one focal point. People usually opt to set the lens for distance vision, using glasses for near and intermediate distances.

Some eye conditions, like corneal scarring or macular diseases, might limit a patient’s choice of IOL to monofocal lenses.

Light Adjustable Lenses

Light adjustable lenses are a premium version of monofocal lenses. Like monofocals, they can only be set at one focal point, but you can customize this focus to your exact preference. These lenses are the only IOL that can be adjusted after surgery. After the procedure, you will have two or three appointments with your eye doctor to adjust the power of the lens using special light treatments. Then, when the lens matches your exact prescription, a final light treatment will lock-in the power of the lens.

Symfony Lens Recall

In 2016, there was a recall by the FDA for the TECNIS Symfony Extended Range of Vision IOL.4 These IOLs were recalled because they were not being checked prior to release and this may have resulted in the release of mislabeled IOLs.4 

Another recall took place in 2023, when the FDA issued a class 2 device recall for this lens due to an issue with toric markings.5 The FDA instructed eye surgeons not to use the affected IOLs.5 

Both incidents were classified as Class II recalls. These recalls involve situations where the use of or exposure to a product may cause temporary or medically reversible adverse health consequences. However, the probability of serious adverse health consequences is considered remote.

References

  1. FDA Approves First Intraocular Lens with Extended Range of Vision for Cataract Patients (2016 Jul 15). U.S. Food & Drug Administration. Accessed on 2024 Sep 06 from: FDA approves first intraocular lens with extended range of vision for cataract patients | FDA.
  2. Johnson & Johnson Vision Introduces All Purpose EDOF, TECNIS Symfony OptiBlue IOL, the Latest PC-IOL Powered by InteliLight Technology (2022 Sep 28). Accessed on 2024 Sep 07. Retrieved from: Johnson & Johnson Vision Introduces All Purpose EDOF, TECNIS Symfony OptiBlue IOL, the Latest PC-IOL Powered by InteliLight Technology (jnj.com).
  3. TECNIS™ PC IOL Portfolio Powered by InteliLight™ (2024). Accessed on 2024 Sep Sept 07. Retrieved from: TECNIS® PC IOL powered by InteliLight™ | J&J Vision Pro (jnjvisionpro.com).
  4. Class 2 Device Recall TECNIS. (September 2016). Food and Drug Administration.
  5. Class 2 Device Recall TECNIS Symfony, Extended Range of Vision (2023 Aug 03). U.S. Food & Drug Administration. Accessed on 2024 Sep 07. Retrieved from: Class 2 Device Recall TECNIS Symfony, Extended Range of Vision (fda.gov).
  6. Monaco G, Gari M, Di Censo F, Poscia A, Ruggi G, Scialdone A. Visual performance after bilateral implantation of 2 new presbyopia-correcting intraocular lenses: Trifocal versus extended range of vision. J Cataract Refract Surg. 2017 Jun;43(6):737-747. doi: 10.1016/j.jcrs.2017.03.037. PMID: 28732606.
  7. Feldman, BH, et al. Trifocal Intraocular Lenses (2023 Jul 23). EyeWiki. Retrieved from: Trifocal Intraocular Lenses – EyeWikiTrifocal Intraocular Lenses – EyeWiki.
  8. Clareon® Panoptix® IOL. Accessed on 2024 Sep 04. Retrieved from: Clareon® Panoptix® IOL | Alcon Professional (myalcon.com).
  9. Succeeding with Tecnis Symfony Extended-Depth of Focus IOLs (2017 Nov). Accessed on 2024 Sep 07. Retrieved from: 1117_Symfonyi.pdf (reviewofophthalmology.com)
  10. Hamid A, Sokwala A. A More Natural Way of Seeing: Visual Performance of Three Presbyopia Correcting Intraocular Lenses. Virtual Mentor Open J Ophthalmol 2016;6:176–183
  11. Okpe, O. Accommodation (2023 Mar 08). Retrieved from: Accommodation (eye): anatomy, definition, pathway | Kenhub.
  12. FDA Panel Recommends Approval for First Accommodating IOL (2003 Jul 19). Retrieved from: FDA Panel Recommends Approval for First Accommodating IOL (reviewofophthalmology.com).
  13. The pros and cons of multifocal and accommodating IOLs (2008 Feb). ASCRS EyeWorld. Accessed on 2024 Sep 07. Retrieved from: The pros and cons of multifocal and accommodating IOLs – EyeWorld
  14. Lavoy A. Real-World Performance of Newer Intraocular Lenses (2021 Dec 15). Review of Optometry. Accessed on 2024 Sep 07. Retrieved from: Real-World Performance of Newer Intraocular Lenses (reviewofoptometry.com)
  15. Scheepers MA, Hall B. Randomized and double-blind comparison of clinical visual outcomes of 2 EDOF intraocular lenses. J Cataract Refract Surg. 2023 Apr 1;49(4):354-359. doi: 10.1097/j.jcrs.0000000000001113. PMID: 36975011.
  16. McClain, C. Symfony Lens Cost (2024 Jul 16). Accessed on 2024 Sep 07. Retrieved from: Symfony Lens Cost – Discovering Employment Paths and Travel Experiences (ncesc.com)
  17. Light Adjustable Lenses: Adjustable Intraocular lens (IOL) (2024 Aug 26). NVISION. Accessed on 2024 Sep 07. Retrieved from: Light Adjustable Lenses: Customizable IOLs for Optimal Vision (nvisioncenters.com)
  18. IOL Implants: Lens Replacements After Cataracts. (October 2019). American Academy of Ophthalmology.
  19. Intraocular Lens Implant (IOL). (July 2017). American Association for Pediatric Ophthalmology and Strabismus.
  20. FDA Approves First Intraocular Lens With Extended Range of Vision for Cataract Patients. (July 2016). Food and Drug Administration.
  21. Before, During, & After Surgery. (January 2018). Food and Drug Administration.
  22. What Is an Intraocular Lens Implant? WebMD.

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