With a spherical lens or spherical lens system, marginal rays will be forces a bit in front of the paraxial rays.This creates a small blur circle rather than one single point of focus.
When lenses or lens systems are designed to be aspheric, the peripheral lens curvature is reduced.This allows the marginal and paraxial rays to be focused at a single point.
The AcrySof® IQ lens design includes a degree of asphericity that reduces the total asphericity in average eyes. This reduces spherical aberration in the eye, which improves contrast sensitivity and functional vision.
The AcrySof® IQ Toric IOL is designed to correct up to 2.0 D of corneal astigmatism at the corneal plane. This range of correction accounts for almost 90% of observed toricity in the normal population.Higher powered cylinder lenses are in development. However, even with current lens options, patients with higher than 2.0 D of corneal astigmatism would benefit from a considerable reduction in their refractive cylinder post-op.
During the FDA approval study, residual refractive cylinder after cataract surgery was significantly lower for eyes implanted with the AcrySof® Toric lens compared to eyes receiving a spherical lens.
The AcrySof® IQ Toric lens includes asphericity to improve visual quality.As noted before, the stability of the AcrySof® platform (i.e., adherence to the lens capsule) means that the lens stays properly oriented after surgery.
The advantages of the IQ ReSTOR® +3.0 D can be seen in this graph. Since its introduction, it has continued to dominate in market share over any other PC-IOL.This is due to the wide acceptance that the IQ ReSTOR® +3.0 D delivers superior visual performance at all distances.
The original IQ ReSTOR® lens was the +4.0 D, which provided about +3.2 D of add power for near. Some patients found this was a near point closer than they would have liked and intermediate vision was sometimes an issue.The IQ ReSTOR® +3.0 D lens provides 2.5 D of add power at near. This new lens design was proposed to move the near point out and improve intermediate vision.
You are all familiar with discussing the nature of cataract surgery with your patients. Make sure you really break it down for them.
When considering the IOL options for a patient there are numerous factors that will influence the decision.A desire to reduce dependence on spectacles is an important consideration for choosing either the IQ Toric or IQ ReSTOR® lens options.
The patients in your practice will benefit from your explanations of their lens options. You may feel a lens is contraindicated, or may feel they are a good candidate for one type of lens or another. Your ability to discuss lens options provides your patient with the time to consider their options in advance of their cataract evaluation.
You may see a patient day one post-op, but the surgeon may take this visit as an opportunity to evaluate the refractive outcome.When measuring acuity, if the patient had a presbyopia-correcting IOL then testing near vision would be appropriate.
Co management with o ds2
Premium IOL and Cataract Co-Management<br />J. Alberto Martinez, M.D.<br />Visionary Ophthalmology<br />October 3, 2010<br />
OUTLINE<br />THE MARKET AND THE OPORTUNITY<br />ETHICAL CONCERNS<br />TECHNICAL ASPECTS<br />LEGAL<br />SURGICAL<br />POSTOPERATIVE CARE<br />
The Graying of America<br />Another boomer turns 50 years of age every 7 seconds<br />They represent the majority of the US workforce<br />They are the US economic engine<br />13 trillion in assets ( 50% of US asset base)<br />Average life span of 78.5 men, 82.5 women<br />As they age: glaucoma, diabetic eye disease and cataracts<br />
The graying of America<br />Are you prepared to meet boomers health care challenges?<br />Are you current with technological advances?<br />Are you embracing the newest ophthalmic technologies?<br />Their increased expectations regarding outcomes is unprecedented!<br />We can not afford to wait. This wave has come to shore!<br />
Ethical Concerns<br />Ethical concerns are absolutely above any considerations<br />Needless to say, the patient’s welfare must remain the top priority of the MD-OD team<br />World class outcomes can not be compromised by transfer of care<br />Team approach must benefit the patient first and MD-OD team second.<br />
Legal concerns<br />Co-management more common but still controversial<br />It is critical that any c0-management relationship be ethical and compliant with all legal requirements<br />Professional societies including AOA have guidelines<br />Fundamental: no agreement to refer back. Must be based on patient choice<br />
Legal Concerns<br />Patients must understand clearly who can provide post-op care<br />Patients must choose to return to OD and sign a statement<br />Work with a knowledgeable attorney<br />Medicare rules are clear on the amounts paid for surgery and for post-op care<br />OD must receive fair market value for their services<br />
Legal Concerns<br />Patient must be informed about the amounts paid to each provider<br />Visionary Ophthalmology will develop a mechanism to allocate appropriate amounts<br />Premium IOLs are most complex c0-management arrangement for it involves covered and non-covered services<br />VO is committed to develop an ethical, legal and fair co-management practice.<br />
High Technology IOLs<br />Many IOLs available. Choosing is a complex decision.<br />Surgeons need to take into account:<br />Patient’s desires and epectations<br />Status of the non-operative eye<br />Presence of any comorbidities<br />Potential risks<br />
