As one of the latest extended depth of focus intraocular lenses to enter the Australian market, DR CHRISTOPHER GO shares why and when he reaches for the TECNIS PureSee IOL.
Dr Christopher Go considers himself a vitreoretinal subspecialist first and foremost, although general ophthalmology accounts for a significant part of his work, with around 2,000 cataract surgeries performed in his career to date.
Familiarity of platform is important, but when deciding which intraocular lenses (IOLs) to implant, it’s his own experience, predictability, IOL technology and design, and the feedback of his peers that carry the most weight.
Dr Go became acquainted with the TECNIS family of IOLs from Johnson & Johnson (J&J) MedTech as a trainee, but his perspective broadened during a project at Westmead Hospital where he first implanted the company’s presbyopia-correcting IOL technology.
After retinal fellowships in Taiwan, Hong Kong, and the UK, Dr Go returned to Australia in 2024 to begin working in private practice where EDOFs have become the new standard of care in his clinic – now implanted in more than 50% of cases.
It’s motivated him to pay close attention to the premium lenses that work best for his patients. And after test driving four EDOF designs, J&J’s latest EDOF design, the TECNIS PureSee IOL with Simplicity Delivery System, has become one of his most-implanted EDOFs today.
“If patients tell me they don’t mind wearing reading glasses and are seeking excellent distance and intermediate vision, these are the cases I tend to recommend and implant TECNIS PureSee,” he says.
“Nowadays, EDOFs are my main lens of choice, even if patients tell me they’re using an iPad, Kindle or phone. This is because the font can be enlarged on these devices, and they then have less of a side-effect profile. I only implant trifocals for patients who would like to read small fonts without glasses like with books; that makes up about 5% of my cases.”
With the EDOF category gathered momentum in recent years, having clarity on patient selection criteria has been a top priority for surgeons, including Dr Go. This is especially important because presbyopia-correcting IOLs providing greater tolerance to refractive errors can potentially benefit patients and alleviate surgeons’ concerns around quality of vision and loss of contrast visual acuity with refractive misses.1
Early on, when the TECNIS PureSee IOL became available in Australia around mid-2024, Dr Go was encouraged by the comments of his ophthalmology peers.
“I heard from many colleagues implanting TECNIS PureSee who were happy with the results and the predictability of refractive outcomes, which is one of the most important things I look for in a lens,” he says. “This supports why it’s one of my preferred lenses today.”
The TECNIS PureSee IOL is described as a purely refractive presbyopia-correcting EDOF2 lens offering excellent distance and intermediate vision, and functional near vision. Other advantages include its ease-of-use,3 consistent visual outcomes,4 and high image contrast in all lighting conditions.5
It’s also been shown to offer a dysphotopsia profile comparable to a monofocal IOL,6 even in the presence of residual refractive error. Excellent contrast sensitivity,7 and high patient satisfaction have also been demonstrated.8
According to J&J, the results of a study – which involved Australian surgeons – indicate that the tolerance to refractive errors could be driven by the combination of the extended depth of focus and high-quality distance vision.1
It’s these consistent visual outcomes and predictability that Dr Go looks for in a presbyopia-correcting IOL.
“Predictability is what I’ve liked most about the TECNIS PureSee,” he says. “The refractive outcome has been spot on for my target. Most of my patients achieve 6/6 distance visual acuity and N8-12 at near, and they’re all pretty happy,” he says.
But the lens stands out for other reasons too, helping to address unmet needs in some key areas of cataract surgery.
Surgeons have come to appreciate the TECNIS platform’s strength in providing good contrast in all lighting conditions, something J&J has worked to maintain in TECNIS PureSee IOL.
As such, J&J reports the lens has been shown to provide superior distance image contrast and less pupil dependency than other EDOFs.9-12
In low light conditions at 5 mm, TECNIS PureSee IOL has been demonstrated to provide better modulation transfer function (MTF) values compared to competing EDOFs. And when assessing the relative MTF decrease when the pupil increases from photopic (3 mm) to mesopic (5 mm) light conditions, the lens has been shown to be consistent with the smallest percentage of change compared with competing EDOFs, according to J&J. 9-12
“Good contrast sensitivity makes me more comfortable in implanting these in patients with mild retinal diseases,” Dr Go adds.
Satisfied patients
One of the big advances in the EDOF category has been the ability of manufacturers to reduce dysphotopsia profiles so they’re comparable to monofocal IOLs.
