Perfect Vision's Dr Con Moshegov presentation on: Aspheric IOLs for CRGH

1. What’s all this talk about aspheric IOLs? Con Moshegov Dept of Ophthalmology Meeting CRGH October 2, 2007.

3. 20/20 ? Quality of Vision?

4. Contrast Sensitivity is a better test of functional vision than Visual Acuity!

5. Sinewave contrast sensitivity is the most widely accepted test of contrast sensitivity It is more specific and sensitive than ETDRS, Pelli-Robson tests

6. Contrast Sensitivity The more cycles per degree the patient can see the better the contrast sensitivity.

8. Reduces contrast sensitivity and increases glare sensitivity… Spherical Aberration … especially at night when the pupil is large

10. Wavefront Aberrometry Provides a description of the entire optical error of the eye

12. Spherical aberration of the cornea positive spherical aberration

13. The cornea of a young eye has positive spherical aberration which is neutralised by the negative spherical aberration of the lens. The Young Eye Spherical Aberration in Human Eyes

15. Wavefront Aberrations of the Eye Increase with Age Guirao A, Artal P. Corneal wave aberration from videokeratography: accuracy and limitations of the procedure. J Opt Soc Am A Opt Image Sci Vis. 2000;17:955-65.

16. Wavefront Aberrations of the Cornea Remain Relatively Constant with Age Guirao A, Artal P. Corneal wave aberration from videokeratography: accuracy and limitations of the procedure. J Opt Soc Am A Opt Image Sci Vis. 2000;17:955-65.

18. Contrast Sensitivity Decreases with Age

19. Aging of the lens Young Old “ The lens grows over a lifetime - and in doing so, changes its curvature. ”(Brown, 1974) “ The Lens becomes thicker …” (Koretz et al, 1989) “ The refractive index of the lens changes …” (Smith et al, 1992)

20. Spherical Aberrations in Human Eyes The positive spherical aberration of the mature cornea is no longer neutralised as the lens also has a positive spherical aberration. The Mature Eye

21. Standard IOLs increase aberrations Aberrations of cornea and standard IOLs

22. Aspheric IOL: Tecnis

23. Conventional IOLs Tecnis T E C N I S Z-SHARP OPTIC TECHNOLOGY A New IOL for Better Vision!

24. Total Spherical Aberration 1 and 3 months after surgery -0.04 -0.02 0 0.02 0.04 0.06 0.08 0.1 0.12 1 month 3 months Z(4,0) µ m SI40 Tecnis™ Mester et al. Impact of a modified optic design on visual function: Clinical comparative study. J Cataract Refract Surg. 2003; 29:652–660

25. Photopic Contrast Sensitivity 3 months after surgery Mester et al. Impact of a modified optic design on visual function: Clinical comparative study. J Cataract Refract Surg. 2003; 29:652–660 * * * * * Spatial frequency (c/deg) contrast sensitivity 0 10 20 30 40 50 60 70 80 90 100 1.5 3 6 12 18 * P < 0.05 Tecnis™ SI40

26. Mesopic Contrast Sensitivity 3 months after surgery Mester et al. Impact of a modified optic design on visual function: Clinical comparative study. J Cataract Refract Surg. 2003; 29:652–660 * * * * * 0 10 20 30 40 50 60 70 80 90 * P < 0.05 Tecnis™ SI40 Spatial frequency (c/deg) Contrast sensitivity 1.5 3 6 12 18

28. Object Detection: Tecnis ™ significantly better than control Data on file. AMO.

30. Improved functional vision with a modified prolate intraocular lens . Packer M, Fine IH, Hoffman RS, Piers PA. J Cataract Refract Surg. 2004 May;30(5):986-92. Methods: Patients randomly assigned to receive a Tecnis Z9000 IOL (Pfizer) or a Sensar OptiEdge AR40e IOL (AMO) in 1 eye were followed for 3 months postoperatively Conclusion: Results show the Tecnis IOL with a modified prolate anterior surface produces better contrast sensitivity than a standard spherical IOL under mesopic and photopic conditions. 15 Patients per group/ 3 months follow up TECNIS Z9000 Studies

32. Aspheric IOLs a Laboratory data on file. Alcon Laboratories, Inc. b Holladay et al., A new intraocular lens design to reduce spherical aberration of pseudophakic eyes. JCRS 2002; 18:683-691. c Mester et al., Impact of a modified optic design on visual function: clinical comparative study. JCRS 2003; 29:652-660. d Altmann et al., Optical performance of 3 intraocular lens designs in the presence of decentration. JCRS 2005; 31:574-585. ~ 0.28 d 0.00 d SofPort AO ~ 0.00 c − 0.27 b Tecnis ~0.1 a − 0.20 a AcrySof IQ Overall Spherical Aberration ( µ m) Lens Spherical Aberration ( µ m) 6.0 mm Pupil Size

33. Residual Spherical Aberration Figures in µm SA Lens Cornea 1. Artal et al. Journal of Vision 2001; 1:1-8. 2. Levy et al. AJO 2005; 139:225-228. 3. Legras R , Chateau N, Charman WN. Assesment of Just-noticeable differences for refractive errors and spherical aberration using visual stimulation. Opt Vis Science (81)9 718-728. 4. Glasser A , Campbell MCW. Vision Res 1998; 38:209–229 5. Holladay et al. J of Refract Surg 2002; 18:683-691. 6. Wang L ,, et al. Higher order aberrations from the internal optics of the eye. JCRS 2005;31. 65 yrs 20 yrs AcrySof IQ AO / AOV Tecnis +0.074 +0.275 0.0 -0.200 0 -0.274 0.274 0.274 0.274 +0.174 +0.094 -0.100 -0.180 0.274 0.274

35. Aspheric IOL Profiles Actual digital photos of 20D lens comparisons AMO AcrySof IQ IOL Equally powered AcrySof Natural IOL B&L

41. Tilting

42. Ammetropia