Gosford talk

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  • Nearly 28 Million -- Most frequently implanted IOL worldwide !!
  • crystalens 5.0 launched in December 2006
  • The AcrySof ® Toric IOL is designed to deliver outstanding rotational stability within the capsular bag.   The STABLEFORCE ® haptic design and the adhesive nature of the AcrySof ® Toric IOL material combine to provide a very high level of rotational stability. This was demonstrated in the clinical study, which showed that the AcrySof ® Toric IOL is stable within the capsular bag, with average rotation of less than 4 degrees 6 months after implantation.   It should be noted that the flexible STABLEFORCE ® haptic design has another important benefit. It allows the IOL to conform to the capsular bag, promoting optimal placement and centration in capsular bags of different sizes. This makes the lens suitable for use in a wide variety of patients.
  • Internal Use Only - Alcon Confidential
  • 35% of patients have 1 or more diopters of cyl. 25% have 1-2D, AND 10% HAVE MORE THAN 2D.
  • The amount of corrective cylinder power varies from 1.5 D to 3.0 D in the three models of the AcrySof ® Toric IOL that will initially be introduced.   The optic design maintains the same central optic thickness for all AcrySof ® Toric IOL models as with monofocal models SA60AT and SN60AT.
  • Internal Use Only - Alcon Confidential
  • Internal Use Only - Alcon Confidential
  • Internal Use Only - Alcon Confidential
  • Internal Use Only - Alcon Confidential
  • Internal Use Only - Alcon Confidential
  • Axis marking: After phacoemulsification, using the reference marks as a guide, the patient’s eye is marked accurately at two positions (180 degrees apart) that define the optimal axis of IOL placement as determined by the AcrySof ® Toric IOL Calculator.
  • Based on the experience of all diffractive and refractive lenses, it is vital that proper patient selection and screening be employed. Age, functional and occupational requirements, degree of general alertness, and ocular pathology must all be taken into account. Before choosing a lens, it is recommended that consideration be made on the patients visual demands, and their expectation on near vision needs. Patients with pre-existing ocular pathology, or those with high degrees of pre-operative astigmatism, are likely to NOT be ideal candidates. Our recommendation is to choose active, alert patients without existing pathology who have 1.0 diopter or less of pre-operative astigmatism. Bilateral implants are also strongly recommended, to ensure optimal results.
  • Gosford talk

    1. 1. AcrySof® IQ ReSTOR® Multifocal Toric IOL Con Moshegov Sydney
    2. 2. AcrySof ® MultiPiece 1994 2000 2003 2004 2005 2006 AcrySof ® TORIC AcrySof ® Single Piece AcrySof ® Product Portfolio / Timeline AcrySof ® IQ ReSTOR ® +3 2008 +3 “ Refractive” Optics
    3. 3. Presbyopia Correcting -IOLs Most Often Used 2009 Source: 2009 Leaming Survey
    4. 4. ReSTOR ® & Crystalens ® US Market Share Trends Source: 3Q09 Market Scope Quarterly Cataract Update +28.2pt 29.3% 57.5% 45.7% 44.5% Q4-07 Q4-08 Q4-09 30 35 40 45 50 55 60 -1.2pt
    5. 6. Overall Spectacle Wear Portion of Time Wearing Glasses Binocular – 6 Months Post op
    6. 7. Overall Spectacle Wear Binocular – 6 Months Post op
    7. 8. 13.0 mm Anterior Apodized Diffractive Optic 6.0 mm 6.0 mm Symmetric Biconvex Anterior Aspheric Optic Anatomy of the Apodized Diffractive Technology
    8. 9. AcrySof ® IQ ReSTOR ® IOL SN6AD3 Add Power: +4.0 D Spectacle Plane: +3.2 D Range: +10.0 D to +34.0 D A-Constant: 118.9 SN6AD1 Add Power: +3.0 D Spectacle Plane: +2.5 D Range: +10.0 D to +34.0 D A-Constant: 118.9
    9. 10. 26 28 30 32 34 36 Uncorrected Centimeters (cm) ~6-7 cm difference Source: AcrySof ® IQ ReSTOR ® IOL Package Insert 38 Average Near Best Distance IQ ReSTOR ® IOL +4.0 D [N=131] IQ ReSTOR ® IOL +3.0 D [N=138]
