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Kenneth Lipstock, MD
Lipstock LASIK and Cataract Center
Richmond, Virginia
www.lipstocklaser.com
Introduction
 The MAST Study demonstrated that the
nanoFLEX (STAAR aspheric single piece
collamer iol) provided optimal v...
All Lenses
Distance-Corrected Bilateral Average Near &
Intermediate VA
0
10
20
30
40
50
60
Near Intermediate
SnellenAcuity...
Binocular VA at Near (40 cm): All Lenses
0%
10%
20%
30%
40%
50%
60%
70%
80%
90%
100%
20/40 or
Better
20/50 or
Better
20/63...
Binocular VA at Intermediate (80 cm): All
Lenses
0%
10%
20%
30%
40%
50%
60%
70%
80%
90%
100%
20/20 or Better 20/25 or Bett...
Purpose
 To evaluate the visual outcomes of
patients undergoing routine cataract
surgery with phacoemulsification
followe...
Methods
 Prospective evaluation of patients who had undergone
bilateral phacoemulsification with implantation of nanoFLEX...
Key Inclusion/Exclusion
 Inclusion Criteria:
 DCVA of 20/25 or better in both eyes
 Spherical equivalent in the dominan...
Patient Baseline Characteristics
 13 pts (ongoing study)
 6 to 20 months post-op
 69% male
 Mean age 64 (52-73)
 Path...
Binocular UCVA
0%
20%
40%
60%
80%
100%
20/15 or Better 20/20 or Better 20/25 or Better 20/32 or Better 20/50 or Better
15%...
Comparison of Reading Acuity at 40cm & 80cm
between nanoFLEX Blended Vision and Premium
IOL
Distance Corrected Visual Acui...
Reading Speed
 Reading Speed of at least 80 wpm:
○ The lower limit for comfortable recreational
reading (Radner, Richter-...
Comparison of Reading Speed at
40cm
using 0.4 LogMAR Print Size (20/50)
0
20
40
60
80
100
120
140
160
180
200
nanoFLEX ReS...
How Often do You Wear Glasses?
0%
10%
20%
30%
40%
50%
60%
70%
80%
Never/Almost Never Sometimes
55%
18%
27%
%ofPatients
73%...
Patient Satisfaction with Near Vision
0.0
0.5
1.0
1.5
2.0
2.5
3.0
3.5
4.0
4.5
Reading
Newspapers
Computer Medicine
Bottles...
Patient Satisfaction with Distance Vision
0.0
0.5
1.0
1.5
2.0
2.5
3.0
3.5
4.0
4.5
Day Driving Night Driving Difficult Weat...
Stereopsis
 Mean NC Far Stereo = 51 sec arc
 Mean UC Far Stereo = 154 sec arc
 Mean NC Near Stereo= 64 sec arc
 Mean U...
nanoFLEX Blended Vision
Patient Satisfaction
0%
10%
20%
30%
40%
50%
60%
70%
80%
90%
100%
Would recommend to family/friends...
Patient Satisfaction
nanoFLEX
Blended
Vision
ReStor D1 Investigator
Vision without
Eyeglasses – Very
Good
100% Lipstock
Wo...
Extreme Difficulty
nanoFLEX ReStor D1 Crystalens
Night Vision 0% 2%* 2%***
Driving in
Difficult
Weather
0% 4%** -
* Maxwel...
Conclusions
 Blended Vision (moderate monovision)
with STAAR Collamer Monofocal one piece IOL (nanoFlex) offers:
 Excell...
