Slide Deck For Cope Course 10 11 2010


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This is a synopsis of the toric intraocular lens implant made by Alcon Laboratories. I have had the opportunity to implant hundreds of these implants.

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  • IQ Toric Sales Aid, Page 12 Diagram
  • IQ Toric Sales Aid, Page 12 Chart
  • From IQ Toric Sales Aid, Page 4, Graph 1
  • From IQ Toric Sales Aid, Page 4, Graph 2
  • From IQ Toric Sales Aid, Page 4, Graph 3
  • From IQ Toric Sales Aid, Page 5, Graph 1
  • From IQ Toric Sales Aid, Page 5, Graph 1
  • IQ Toric Sales Aid, Page 10 Graph
  • IQ Toric Sales Aid, Page 10 Chart
  • From IQ Toric Sales Aid, Page 6, Top Right Diagram
  • From IQ Toric Sales Aid, Page 6, Bottom Right Diagram
  • From IQ Toric Sales Aid, Page 6, Chart 1
  • IQ Toric Sales Aid, page 7, graph 1
  • Key Point With a 5-mm aperture, asphericity even more dramatically improved the MTF of the AcrySof ® IQ over its spherical Natural comparator, and the MTF of the IQ Toric is similar to the AcrySof ® IQ. Background Measured in a model eye having a simulated cornea exhibiting typical adult human spherical aberration Each trace represents the average of 10 replicate IOLs Reference Data on file, Alcon Laboratories Inc.
  • Key Point With a 3-mm aperture, asphericity improved the MTF of the AcrySof ® IQ lens over its Natural comparator, and the MTF of the IQ Toric is similar to the AcrySof ® IQ. Background Measured in a model eye having a simulated cornea exhibiting typical adult human spherical aberration Each trace represents the average of 10 replicate IOLs Reference Data on file, Alcon Laboratories Inc.
  • Key Point The improved MTF yielded better contrast sensitivity with the Natural-to-IQ evolution; contrast sensitivity with the IQ Toric is being tested to see whether the same trend follows. Background Study 1 (Awwad et al): 52 eyes, groupwise comparison Study 2 (Pandita et al): 120 eyes, groupwise comparison, contrast sensitivity measured using artificial pupils (contact lenses) at 4 mm and 6 mm Study 3 (Tzelikis et al): 50 eyes, intraindividual/contralateral comparison References 1. Awwad ST, Warmerdam D, Bowman RW, et al. Contrast sensitivity and higher order aberrations in eyes implanted with AcrySof IQ SN60WF and AcrySof SN60AT intraocular lenses. J Refract Surg 2008;24:619–625. 2. Pandita D, Raj SM, Vasavada VA, et al. Contrast sensitivity and glare disability after implantation of AcrySof IQ Natural aspherical intraocular lens: prospective randomized masked clinical trial. J Cataract Refract Surg 2007;33:603–610. 3. Tzelikis PF, Akaishi L, Trindade FC, et al. Ocular aberrations and contrast sensitivity after cataract surgery with AcrySof IQ intraocular lens implantation Clinical comparative study. J Cataract Refract Surg 2007;33:1918–1924.
  • IQ Toric Sales Aid, page 7, graph 2
  • IQ Toric Sales Aid, Page 8 Diagram
  • IQ Toric Sales Aid, Page 9 Graph More information about the study: The nighttime city driving scene employs a variety of street lights, car lights, store lights and signs to recreate the high level of ambient lighting typical under these conditions. The nighttime rural driving scene uses a minimal amount of ambient lighting. Simulated driving speeds of approximately 35 mph and 55 mph were used for the city and rural scenes, respectively. Patients were asked to detect and identify a series of targets in each scene, including white-green highway information signs, black-yellow warning signs and pedestrians. Patients were asked to respond when they saw the first target, allowing a detection distance to be recoded. Patients were then asked to respond when they could distinguish the target (e.g., what the signs say, which direction the pedestrian was walking, etc.) so that an identification distance could be recorded.
  • This slide is hidden, but should be used if possible, to communicate AcrySof Toric is approved for correction of REGULAR corneal astigmatism in patients. These points are listed in the speaker notes in IOL Calculation Slide (next).
  • Patient Selection (minimum criteria): 1. Regular corneal astigmatism 2. Intact capsule 3. Continuous curvilinear capsulotomy (CCC) 4. In the bag lens placement
  • With my understanding of your visual needs anad based on lyour exam I believe that you are and excellent candidate for an astigmatism or premium IOL.
