Using TECNIS Odyssey™️ IOL in practice: patient selection and outcomes

Sumit Garg, MD, spoke with Ophthalmology 360 at the 2024 AAO Annual Meeting about the recent launch of the TECNIS Odyssey IOL and which patients may be the best candidates for this lens.

Sumit Garg, MD:

My name is Sumit Garg. I’m at the University of California, Irvine, Gavin Herbert Eye Institute where I’m a professor of cataract, cornea, and refractive surgery.

The TECNIS Odyssey is the newest IOL from Johnson & Johnson. It’s a full range of vision lens, so it gives you really great distance, intermediate, and near vision, and it has what they’re calling a free-form design. The optic has been modified to allow this great range of vision, also minimizing dysphotopsia and actually enhancing any kind of residual refractive error. There’s some tolerance to residual refractive error. So far in my practice, patients have been really enjoying the lens. I’ve been using the lens for a while now, and it’s really become my fastball when I go to a diffractive optic lens. Previously with other platforms, I had some variability of results, and I’m finding that patients here, especially when it’s implanted bilaterally, they’re getting phenomenal distance vision, intermediate and reading with very low dysphotopsia. A very happy patient and a very happy surgeon.

I start every consult with, “There’s no perfect lens on the market,” and when we talk about diffractive optics in general, our historical lenses have been a little bit of a challenge with respect to predictability of that dysphotopsia. Some patients, they get a lot of it, some patients get very little. With this, patients, by and large, they’re still getting it upfront, but it’s fading very quickly. Their acceptance rate of the dysphotopsia, the minimal dysphotopsia, is really, really high. Several patients say they don’t even see it anymore, which is surprising to me given the diffractive optics. But the proof is in their results. They really are quite happy with the quality of vision. It’s not just my patients. Talking to colleagues and friends who’ve used the lens in several patients, they find the same thing.

When you start with any kind of new lens, you want to start with sort of middle of the road patients. You want to start with patients who have a desire to be out of spectacles, who have otherwise healthy eyes, that they have normal, regular corneal astigmatism, that their retina is healthy, and so typically, I’m looking for those patients that are straightforward. As we go forward off-label indications, post-refractive, putting it just in 1 eye, it’s not off-label, but I find that these lenses usually do well better when you have it in both eyes because you get the binocular summation. But really, good temperament, reasonable, all those things are what you’re looking for in a patient that you’re putting this kind of lens in.

I go through all the options. I’ll start with a monofocal lens. I’ll show them what they’re getting with that lens, and more importantly what they’re not getting with that lens. Then I’ll go through talking about a toric lens, and I have little models that help me really illustrate to the patient. The toric lens, again, talking about the pros and the cons and what you’re getting and not getting and then I’ll move to something like a diffractive lens. With this, I’ll show them the rings. I say, “The reason you get this predictable range of vision is because of these rings, but the vast majority of patients, if you’re a good candidate for the lens, have done really well with it.” Then I ask the typical questions about how important is their range of vision versus their quality of vision. There’s been several patients that say, “Listen, doc, I don’t want any halo and glare.” When I sort of talk to them about the lens a little bit, just to educate them, they realize that, “You know what? Maybe that’ll be okay.” They’ve been very happy with the lens.

I’m actually very, almost shocked, with how minimal the dysphotopsy is. There is still some, so I don’t want to say that there’s none. But the sort of balancing the range of vision with the quality of vision, and then knowing that it’s a TECNIS platform, which is a tried and true platform, there’s some great attributes to that platform that live in this lens as well. All in all, it’s been a really nice offering.