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Evaluation of Visual Outcomes of Monovision Patients Bilaterally Implanted with Nanoflex Collamer Intraocular Lenses

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Evaluation of Visual Outcomes of Monovision Patients Bilaterally Implanted with Nanoflex Collamer Intraocular Lenses

  1. 1. Kenneth Lipstock, MD Lipstock LASIK and Cataract Center Richmond, Virginia www.lipstocklaser.com
  2. 2. Introduction  The MAST Study demonstrated that the nanoFLEX (STAAR aspheric single piece collamer iol) provided optimal vision at intermediate and satisfactory at near  Intermediate (80cm) binocular DCVA = 20/24  Near (40cm) binocular DCVA = 20/50  Present study designed to evaluate how best to utilize the intrinsic properties of the nanoFLEX to optimize visual outcomes
  3. 3. All Lenses Distance-Corrected Bilateral Average Near & Intermediate VA 0 10 20 30 40 50 60 Near Intermediate SnellenAcuity20/- NanoFLEX (n=63) AMO Tecnis sililcone aspheric 3 piece iol (n=61) 20/50 20/24 20/28 20/52 p = 0.832 p = 0.072
  4. 4. Binocular VA at Near (40 cm): All Lenses 0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100% 20/40 or Better 20/50 or Better 20/63 or Better 20/80 or Better 32% 71% 95% 100% 46% 72% 79% 93% %ofPatients NanoFLEX (n=63) AMO Tecnis sililcone aspheric 3 piece iol (n=61) p = 0.006 p = 0.112
  5. 5. Binocular VA at Intermediate (80 cm): All Lenses 0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100% 20/20 or Better 20/25 or Better 20/32 or Better 20/40 or Better 35% 79% 100% 100% 34% 74% 82% 93% %ofPatients NanoFLEX (n=63) AMO Tecnis sililcone aspheric 3 piece iol (n=61) p = <0.001
  6. 6. Purpose  To evaluate the visual outcomes of patients undergoing routine cataract surgery with phacoemulsification followed by bilateral implantation of aspheric (nanoFLEX) intraocular lenses (IOLs) using blended vision.
  7. 7. Methods  Prospective evaluation of patients who had undergone bilateral phacoemulsification with implantation of nanoFLEX IOLs.  All patients with a DCVA 20/25 or better in each eye underwent ETDRS testing under controlled lighting utilizing the Functional Vision Analyzer (Stereo Optical) for binocular UCDVA and UCNVA and repeated for the dominant eye.  MN Reading Cards were used to measure binocular UCNVA and UCIVA and reading speed.  Patient satisfaction questionnaire administered  IRB approval obtained
  8. 8. Key Inclusion/Exclusion  Inclusion Criteria:  DCVA of 20/25 or better in both eyes  Spherical equivalent in the dominant eye to be ± 0.50 or less and in the nondominant eye between -0.88 and -1.87 and cyl ± 0.75 both eyes  Exclusion Criteria:  No amblyopia or tropias or posterior capsular opacification  All other ocular pathology allowed as long as DCVA ≤ 20/25 and no significant visual field loss  No LVC pre-op or post-op
  9. 9. Patient Baseline Characteristics  13 pts (ongoing study)  6 to 20 months post-op  69% male  Mean age 64 (52-73)  Pathology: dry eye, paracentral full thickness corneal scar, ABMD, AMD  Post Operative Refractions (means)  Mean Spherical Equivalent • Dominant = +0.02 D • Non-dominant = -1.23 D  Mean Cylinder • Dom = 0.44 D • Non-dom = 0.42  Mean Corrected Distance Vision (BCDVA) • Dom= 20/16.8 • Non-dom = 20/18.6
  10. 10. Binocular UCVA 0% 20% 40% 60% 80% 100% 20/15 or Better 20/20 or Better 20/25 or Better 20/32 or Better 20/50 or Better 15% 38% 69% 85% 100% 61% 92% 100% 54% 100% %ofPatients Near (40cm) Mean = 20/25 Intermediate (80cm) Mean = 20/16 Distance Mean = 20/19
  11. 11. Comparison of Reading Acuity at 40cm & 80cm between nanoFLEX Blended Vision and Premium IOL Distance Corrected Visual Acuities nanoFLEXBV ReSTORD1¤ Synchrony# CrystaLens§ TecnisMF¥ nanoFLEXBV ReSTORD1* Synchrony# CrystaLens§ TecnisMF¥ 0 5 10 15 20 25 30 35 MeanSnellenAcuity ¤ Santhiago JCRS 11/10; # Bohorquez JCRS 11/10; § Pepose AJO 9/07; ¥ Hutz JRS 3/08; *Alfonso JCRS 5/09 Near 40cm Intermediate 80cm 20/25 20/21 20/23 20/32 20/27 20/18 20/28 20/17 20/17 (Letter Acuity (70cm ) 20/26
  12. 12. Reading Speed  Reading Speed of at least 80 wpm: ○ The lower limit for comfortable recreational reading (Radner, Richter-Mueksch, Rubin, West)  Maximum reading speed beyond approximately 150 WPM is likely more a measure of brain function than optical acuity  .4 LogMAR (20/50) ○ Reading speed at this print size commonly reported because it is newspaper print size.