  • Slide Deck For Cope Course 10 11 2010

    1. 1. AcrySof ® IQ Toric Astigmatism IOL
    2. 2. Blurred Vision <ul><li>It’s not what you always think! </li></ul><ul><li>Donny Reeves, M.D. </li></ul><ul><li>The Reeves Eye Institute </li></ul><ul><li>C.O.P.E. # 29494-PO </li></ul>
    3. 3. Perception is different than reality………..
    4. 4. De Lejos Estan Todas Buenas <ul><li>English literal translation: </li></ul><ul><li>By far(distance) it’s all good! </li></ul>
    5. 5. Financial Disclosures <ul><li>Alcon Laboratories, Consultant </li></ul><ul><li>Bausch and Lomb, Consultant </li></ul><ul><li>Allergan Inc, Speaker’s Bureau </li></ul><ul><li>Abbott Medical Optics, Investigator </li></ul>
    6. 6. Toric Intraocular Lenses Why should you incorporate them into your practice?
    7. 7. <ul><li>We have to meet or exceed our patients demands for excellent vision </li></ul><ul><li>Knowing what is available and how to use it is critical to your practice success </li></ul><ul><li>Cataract surgery is your patients opportunity to enhance their vision lifestyle </li></ul><ul><li>Astigmatism and premium IOLs are available to meet these expectations. </li></ul>
    8. 8. The Question now is…. <ul><li>Why is it in life that you would never give glasses without correcting the patients astigmatism, but when I do cataract (now) surgery I don’t fix it? </li></ul>
    9. 9. <ul><li>How do we treat it? </li></ul>So What About Astigmatism? Vision without astigmatism Vision with astigmatism 1.5D cyl @ 90 Vision with astigmatism 3.0D cyl @ 90
    10. 10. No astigmatism 1.0 D astigmatism 2.0 D astigmatism Quality of vision is deteriorated considerably by astigmatism
    11. 11. AcrySof ® IQ Toric IOL <ul><li>Newest monofocal IOL builds on long line of innovation from Alcon </li></ul><ul><li>Takes the trusted platform for precise astigmatism correction and adds the enhanced image quality of an aspheric lens </li></ul>
    12. 12. AcrySof ® IQ Toric IOL Specifications
    13. 13. AcrySof ® IQ Toric Benefits Offers combined advantages of toricity and asphericity. <ul><li>Toricity </li></ul><ul><ul><li>Rotational stability </li></ul></ul><ul><ul><li>Reduction of residual refractive cylinder </li></ul></ul><ul><ul><li>Increased spectacle-independent distance vision </li></ul></ul><ul><ul><li>Wide range of cylinder powers </li></ul></ul><ul><li>Asphericity </li></ul><ul><ul><li>Enhanced image quality </li></ul></ul><ul><ul><ul><li>Reduction in spherical and total higher order aberrations </li></ul></ul></ul><ul><ul><ul><li>Increased contrast sensitivity </li></ul></ul></ul><ul><ul><ul><li>Improved functional vision </li></ul></ul></ul><ul><ul><li>Thinner edge profile </li></ul></ul>
    14. 14. <ul><li>Precise Astigmatism Correction </li></ul><ul><li>AcrySof ® IQ Toric IOL offers cataract surgery </li></ul><ul><li>patients with astigmatism: </li></ul><ul><li>Reduction of residual refractive cylinder </li></ul><ul><li>Improved uncorrected distance visual acuity </li></ul><ul><li>Increased spectacle-independent distance vision </li></ul>
    15. 15. Reduction of Residual Refractive Cylinder <ul><li>63% of patients achieved ≤0.50 diopters of residual refractive cylinder 1 . </li></ul><ul><li>87% of patients achieved ≤1.00 diopters of residual refractive cylinder 1 . </li></ul><ul><li>†† AcrySof ® Single-Piece (SA60AT) </li></ul>
    16. 16. Improved Uncorrected Distance Visual Acuity <ul><li>94% of patients implanted achieved uncorrected distance visual acuity of 20/40 or better 1 . </li></ul><ul><li>†† AcrySof ® Single-Piece (SA60AT) </li></ul>
    17. 17. Spectacle Freedom for Distance <ul><li>p<0.0001 CMH test </li></ul><ul><li>97% of patients with bilateral AcrySof Toric IOL implantation (N=37) </li></ul><ul><li>* </li></ul>