The TECNIS PureSee IOL has been shown to have a dysphotopsia profile similar to J&J’s TECNIS Eyhance IOL and TECNIS 1-piece monofocals — even in the presence of defocus.6
Dr Go is still mindful of the potential for dysphotopsias even in monofocals, so makes a point to counsel all patients on this. But the TECNIS PureSee IOL, with a purely refractive EDOF design, is helping open the presbyopia-correcting category to more patients who might have otherwise settled for a monofocal.
Dr Go would exclude patients with significant maculopathies such as moderate-to-severe macular degeneration or a previous macular hole repair from an EDOF lens, but as a vitreoretinal surgeon he says not all retinal pathology cases are excluded from the EDOF conversation.
For example, those with a mild epiretinal membrane that’s been stable for a long time may still qualify.
“I still offer these patients the option, but I warn them that the performance of the lens may not be as good. I have implanted the lens in a few patients who either have had retinal membrane surgery with good recovery, or have a mild epiretinal membrane, and they have been happy with the results,” he says.
“Most of them actually achieve the level of vision I’d expect in someone with no retinal problems at all.”
And in the case of high myopes?
“I would still, for example, implant a PureSee lens because they’re made from a hydrophobic material. If it was hydrophilic, I’d be less inclined, since they may need retinal surgery later.”
All in all, he says the TECNIS PureSee IOL is offering a compelling option for surgeons seeking to provide patients greater freedom from spectacles.
And patients appear happy with the results: in one study, 97% said they would recommend the lens to friends or relatives, 88% were satisfied with their overall vision without glasses, and 100% did not need glasses for distance.8
These findings align with Dr Go’s observations.
“Overall, patients have been satisfied with the IOL,” he says, “and are definitely benefiting from reduced spectacle dependence following TECNIS PureSee implantation.”
More reading
Presbyopia update 2025 – latest techniques, technology
Special Report: Do monofocals still have a place?
Clearing up IOL nomenclature confusion
References
1. Black, D.A., Bala, C., Alarcon, A. and Vilupuru, S., 2024. Tolerance to refractive error with a new extended depth of focus intraocular lens. Eye, pp.1-6. 2024REF4934
2. TECNIS PureSee™ IOL with TECNIS SIMPLICITY™ Delivery System, Model DEN00V, DfU INT, Z311782, current revision.
3. DOF2023CT4043 – Clinical Investigation of the TECNIS™ IOL, Models C1V000 and C2V000. Patient Satisfaction Outcomes. 18 July 2023
4. Corbett, D., Black, D., Roberts, T.V., Cronin, B., Gunn, D., Bala, C., Versace, P., Tsai, L., Papadatou, E., Alarcon, A. and Vilupuru, S., 2024. Quality of vision clinical outcomes for a new fully-refractive extended depth of focus Intraocular Lens. Eye, pp. 1-6.
5. DOF2023CT4036 – Clinical Investigation of the TECNIS™ IOL, Models C1V000 and C2V000. Contrast Sensitivity Outcomes. 17 July
6. DOF2023CT4011 Simulations of visual symptoms under defocus for TECNIS PureSee™ IOL. 29 March 2023.
7. DOF2023CT4036 Clinical Investigation of the TECNIS™ Intraocular Lens, Models CV1000 and CV2000. Contrast Sensitivity Outcomes. 17 July 2023. Corbett, D., Black, D., Roberts, T.V., Cronin, B., Gunn, D., Bala, C., Versace, P., Tsai, L., Papadatou, E., Alarcon, A. and Vilupuru, S., 2024. Quality of vision clinical outcomes for a new fully-refractive extended depth of focus Intraocular Lens. Eye, 38(Suppl 1), p.9-14. 2024REF4935
8. DOF2023CT4043 – Clinical Investigation of the TECNIS™ IOL, Models C1V000 and C2V000. Patient Satisfaction Outcomes. 18 July 2023.
9. DOF2023CT4017 – MTF of the Bausch & Lomb LuxSmart IOL. 28 March 2023.
10. DOF2023CT4025 – MTF of TECNIS PureSee™ IOL and other lens models in low-light conditions. 4 April 2023.
11. DOR2023CT4028 – Simulated VA of the TECNIS PureSee™ IOL compared to Vivity. 24 April 2023.
12. Alarcon, A., Canovas, C., Koopman, B., Pande, M.V., Koch, D.D. and Piers, P., 2023. Optical bench evaluation of the effect of pupil size in new generation monofocal intraocular lenses. BMC Ophthalmology, 23(1), p.112.
Disclaimer: This article reflects the opinion of Dr Christopher Go. Dr Christopher Go was not paid for this article. Images have been provided by Johnson & Johnson at the request of Insight.