  13. 13. Comparison of Reading Speed at 40cm using 0.4 LogMAR Print Size (20/50) 0 20 40 60 80 100 120 140 160 180 200 nanoFLEX ReSTOR D1 ** Synchrony # CrystaLens ¥ TetraFlex ¥ 179 360 184 70 90 WPM ** Santhiago JCRS 11/10; # Bohorquez JCRS 11/10; + Pepose AJO 9/07; ¥ Brown JCRS 10/09
  14. 14. How Often do You Wear Glasses? 0% 10% 20% 30% 40% 50% 60% 70% 80% Never/Almost Never Sometimes 55% 18% 27% %ofPatients 73% Never or Almost Never
  15. 15. Patient Satisfaction with Near Vision 0.0 0.5 1.0 1.5 2.0 2.5 3.0 3.5 4.0 4.5 Reading Newspapers Computer Medicine Bottles Shaving/Doing Make-up Cooking/Sewing 3.4 3.6 2.5 4.0 3.5 Mean Score No Difficulty Extreme Difficulty 4= Very good / 3= good / 2 = poor / 1 = very poor
  16. 16. Patient Satisfaction with Distance Vision 0.0 0.5 1.0 1.5 2.0 2.5 3.0 3.5 4.0 4.5 Day Driving Night Driving Difficult Weather Driving TV Out of home activities 4.0 3.4 3.5 4.0 3.9 Mean Score 4= Very good / 3= good / 2 = poor / 1 = very poor No Difficulty Extreme Difficulty
  17. 17. Stereopsis  Mean NC Far Stereo = 51 sec arc  Mean UC Far Stereo = 154 sec arc  Mean NC Near Stereo= 64 sec arc  Mean UC Near Stereo= 278 sec arc ○ Dropping 1 patient with abnormal near stereo with NC mean: 221  Visual Disturbance with Depth Perception  Scale 0-4 (Severe to None) = 3.9  Stereopsis in other Pseudophakic Blended Vision Studies: ○ Zhang JCRS 3/11: Mean Near Stereopsis= 127 ○ Finkelman JCRS 6/09 Mean Near Stereopsis=176
  18. 18. nanoFLEX Blended Vision Patient Satisfaction 0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100% Would recommend to family/friendsWould have blended vision again 100% 100% % Patients Responding Positively
  19. 19. Patient Satisfaction nanoFLEX Blended Vision ReStor D1 Investigator Vision without Eyeglasses – Very Good 100% Lipstock Would have Blended Vision Again 100% Lipstock Would recommend BV to Family/Friend 100% Lipstock Would have the Procedure Again 94% Maxwell JCRS 12/09
  20. 20. Extreme Difficulty nanoFLEX ReStor D1 Crystalens Night Vision 0% 2%* 2%*** Driving in Difficult Weather 0% 4%** - * Maxwell JCRS 12/09 ** Kohnen JCRS 12/09 *** FDA Crystalens Study
  21. 21. Conclusions  Blended Vision (moderate monovision) with STAAR Collamer Monofocal one piece IOL (nanoFlex) offers:  Excellent distance acuity  Good reading acuity  Excellent intermediate reading acuity  Comfortable reading speed for newspaper print size  High rate of spectacle independence  Extremely high patient satisfaction  nanoFLEX Blended Vision can be offered to patients with pre-op pathologies such as dry eye, ABMD and AMD – more importantly, unlike multifocal iols, if new ocular pathologies occur over time BCVA can always be obtained with eyeglasses  Pan-focal visual outcomes comparable to “premium IOLs”  Reduced Cost to Patient  Great option for patients who can’t afford “premium IOL” presbyopic corrections

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