Spherical aberration occurs when light rays are <br />over-refracted at the periphery of a lens system,<br />resulting in a region of defocused light which can<br />decrease image quality.<br />The Problem: Spherical Optics<br />*Smith G, Atchinson D A. The Eye and Visual Optical Instruments. Cambridge University Press, Cambridge, United Kingdom. 1997;667.<br />
Aspheric optics align the light rays to compensate for<br />positive corneal spherical aberration, resulting in<br />enhanced image quality.<br />The Solution: Aspheric Optics<br />*Smith G, Atchinson D A. The Eye and Visual Optical Instruments. Cambridge University Press, Cambridge, United Kingdom. 1997;667.<br />
Clinical improvements<br />demonstrated over spherical<br />control lens include:<br />Improved functional vision <br />Increased contrast sensitivity<br />Reduction of spherical aberration and total high order aberrations (HOAs)<br />Benefits of Asphericity<br />
Why Toric IOL?<br />The AcrySof® IQ Toric IOL offers cataract surgery patients<br />with astigmatism:<br />Reduction of residual refractive cylinder<br />Improved uncorrected distance visual acuity<br />Increased spectacle-independent distance vision<br />
Selection criteria for Toric IOL<br />Preoperative regular astigmatism <br />CCC possible <br /> Intact capsular bag <br /> Precautions in patients with pre-existing ocular disease conditions <br /> Careful consideration in the cases of those with prior corneal refractive surgery <br />
Designed for a Wide Range of Astigmatic Patients<br />AcrySof® IQ Toric IOL is<br />designed to accommodate<br />a variety of cataract<br />patients with astigmatism<br />A wide range of cylinder <br />powers means more <br />candidates can benefit <br />from AcrySof® IQ Toric IOL<br />
Dramatically Reduces Residual Refractive Cylinder<br /> 63% of patients achieved ≤0.50 diopters of residual<br /> refractive cylinder1<br /> 87% of patients achieved ≤1.00 diopters of residual<br /> refractive cylinder1<br />
The AcrySof® IQ Toric IOL:<br />Builds on a long line of innovation from Alcon<br />Takes the trusted platform for precise astigmatism correction and adds the enhanced image quality of an aspheric lens<br />The Next Step in Toric Technology<br />
Presbyopia-correcting IOLs<br />Crystalens: an accomodating IOL. Reversible and unpredictable<br />Rezoom: A refractive mutifocal IOL (AMO)<br />Restor: Difractive IOL (Alcon)<br />Tecnis: Difractive IOL (AMO)<br />
US Presbyopia-Correcting IOL Survey Share<br />Source: Market Scope Quarterly Cataract Update<br />* Trademarks are the property of their respective owners. <br />
Two Different Add Power Options<br />SN6AD3<br />Add Power: +4.0 D<br />Spectacle Plane: +3.2 D<br />Range: +10.0 D to +34.0 D <br />A-Constant: 118.9<br />SN6AD1<br />Add Power: +3.0 D<br />Spectacle Plane: +2.5 D<br />Range: +6.0 D to +34.0 D <br />A-Constant: 118.9<br />Source: AcrySof® IQ ReSTOR® IOL Package Insert.<br />
AcrySof® IQ ReSTOR® IOL +3.0 D was specifically designed to:<br />Maintain existing optical design characteristics and manufacturing processes<br />Move near vision distance out 6-7 cm<br />Improve intermediate vision without sacrificing distance and near1<br />True Performance at All Distances<br />Source: AcrySof® IQ ReSTOR® IOL Package Insert.<br />1.Maxwell A, et al. Functional Outcomes After Bilateral Implantation of ApodizedDiffractive Aspheric Acrylic <br />Intraocular Lenses with a +3.0 or +4.0 Diopter Addition Power. J Cataract Refractive Surg. Vol. 35, December 2009.<br />
Define<br />Clouding of the natural lens that allows less light to pass through to the retina<br />Symptoms<br />Blurred vision<br />Dull colors<br />Poor night vision<br />Sensitivity to light<br />Treatment<br />ONLY treatment is to have it surgically removed and replaced with an artificial lens<br />Begin with the Problem: Cataracts<br />
Take into account:<br /> Pathology<br /> Lifestyle<br /> Astigmatism<br /> Preexisting ocular conditions, i.e. dry eye<br />Consider Their Needs<br />
Before they leave the office, patients should have:<br />Educational materials on cataracts and the procedures<br />Materials that explain their IOL options<br />A follow-up appointment for their cataract surgical evaluation<br />Keep Them Informed<br />
Measure visual acuity<br />Test all distances if the patient has a presbyopia-correcting IOL<br />Look for a quiet anterior chamber<br />Continue antibiotic, steroidal and NSAID therapy<br />Treat dry eye aggressively<br />What to Expect After Surgery – Day One<br />
VO is committed to educating co-management physicians to provide seamless care.<br />Mini-fellowships to include:<br />Day one post-op care at VO<br />Three week post-op visit at VO<br />Pre-op evaluation and choosing the apropriate IOL<br />OR visit at our ASC to learn the technical issues associated with Toric and Multifocal IOL<br />Educational process tailored to individual needs<br /> Educational Process for Optometrists<br />
Premium IOLs are not only great technology to offer patients but can have a significant financial impact in your practice as well<br /> Financial Rewards<br />
“To be on the cutting edge of optometry, you need to<br /> be on the cutting edge of ophthalmology.” <br /> - Richard Van De Velde, O.D. <br />Imhoff Eye Center Brunswick, GA<br />Today’s optometrist provides…<br />Patient care at any age<br />Patient support <br />Patient education for all conditions<br />Today's Optometrist<br />