Multifocal Toric Swiss Army Knife For the Cataract and Refractive Surgeon

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$Multifocal Toric Swiss Army Knife For the Cataract and Refractive Surgeon$

1 Multifocal Toric Swiss Army Knife For the Cataract and Refractive Surgeon Leonidas Mavroudis Thessaloniki Orasi Day Case Microsurgery Clinic Athens 2018

2 Disclaimer : Alcon Leonidas Mavroudis Thessaloniki Orasi Day Case Microsurgery Clinic Athens 2018

3 Panoptix Toric IOL Do we need this technology Do we have to put the effort? How many patients Is it different than Restor Toric? Is it technically challenging? Do we need special tools (laser)?

4 BEFORE clear lens extraction Patients demand Perfect far distance vision Perfect medium distance vision Pefect near distance vision

5 BEFORE cataract extraction Patients demand Removal of cataract Wish for very good far vision Do not know about medium vision Think they will have near vision

6 BEFORE cataract extraction Patients demand Removal of cataract Do not know about Monofocal Toric - Multifocal lenses Lenses at all

7 AFTER the operation After removal of the crystaline lens all patients are the same (clear lens or cataract) Did not know about Monofocal Toric - Multifocal lenses Lenses at all

8 AFTER the operation After removal of the crystaline lens all patients are the same They know that they have not been informed They have to wear glasses for Distance and near (monofocal + astigmatism) Near (monofocal)

9 AFTER the operation Patients know they have not been informed They have to wear glasses AND Their neighbor who was operated by somebody else (better doctor) does not have to wear glasses

10 Multifocal Toric IOL In the absence of accommodation The only technology that can address (stereoscopically) Spherical error Astigmatic error Presbyopia No glasses most of the time

11 Panoptix Toric IOL Do we need this technology Do we have to put the effort? How many patients? Is it different than Restor Toric? Is it technically challenging? Do we need special tools (laser)?

Even small amounts of astigmatism impact visual acuity*

5 D = 20/25 DCVA = distance-corrected visual acuity

astigmatism were simulated. n=30 eyes @ 3 months postop.

significantly per the degree of added astigmatism (P<0.

12 Even small amounts of astigmatism impact visual acuity* Change in Mean DCVA 1 0 D = 20/ D = 20/25 DCVA = distance-corrected visual acuity *After implantation of monofocal IOL, various degrees of astigmatism were simulated. n=30 3 months postop. The mean visual acuity at all distances changed significantly per the degree of added astigmatism (P< at each distance). 1. Hayashi K, et al. J Cataract Refract Surg. 2010;36:

13 Diffractive multifocal IOL

14 Panoptix Toric IOL Do we need this technology Do we have to put the effort? How many patients? Is it different than Restor Toric? Is it technically challenging? Do we need special tools (laser)?

15 Frequency** (%) Prevalence of Corneal Astigmatism Prior to Cataract Surgery Cumulative frequency of magnitude of corneal astigmatism N=15,448 patients 0.5 Up to ~36% of cataract patients* with 1.0 D of astigmatism 1.00 Frequency, 1.5, * Data set evaluation of eyes from patients. **Cumulative frequency distribution of corneal astigmatism measured by partial coherence interferometry. 1. Hoffman PC and Hϋtz WW. J Cataract Refract Surg. 2010;36: Frequency, 2.0, 8.10 Frequency, 2.5, 4.40 Frequency, Frequency, 3.0, 2.65 Frequency, 3.5, 1.57 Frequency, 4.0, 0.99 Frequency, 4.5, , Frequency, , 6.0, Astigmatism (D)

16 How many patients? Retrospetive review of 2010 (out of 900) Total T3 T4 T5 T7 T8 T <= 0.5D 104/ /75 24/27 8/20 1/3 1/4 <= 0.75D <= 1.00D 13/129 5/75 3/27 5/20 2/4 8/129 3/20 2/3 1/4

17 Panoptix Toric IOL Do we need this technology Do we have to put the effort? How many patients Is it different than Restor Toric? Is it technically challenging? Do we need special tools (laser)?

18 Acrysof IQ Restor Toric Η Ιθάκη; ακόμη ένα λιμάνι; 25 0 Συνέδριο ΕΕΦΔΧ Άνδρας Ηλικία 75 ετών Κύλινδρος Ενδοφακός Acrysof IQ Restor Toric T Dpt Λοξός παρά τον κανόνα αστιγματισμός Αθήνα 2011

19 Acrysof Restor aspheric Ζώνες 9 Ζώνες

20 Acrysof Restor aspheric Ζώνες 9 Ζώνες

21 Bench Headlight Image Simulation AcrySof IQ IOL ReSTOR +2.5 IOL ReSTOR +3.0 IOL Other M IOL Other M IOL Other M IOL

22 The ReSTOR +2.5 D IOLModel Provides Improved Compression and Contrast of Halos PSF Images with & without Defocus ReSTOR +3.0 D IOL ReSTOR +2.5 D IOL 3.0 mm (0 defocus) 3.0 mm (0.5D defocus) Less compact, Lower contrast More compact, Better contrast Bench Data; Alcon Data on File 22

24 Alcon model Distance 80cm 70cm 60cm 40cm ReSTOR +3.0 D IOL ReSTOR +2.5 D IOL AcrySof IQ IOL

25 PATIENT SELECTION Near Intermediate Distant

26 Restor / Panoptix 7 Ζώνες 15 Ζώνες

29 Restor / Panoptix defocus

30 Panoptix Toric IOL Do we need this technology Do we have to put the effort? How many patients Is it different than Restor Toric? Is it technically challenging? Do we need special tools (laser)?