    18. 18. Visual acuity outcomes <ul><li>Most recent completed patients using IOL master optimized by Holladay II program </li></ul><ul><li>Sample size 14 </li></ul><ul><li>42% were 20/20 UCVA </li></ul><ul><li>82% were +/- 0.25D </li></ul>
    19. 19. <ul><li>Toric IOL Master outcomes with Holladay II optimization </li></ul><ul><li>88% are less than <0.50D </li></ul><ul><li>Sample size last 14 patients </li></ul>
    20. 20. Increased Spectacle- Independence for Unilateral Distance Vision <ul><li>Approximately 60% of unilateral patients implanted achieved spectacle-independent distance vision 1 . </li></ul><ul><li>†† AcrySof ® Single-Piece (SA60AT) </li></ul>
    21. 21. Rotational Stability IOL rotation can have significant impact on astigmatism correction. <ul><li>Generally, for every 1º of IOL rotation, 3.3% of lens cylinder power is lost 2 . </li></ul><ul><li>A complete loss of cylinder power can occur with a rotation of >30º 2 . </li></ul>
    22. 22. Rotational Stability, continued AcrySof ® IQ Toric IOL ensures minimal rotation – less than 4º average rotation 6 months after Implantation 1,2 . <ul><li>81.1% of patients were ≤5º of intended axis 2 . </li></ul><ul><li>97.1% of patients were ≤10º of intended axis 1 . </li></ul>
    23. 23. <ul><li>Rotational Stability, continued </li></ul><ul><li>Proven biomechanics and biomaterial ensure </li></ul><ul><li>AcrySof ® IQ Toric IOL stays right where you want it. </li></ul><ul><li>STABLEFORCE ® haptics keep IOL highly stable and centered in capsular bag 2 . </li></ul><ul><li>Flexible haptic design provides optimal placement in capsular bag, regardless of size 2 . </li></ul><ul><li>AcrySof ® lens materials binds to fibronectin. </li></ul><ul><ul><li>Ensures adhesion to anterior/ posterior capsule 3 </li></ul></ul>
    24. 24. Cylinder Powers AcrySof ® IQ Toric IOL is designed to accommodate a variety of cataract patients with astigmatism.
    25. 25. Cylinder Powers, continued A wide range of cylinder powers means more candidates can benefit from AcrySof ® IQ Toric IOL.
    26. 26. <ul><li>Benefits of AcrySof ® Aspheric Optics </li></ul><ul><li>Clinical improvements demonstrated over spherical control lens: </li></ul><ul><li>Improved Functional vision </li></ul><ul><li>Increased Contrast Sensitivity </li></ul><ul><li>Reduction of spherical aberration and total high order aberrations (HOAs) </li></ul>
    27. 27. <ul><li>This region of defocused light can reduce image quality. </li></ul>Spherical Aberration The Problem: Occurs when light rays are over-refracted at periphery of optics.
    28. 28. <ul><li>This results in enhanced clarity and image quality. </li></ul>Aspheric Optics The Solution: Negative spherical aberration aligns the light rays to compensate for positive spherical aberration.
    29. 29. Reduction in Spherical Aberrations <ul><li>AcrySof ® IQ Toric IOLs aspheric design** offers statistically significant reduction in both spherical and total higher order aberrations 4 . </li></ul> Differences favor AcrySof ® IQ IOL overall and at each visit ( p <0.0001).
    30. 30. Contrast Sensitivity The aspheric design of AcrySof ® IQ IOL offers improved contrast sensitivity – vital for visual performance. AcrySof ® IQ IOL showed statistically significant improvement 4 in mesopic contrast sensitivity over the control lens in situations with and without glare at 6 cycles per degree (cpd) using the Vector Vision CSV-1000 § **. *Contrast sensitivity was measured using Vector Vision CSV-1000. §At 3 cpd, there was no significant change in mesopic contrast sensitivity.
    31. 31. Alcon data on file. MTF Values 5 mm Aperture. <ul><li> Data for the SN6AT5 , with cylinder power of </li></ul><ul><ul><li>3.0 D at IOL plane </li></ul></ul><ul><ul><li>2.1 D at corneal plane </li></ul></ul>Contrast Sensitivity The aspheric design of AcrySof ® IQ IOL offers Improved contrast sensitivity – for improved image quality .
