Presentation of Detlev Breyer (MD) at the ASCRS 2017 in Los Angeles. Title: New refractive optical MIOL concepts – 
Comparison of different optical systems.

1. New refractive optical MIOL concepts -
Comparison of different optical systems
P. Hagen, D. Breyer, H. Kaymak, K. Klabe, F. Kretz, G. Auffarth

2. Financial Disclosure
Breyer, Kaymak & Klabe Eye Surgery and Premium Eyes are Consulting, Study Center & MAB for:
Abott, Alcon, AlimeraSciences, Allergan, AMO, Bayer, Carl Zeiss Meditec, Ellex, Fluoron, Geuder, iOptics, LensAR,
Novartis, Oculentis, Oertli, Revision Optics, Santen, Staar Surgical, Thea, Topcon, Visufarma, Ziemer

3. WIOL-CF (Medicem): Properties & Optical Principle
• Rotationally symmetric
• Bioanalogous hyperbolic optic:
Extended focus area achieved by
decreasing refractive power from
the center to the edge
• Diameter: 9mm
• No haptic!
• Material:
Hydrogel (water content 42%)
Negatively charged
3
0%
20%
40%
60%
80%
100%
1 2 3 4 5
Far
Near
Intermediate
Pupil diameter
Light distribution

4. MiniWell (Sifi Meditec): Properties & Optical Principle
• Rotationally symmetric
• Biconvex, progressive optic:
Continuous „Multifocality“ is achieved through
variation of the spherical aberration (SA):
D1: SA > 0
D2: SA < 0
D3: SA = 0
• Optical diameter: 6mm
• Material: Copolymer
Steps between zones are
visible in Pukinjereflexes

5. • Rotationally asymmetric
• Purely refractive bifocal optic
 No diffractive ring structures
 High light transmission
• Anterior: Sector-shaped segment with
+1.5D (Comfort MF15) or
+2.0D (Mplus MF20) addition for
improved intermediate vision
• Posterior: Aspherical surface
• Optics and haptics with square edges
Pictures are used with the kind
permission of Oculentis
Lentis Comfort MF15 & Mplus MF20 (Oculentis):
Properties & Optical Principle

6. • Rotationally asymmetric
• Purely refractive bifocal optic
 No diffractive ring structures
 High light transmission
• Anterior: Sector-shaped segment with
+3.0D addition for improved near vision
Posterior: Aspherical surface
• Optics and haptics with square edges
• Small transition zones between additional segment
and the rest of the MIOL
Lentis MplusX MF30 (Oculentis):
Properties & Optical Principle

7. Mean ± Stdv WIOL-CF MiniWell Comfort MF15 Mplus MF20 MplusX MF30
Number of
eyes
21 25 1281 71 61
M:F [%] 48:52 28:72 45:55 37:63 41:59
Age [years] 66±8 67±10 67±10 62±13 62±12
Spherical
Equivalent (SE)
[D]
0.6±2.5 -1.0±2.5 -0.9±4.3 -1.2±4.2 0.6±3.6
Cylinder [D] -0.7±0.5 -0.5±0.5 -0.9±0.8 -1.0±1.1 -0.9±0.9
IOL-Power [D] 24.6±3.1 19.7±3.0 19.6±5.0 20.2±5.5 21.8±4.5
Target
Refraction [D]
-0.3±0.3 -0.5±0.6 -0.4±0.5 -1.0±0.5 -0.3±0.2
Materials and Methods: Preoperative Patient Data
Deviation from emmetropia
due to implantation within
blended vision variant
Compare results for MIOL with different optical designs

8. Follow-up measurements
(up to 3 months postop.)
• Manifest Refraction
(Phoropter)
• Visual Acuity
(ETDRS reading chart)
• Defocus curves
• Subjective photopsia
(Halo&Glare Simulator, CZM)
• Patient questionnaire
(Quality of Vision)
Materials und Methods: Postoperative Examinations

9. • No eye with loss 2
• High gains due to cataract patients
• Overall good results for refractive MIOL in terms of safety
Results: Safety
0%
25%
50%
75%
100%
loss3
ormore
loss2
loss1
unchanged
gain1
gain2
gain3
ormore
Percentageofeyes[%]
∆CDVA [Snellen Lines]
Safety: CDVA(post) - CDVA(pre)
Comfort MF15 (n=627)
Mplus MF20 (n=51)
MplusX MF30 (n=33)
WIOL-CF (n=14)
MiniWell (n=21)