    10. 11. Moshegov <ul><li>Best near focus with ReSTOR +4: 32cm (median 34cm) </li></ul><ul><li>Best near focus with ReSTOR +3: 37cm (median 40cm) </li></ul>
    11. 13. Night Vision Problems Halos Glare AcrySof ReSTOR +4 6 months AcrySof ReSTOR +3 3 months Moderate None, Mild Severe Visual Disturbances
    12. 14. Toric IOL Preferred 2009 Source: 2009 Leaming Survey
    13. 15. IOL Design – Rotational Stability <ul><li>Adhesive nature of AcrySof ® Toric IOL material provides high level of rotational stability </li></ul><ul><li>STABLEFORCE ® haptic design allows the IOL to conform to the capsular bag </li></ul><ul><li>Promotes optimal placement and centration in different sized capsular bags </li></ul><ul><li>Average rotation of less than 4° at six months post-op </li></ul>
    14. 17. Measuring axis post-op
    15. 18. IOL rotation <ul><li>Follow-up: I month post op </li></ul><ul><li>n = 38 </li></ul><ul><li>92% < 5 ° (highest was 7.5 °) </li></ul><ul><li>Direction: equal clockwise and anticlockwise </li></ul>
    16. 19. <ul><li>For every 1°of rotation, 3.3% of the lens cylinder power is lost </li></ul><ul><li>For 30° of rotation there is a complete loss of astigmatic correction </li></ul><ul><li>Additional astigmatism or visual problems with greater than 30° of rotation </li></ul>
    17. 21. Post op: Toric vs. LRI Acrysof Toric SN60AT + LRIs >/= 6/6 56% 24% >/= 6/12 93% 85% Post-op refractive cyl 0.48 D 0.97 D Mean SE -0.45 -0.575
    18. 22. The Latest Advance in AcrySof® Technology Australian launch: November 2010
    19. 23. AcrySof ® IQ ReSTOR® Multifocal Toric IOL <ul><li>Single surgical procedure for presbyopia correction and corneal astigmatism management </li></ul><ul><li>Reduce or eliminate need to refine residual cylinder with LRI, LASIK, or PRK </li></ul>
    20. 24. Cylinder Distribution Cylinder D ( < ) % of Patients N = 10,411 Moderate 1.0 – 2.0D 25% Severe >2.0 D 10%
    21. 25. Corrective Cylinder Power
    22. 26. <ul><li>Anterior Apodized Diffractive Aspheric Surface </li></ul><ul><ul><li>Same design as current AcrySof® IQ ReSTOR® +3.0D </li></ul></ul><ul><ul><ul><li>9 apodized diffractive steps for +3.0D add power </li></ul></ul></ul><ul><ul><ul><li>Negative spherical aberration factor corrects for the </li></ul></ul></ul><ul><ul><ul><li>positive spherical aberration of the cornea </li></ul></ul></ul>AcrySof® IQ ReSTOR® Multifocal Toric IOL Product Evolution <ul><li>Posterior Toric Lens Surface </li></ul><ul><li>Same design as current AcrySof® Toric IOLs </li></ul><ul><ul><ul><li>Posterior toric axis marks </li></ul></ul></ul><ul><ul><ul><li>Posterior toric surface </li></ul></ul></ul>
    23. 27. Cylinder Powers Detail (Models SND1T2 – T5) * Based on an average pseudophakic human eye IOL Model Cylinder Power @ IOL Plane Cylinder Power @ Corneal Plane* Diopter Power Available** 0.5D increments (Spherical Equivalent) SND1T2 1.00 0.68 6.0 to 34.0D SND1T3 1.50 1.03 6.0 to 34.0D SND1T4 2.25 1.55 6.0 to 34.0D SND1T5 3.00 2.06 6.0 to 34.0D
    24. 28. AcrySof® IQ ReSTOR® Multifocal Toric IOL (Model SND1TT) Product Characteristic Summary Table Internal Use Only – For Sales Training Purposes Model Numbers Product Characteristic SND1T2 * SND1T3 SND1T4 SND1T5 Optic Type Biconvex Apodized Diffractive Aspheric Toric Material Ultraviolet and blue light filtering Acrylate / Methacrylate Copolymer Optic Diameter (mm) 6.0 Overall Length (mm) 13.0 Haptic Angle 0° IOL Powers (spherical equivalent diopters) Current availability is 10.0 to 30.0 D ( 0.5D increments) IOL Cylinder Powers (IOL Plane) 1.00 D 1.50 D 2.25 D 3.00 D IOL Cylinder Powers (Corneal Plane) † 0.68 D 1.03 D 1.55 D 2.06 D Add Power +3.0 D Add Power at Spectacle Plane +2.5 D Suggested A-Constant 118.9 † Based on average pseudophakic human eye * Model number SND1T2 not currently available.