    32. 32. Alcon data on file. MTFs for 21.0-D IOLs: 3 mm Aperture. <ul><li> Data for the SN6AT5 , with cylinder power of </li></ul><ul><ul><li>3.0 D at IOL plane </li></ul></ul><ul><ul><li>2.1 D at corneal plane </li></ul></ul>
    33. 33. 1. Awwad ST, et al. J Refract Surg 2008;24:619. 2. Pandita D, et al . J Cataract Refract Surg 2007;33:603. 3. Tzelikis PF, et al. J Cataract Refract Surg 2007;33:1918. <ul><li>AcrySof ® IQ Aspheric IOLs </li></ul><ul><li>With the spheric to aspheric monofocal IQ evolution, </li></ul><ul><ul><li>MTF improved (shown here) </li></ul></ul><ul><ul><li>Contrast sensitivity under mesopic conditions improved 1-3 </li></ul></ul><ul><li>With the Toric to IQ Toric evolution, </li></ul><ul><ul><li>MTF similar to AcrySof ® IQ (non-toric monofocal IOL) </li></ul></ul><ul><ul><li>Contrast sensitivity under mesopic conditions is being tested </li></ul></ul>
    34. 34. <ul><li>Enhanced Image Quality </li></ul><ul><li>IOLs that correct some (but not all) spherical </li></ul><ul><li>aberration result in vision similar to a young, </li></ul><ul><li>natural crystalline lens. </li></ul><ul><li>Spherical aberration in human eyes: </li></ul><ul><ul><li>0.08 microns for populations with normal vision 5 . </li></ul></ul><ul><li>AcrySof ® IQ IOL: </li></ul><ul><ul><li>Corrects about .20 microns of spherical aberration. </li></ul></ul><ul><ul><li>Designed to leave a residual ~0.08 microns. </li></ul></ul><ul><li>AcrySof ® IQ Toric IOL is designed with a similar </li></ul><ul><li>level of spherical aberration correction. </li></ul>
    35. 35. Contrast Sensitivity, continued AcrySof ® IQ IOL improves contrast sensitivity in both well-lit and low-light conditions 4 . <ul><li>Virtually the same image quality** whether aperture size is 3 or 5 mm. </li></ul><ul><li>Image quality was characterized by measuring modular transfer function (MTF) in a model eye utilizing simulated cornea with typical adult human spherical aberration. </li></ul>
    36. 36. Improved Functional Vision <ul><li>The aspheric design of the AcrySof ® IQ IOL </li></ul><ul><li>provides improved functional vision in </li></ul><ul><li>challenging, low-visibility environments . </li></ul><ul><li>Allows patients to more quickly detect and identify objects. </li></ul><ul><li>Allows for greater reaction time. </li></ul><ul><li>May increase patient safety. </li></ul>
    37. 37. Functional Vision Study <ul><li>Patients were tested monocularly in a night driving simulator in simulated city and rural settings under normal, glare and fog conditions. </li></ul><ul><li>Patients with AcrySof ® IQ IOL performed functionally better than the control lens in 34 of 36 conditions tested 4 . </li></ul>
    38. 38. Functional Vision Study, cont’d AcrySof ® IOL aspheric design makes a difference, performing better in 34 of 36 conditions.
    39. 39. AcrySof ® IQ Toric Surgical Planning and Procedural Considerations
    40. 40. <ul><li>AcrySof ® Toric IOL </li></ul><ul><li>Procedural Considerations </li></ul><ul><li>Surgeon performs standard cataract procedure from capsulorhexis through phacoemulsification </li></ul><ul><li>AcrySof ® Toric IOL implantation requires only minor variation from standard procedure: </li></ul><ul><li>1. IOL calculation </li></ul><ul><li>2. Marking of the eye </li></ul><ul><li>3. IOL alignment (on-axis) </li></ul>
    41. 41. <ul><li>Patient Selection </li></ul><ul><li>(minimum criteria) </li></ul><ul><li>Regular corneal astigmatism </li></ul><ul><li>Intact capsule </li></ul><ul><li>Continuous curvilinear capsulotomy (CCC) </li></ul><ul><li>In the bag lens placement </li></ul>
    42. 42. <ul><li>IOL Calculation </li></ul><ul><li>Step I: </li></ul><ul><li>Determine required spherical power using preferred biometric method </li></ul><ul><li>Step II: </li></ul><ul><li>Utilize AcrySof ® Toric IOL Calculator to determine: </li></ul><ul><ul><li>The recommended IOL model, and </li></ul></ul><ul><ul><li>Optimal axis location of the IOL in the capsular bag </li></ul></ul>