10. • Small deviation from target refraction for rotationally symmetric MIOL
• Segment with additional power makes precise measurement of manifest refraction
harder (especially in case of MplusX with +3.0D addition)
Results: Predictability
0%
25%
50%
75%
100%
(-oo, -1) [-1, -0.5) [-0.5, 0.5] (0.5, 1] (1, oo)
Percentageofeyes[%]
∆SE [D]
Predictability: SE(post) - SE(target)
Comfort MF15 (n=643)
Mplus MF20 (n=51)
MplusX MF30 (n=43)
WIOL-CF (n=14)
MiniWell (n=22)

11. Monofocal IOL (mon, cc)
WIOL-CF (mon, cc, n=9)
MiniWell (mon, cc, n=19)
MplusX MF30 (mon, cc, n=12)
Mplus MF20 (mon, cc, n=17)
Comfort MF15 (mon, cc, n=63)
Reference Curve VA=1,0 (mon, sc)
0.00
0.25
0.50
0.75
1.00
1.25
-3.0
-2.5
-2.0
-1.5
-1.0
-0.5
0.0
DecimalVA
Defocus [D]
72%
74%
43%
100%
n = Number of eyes
cc = Distance corrected
MIOL-capacity = Area
under the defocus curve
76%
• Shape of WIOL-CF curve similar to Comfort MF15
Shape of MiniWell curve similar to Mplus MF20
• Slightly higher monocular MIOL-capacities for
rotationally asymmetric segmental MIOL
Results: Monocular Defocus Curves
69%
62%

12. Monofocal IOL (mon, cc)
MiniWell EV (bin, sc, n=12)
WIOL-CF EV (bin, sc, n=8)
Comfort MplusX (bin, sc, n=22)
Comfort EV (bin, sc, n=36)
Comfort Mplus BV (bin, sc, n=32)
Comfort BV (bin, sc, n=56)
Reference Curve VA=1,0 (mon, sc)
0.00
0.25
0.50
0.75
1.00
1.25
-3.0
-2.5
-2.0
-1.5
-1.0
-0.5
0.0
DecimalVA
Defocus [D]
95%
92%
43%
100%
Results: Binocular Defocus Curves
75%
79%
85%
91%
• Higher binocular MIOL-capacities for rotationally
asymmetric segmental MIOL
n = Number of eyes
sc = Uncorrected
MIOL-capacity = Area
under the defocus curve
EV = Emmetropic Vision
BV = Blended Vision

13. Simulation software from CZM:
• Subjective matching of patients photopsia via a graphic user interface
• Binocular and uncorrected
• 4 categories:
„mild“„none“
„moderate“ „severe“
Halo and Glare Simulator

14. 0%
25%
50%
75%
100%
"none" "mild" "moderate" "severe"
PercentageofEyes[%]
Strength of Halo&Glare
Halo & Glare Simulator
Phakic Eyes (n=126)
WIOL-CF EV (n=12)
MiniWell EV (n=10)
Comfort EV (n=30)
Comfort MplusX (n=10)
MplusX EV (n=8)
n = Number of eyes
Phakic Eyes = Employees
(age: 16-60)
• No significant differences between phakic eyes and refractive MIOL
• More data need (especially for WIOL-CF and MiniWell)
Results: Halo and Glare – Phakic Eyes & Refractive MIOL

15. • Similar results in terms of safety and predictability for rotationally
symmetric and segmental MIOL
• Knowledge of defocus curves and MIOL capacities is essential to
meet patients visual needs
• Monocular MIOL capacities:
- WIOL-CF: 62%
- MiniWell: 69%
- Comfort MF15: 72%
- Mplus MF20: 76%
- MplusX MF30: 74%
• Photopsia such as Halo&Glare (though physically inevitable for
MIOLs) comparable to phakic eyes
• Very satisfied patients: Our favorite = Comfort MF15
Conclusion and Outlook

16. Thank you very much for your attention!