    25. 29. Product Characteristics Light Transmission Curve
    26. 30. AcrySof® IQ ReSTOR ® IOL +3.0 D Theoretical Total Energy Balance S ource: Data on file. Alcon, Inc. R&D Technical Report Product Performance AcrySof® IQ ReSTOR® IOL
    27. 31. Refraction (D) AcrySof® IQ ReSTOR ® IOL +3.0 D [N=117] Mean Defocus Curve for AcrySof® IQ +3.0 D ReSTOR® IOL Binocular, Best Case, 6 Months Postoperative S ource: AcrySof ® IQ ReSTOR ® IOL Package Insert 70 cm 50 cm 40 cm 33 cm ∞ 20/25 20/32 20/40 20/50 20/63 20/80 20/100 20/20 +1.00 +0.50 0.00 -0.50 -1.00 -1.50 -2.00 -2.50 -3.00 -3.50 -4.00 Product Performance: IQ ReSTOR® Double Peaked Defocus Curve
    28. 32. Updated Online Calculator www.acrysoftoriccalcular.com
    29. 33. ASICO instruments
    30. 34. PRE-OP TORIC REFERENCE MARKER A. AE-2791 Marking Eye with Patient Sitting Up B. Patient Lying Down AE-2791
    31. 37. Marking of the Eye – Axis Marking
    32. 38. INTRA-OP MARKER A. AE-2792 Aligned to Steepest Meridian B. Marks on Steepest Meridian AE-2792
    33. 39. <ul><li>62 yr old female </li></ul><ul><li>+2.00/-2.00x5 +2.50/-0.50x180 </li></ul><ul><li>42.50/44.0x90 42.75/44.0x87 </li></ul><ul><li>+22.0 ReSTOR T4 BE </li></ul><ul><li>2.2mmx135 2.2mmx30 </li></ul><ul><li>[email_address] [email_address] </li></ul><ul><li>Assume +0.50D SIA </li></ul><ul><li>At 1 week: 6/7.5 6/9 </li></ul><ul><li>J4 at 43cm </li></ul><ul><li>42.50/44.25x83 and 42.25/43.75x85 </li></ul>
    34. 40. <ul><li>52 yr old Indian male restauranteur </li></ul><ul><li>+1.75/-0.75x80 +1.25/-0.25x100 </li></ul><ul><li>42.88/43.90x165 43.32/44.5x15 </li></ul><ul><li>+22.0 ReSTOR T3 BE </li></ul><ul><li>2.2mmx170 2.2mmx30 </li></ul><ul><li>At 1 month: 6/6 6/6 </li></ul><ul><li>J1 at 43cm </li></ul>
    35. 41. ReSTOR +3D Toric
    36. 42. The majority work very well but.. <ul><li>Success with the ReSTOR requires: </li></ul><ul><li>Careful patient and doctor/practice selection </li></ul><ul><li>Good patient counseling </li></ul><ul><li>Accurate preoperative biometry </li></ul><ul><li>Careful surgical technique </li></ul><ul><li>Attention to astigmatism </li></ul>
    37. 43. Concerns <ul><li>Optometrists will stop referring patients if I use ReSTOR </li></ul>
    38. 44. Concerns <ul><li>Patients don’t mind wearing glasses </li></ul>
    39. 45. Concerns <ul><li>Glare and halos are a big problem with multifocals </li></ul>
    40. 46. Concerns <ul><li>Multifocals may need to be explanted </li></ul>
    41. 47. Ideal patients for the ReSTOR
    42. 48. Ideal patients for the ReSTOR <ul><li>Patients with no other ocular pathology </li></ul><ul><li>Patients in line for bilateral surgery </li></ul><ul><li>People with easy going personalities, realistic expectations and not too obsessive </li></ul><ul><li>Care with engineers, high school teachers, pharmacists and accountants </li></ul>
    43. 49. Bad patients for the ReSTOR
    44. 50. Intra-operative Exclusion Criteria <ul><li>Exclusion during surgery </li></ul><ul><ul><li>Significant vitreous loss </li></ul></ul><ul><ul><li>Damage to zonules </li></ul></ul><ul><ul><li>Pupil trauma </li></ul></ul>
    45. 51. Preoperative counseling <ul><li>Patient Information video </li></ul><ul><li>Can’t compete with young crystalline lens </li></ul><ul><li>Explain inevitability of faint halo around letters and lights </li></ul><ul><li>ReSTOR will give excellent distance vision and excellent near vision, the new +3 gives good intermediate vision </li></ul><ul><li>You may be more comfortable using magnifiers for computers or reading under poor light </li></ul>
    46. 52. Preoperative counseling <ul><li>But </li></ul><ul><li>You won’t have to struggle with your bifocal or multifocal glasses </li></ul><ul><li>You’ll love being able to see your watch, mobile phone, prices in stores, menu in restaurants and be able to put on makeup </li></ul><ul><li>These lenses will free you up! </li></ul>
    47. 53. IQ ReSTOR® Toric Conclusions <ul><li>AcrySof® IQ ReSTOR® Toric has been designed to perform at all distances for patients with and without astigmatism </li></ul><ul><li>Gives surgeon the ability to reduce or eliminate the need to correct residual cylinder with LRI, LASIK, or PRK. </li></ul><ul><li>Allows single surgical procedure for presbyopia correction and corneal astigmatism management </li></ul><ul><li>It increases the number of patients who can be considered for multifocal IOL implantation . </li></ul>

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