31 Correction of astigmatism during lens surgery with a toric IOL Possible high order aberration induction

$patient-specific effective lens position Designed to improve refractive predictability by using a centroid value for SIA 3 1. 1. Abulafia A, Barrett GD, et al.$

32 The ALCON Online Toric IOL Calculator Barrett Toric Algorithm Best-in-class preoperative prediction of residual astigmatism 1,2 Theoretically accounts for posterior corneal astigmatism Calculates patient-specific effective lens position Designed to improve refractive predictability by using a centroid value for SIA Abulafia A, Barrett GD, et al. Prediction of refractive outcomes with toric intraocular lens implantation. J Cataract Refract Surg. 2015;41: Abulafia A, Hill WE, Franchina M, Barrett GD. Comparison of methods to predict residual astigmatism after intraocular lens implantation. J Refract Surg. 2015;31(10): Alpins N, Barrett GD, Hansen MS, Berdahl JP, Hardten DR, Holladay JT. Innovative toric IOL calculators and how to use them: Barrett Toric Calculator. Cataract Refract Surg Today Europe. May 2015 supplement.

34 25 0 Συνέδριο ΕΕΦΔΧ Αθήνα 2011

36 Calculation of corneal astigmatism axis for accurate installation of toric intraocular lenses using five different techniques Εleftheriadou D, Mavroudis L Ophthalmic Day Care Microsurgery Clinic "LEONIDAS MAVROUDIS Thessaloniki

37 Methods Instruments Topcon KR7000P topography - keratometry Iol Master optical biometry - keratometry Biograph/Lenstar optical biometry - keratometry itrace topography, Chang corneal analysis Verion Image Guided System

38 Clinical Relevance Analysis of results 28% of eyes deviation >10 from the Median in at least one instrument Topcon Biograph itrace Verion Iol Master

39 Group B (>1.5 dpt), deviation >10 0 from median topcon biograph itrace verion

40 TOPOGRAPHY IS IMPORTANT Patient S.I., 77y/o OD OS Topcon Biograp h itrace Verion Iol Master

41 Στάδια ένθεσης

42 Panoptix Toric IOL Do we need this technology Do we have to put the effort? How many patients? Is it different than Restor Toric? Is it technically challenging? Do we need special tools (laser)?

44 13 of the 15 consecutive operations in one surgical day Circularity 0.99 ( ) Roundness 0.97 ( ) Centricity 140μm (90-190)

46 VERUS

47 Multifocal IOLS work Centered IOL Perfect rhexis Corrected Spherical equivalent Astigmatism High order abbrrations Clear capsule Normal macula

48 Acrysof Panoptix Toric Patient selection Management of expectations Use in patients who do not want to wear gls for any distance (multifocal gls users) Explain compromises (will not become 20 yrs old) Explain possibility of difficulty driving at night (vast improvement compared to previous models) Most hyperopes and many myopes already have night driving difficulty months adaptation period

49 Acrysof Panoptix Toric You can promice Very good distance vision (medium as well) Permanent near vision correction No gls most of the time (computer or tablet as well)

Conclusion The AcrySof IQ PanOptix Presbyopia- Correcting IOL designed for more natural adaptability 1 : Designed for a more comfortable near to intermediate range 1-6 20/25 or better at every

50 Conclusion The AcrySof IQ PanOptix Presbyopia- Correcting IOL designed for more natural adaptability 1 : Designed for a more comfortable near to intermediate range /25 or better at every meaningful focal point 4-7 High light utilization 8, 9 Less dependence on pupil size 1 Toric model important part of our armamentarium 1. Alcon Data on File. TDOC (Dec 19, 2014). 2. Charness N, Dijkstra K, Jastrzembski T, et al. Monitor viewing distance for younger and older workers. Proceedings of the Human Factors and Ergonomics Society 52nd Annual Meeting, Accessed April 9, Average of American OSHA, Canadian OSHA and American Optometric Association Recommendations for Computer Monitor Distances. 4. Lawless M, et at. Visual and refractive outcomes following implantation of a new trifocal intraocular lens. Eye and vision (2017) 4: Garcia-Pérez JL. Short term visual outcomes of a new trifocal intraocular lens. BMC Ophthalmology (2017) 17: Gundersen LG, et al. Trifocal intraocular lenses: a comparison of the visual performance and quality of vision provided by two different designs. Clinical Ophthalmol 2017:11; Alcon Data on File. TDOC (June 12, 2015). 8.AcrySof IQ PanOptix IOL Directions for Use.9. Alcon Data on File. TDOC Nov 19, 2015)

Premium Implant Options for the Cataract Patient. Justin Schweitzer, OD, FAAO Vance Thompson Vision Sioux Falls, South Dakota

Premium Implant Options for the Cataract Patient Justin Schweitzer, OD, FAAO Vance Thompson Vision Sioux Falls, South Dakota Glaukos Bausch and Lomb Alcon Allergan Bio- Tissue TearScience Reichert Trends