    43. 43. AcrySof ® IQ Toric IOL Calculator <ul><li>Makes precise surgical planning easy! </li></ul><ul><li>Intuitive input </li></ul><ul><li>Patient data </li></ul><ul><li>Keratometry </li></ul><ul><li>IOL spherical power </li></ul><ul><li>Surgically induced astigmatism </li></ul><ul><li>Incision location </li></ul><ul><li>Powerful output </li></ul><ul><li>Recommended IOL model and spherical equivalent power </li></ul><ul><li>Optimal axis placement </li></ul><ul><li>Magnitude and axis of anticipated </li></ul><ul><li>residual astigmatism </li></ul>
    44. 44. IOL Alignment <ul><li>I. Gross Alignment </li></ul><ul><ul><li>Rotate IOL clockwise to approximately 15 degrees short of desired position </li></ul></ul><ul><ul><li>Completed while the IOL is unfolding in the capsular bag </li></ul></ul><ul><ul><li>Can be rotated after IOL has unfolded, if needed, but take care to have capsular bag inflated with OVD </li></ul></ul>
    45. 46. IOL Alignment <ul><li>II. Stabilize IOL During OVD Removal </li></ul><ul><ul><li>Take care to prevent IOL from rotating past intended axis during OVD removal </li></ul></ul><ul><ul><ul><li>2 nd instrument </li></ul></ul></ul><ul><ul><ul><li>Silicone I/A tip </li></ul></ul></ul>
    46. 48. IOL Alignment <ul><li>III. Final Alignment </li></ul><ul><ul><li>Carefully rotate IOL clockwise onto the intended axis of alignment </li></ul></ul><ul><ul><li>Tap IOL down into capsular bag to seat lens in place </li></ul></ul>
    47. 50. Discussion points <ul><li>Show them the astigmatism and take it out of the phoropter </li></ul><ul><li>Use a vision questionnaire to determine their spectacle needs </li></ul>
    48. 51. They are your patient, they love you! <ul><li>This is an opportunity to educate them about their visual function and get to know them better. </li></ul><ul><li>Use of a portable DVD in your practice is a great option! </li></ul><ul><ul><li>Educational DVDs are free </li></ul></ul><ul><ul><li>Eyemaginations </li></ul></ul><ul><li>Financing options </li></ul>
    49. 52. <ul><li>1.50 dioptors or more equals Toric in my practice (experience from multifocals) </li></ul>
    50. 53. Dealing with the unhappy patient <ul><li>I have very few in this group! </li></ul><ul><li>Patients accept residual astigmatism </li></ul><ul><li>20/Happy! </li></ul>
    51. 54. Discussion points <ul><li>LASIK enhancements are an option </li></ul><ul><li>Toric outcomes for FDA is much better than LASIK and PRK </li></ul><ul><li>“ I would never give you a spectacle or contact lens prescription that did not treat your astigmatism.” </li></ul>
    52. 55. Practice builder for you…. <ul><li>90% of LASIK patients buy an expensive pair of sunglasses </li></ul><ul><li>Options of plano progressive lenses. </li></ul><ul><li>If they are happy they are going to tell other patients about your practice! </li></ul><ul><li>Reimbursement is $110.00/eye in addition to standard co-management reimbursement through insurance (~150.00). </li></ul>
    53. 56. Summary <ul><li>This astigmatism type Premium IOL is very forgiving! </li></ul><ul><li>All you have to say is, “You have a lot of astigmatism! Your surgeon is going to discuss with you about your astigmatism and ways to address it.” </li></ul><ul><li>Recommend! </li></ul>
    54. 57. References 1. Based on unilateral clinical study results (Models SA60T3, SA60T4, SA60T5). See package insert. 2. Data on file. Alcon, Inc. 3. Linnola RJ, Sund M, Yl önen R, Pihlajaniemi T. Adhesion of soluble fibronectin, lamin, and collagen type IV to intraocular lens materials. J Cataract Refract Surg. 1999;25:1486-1491. 4. Results of a controlled, randomized, double-masked, multicenter, contralateral implant clinical study of the AcrySof® IQ IOL versus an AcrySof® Single-Piece IOL (SA60AT). See Directions for Use. 5. Cheng X, Bradley A, Hong X, Thibos LN. Relationship between refractive error and monochromatic aberrations of the eye. Optom Vis Sci . 2003;80:43-49. ** The effects of this aspheric design have been clinically assessed on AcrySof® IQ IOL Model SNW60WF (See Directions for Use) )