The document discusses how advances in diagnostic technology have reduced refractive surprises following cataract surgery. It notes some remaining challenges and outlines technologies from ZEISS that further address these issues: 1. The IOLMaster 700 allows biometry measurements in over 99% of patients, significantly reducing the need for less precise ultrasound measurements. 2. The IOLMaster 700's improved repeatability results in more consistent measurements, potentially reducing refractive outcomes by over 0.3 diopters. 3. The IOLMaster 700's fixation check can help detect unusual eye structures and prompt further OCT examination. 4. The CALLLISTO eye and Cataract Suite markerless combine the IOLMaster 700's reference image

1. OIS symposium
Diagnostics: Impact on the premium Channel
May 2016
Dr. Karlheinz Rein
Vice President FOB Cataract & Retina Surgery

2. Impact of technology in diagnostics on
premium outcomes
42%1 61%1 86%2
0
100
Contact.Ultrasound IOLMaster IOLMaster.500
1
Connors R.et. al. Accuracy and reproducibility of biometry using partial coherence interferometry. J Cataract Refractive Surgery 2002; 28: 235-238
2
Reitblat O. et. al. Accuracy of predicted refraction with multifocal intraocular lenses using two biometry measurement devices and multiple intraocular lens power calculation formulas. Clinical and
• The number of refractive surprises have decreased with the introduction of new technologies, but:
1. Are all patients eligible for gold standard technology?
2. Can gold standard technology be optimized to further improve biometry?
3. Are pathologies sometimes overlooked?
4. Do intra-operative tools for toric patients reach the same precision as pre-operative
biometry?
• How can technology help to overcome these remaining reasons for refractive surprises?
% of patients within +/- 0.5D of the predicted refractive cylinder
Ultrasound imposes
a substantial risk of
refractive surprises
In some cases even
with gold standard
technology something
goes wrong

3. 3
ZEISS IOLMaster 700 – Better cataract penetration to
treat more patients with better technology1
• AL measurements with PCI biometry
fail in 6% of patients2
• The IOLMaster ®
700 with SWEPT
Source Biometry®
shows a cataract
penetration of > 99%2
• That means 92% fewer ultrasound
cases1
• Fewer ultrasound cases result in
fewer refractive surprises
1
Clinical study of Dr. Akman, Evaluation and comparison of the new swept sourceOCT-based IOLMaster 700 with the IOLMaster 500
2
Clinical data of Dr. Hirnschall, Hanusch Clinic Vienna, Austria, based on >1.200 European eyes;
„From one or two ultrasound cases a day to one every 2-3 weeks!“ (Dr. Hirnschall,
Hanusch Hospital, Vienna)
Figure 1. White intumescent cataract
(Case 1)
Figure 2. Slit lamp image of the Cataracta
rubra eye (Case 2)
Figure 3. ZEISS IOLMaster 700 OCT image with measurement calipers

4. ZEISS IOLMaster 700 – Better repeatability
for better outcomes
4
• Distance-independent telecentric
keratometry for robust and repeatable
keratometry measurements - even with
unexperienced users
• Repeatability of AL measurement
differs up to 26 µm between devices
• Depending on the device used the
refractive outcome may differ > 0.3D
Repeatability comparison of AL measurement1
1
Sources: LENSTAR LS900, HS-Art.No. 1511.7220032.02060, standard deviation (1,σ); IOLMaster 500, Vogel A, Dick B, Krummenauer F: Reproducibility of optical biometry using partial coherence interferometry.
Intraobserver and Interobserver reliability. J Cataract Refract Surg 27: 1961-1968, 2001 standard deviation (1,σ); IOLMaster 700 see technical data
* Based on technical device specifications
26 µm differenceConstant spot
distance
0,58
0,32 0,26
0
0.25
0.5
0.75
LENSTAR/LS900 IOLMaster/500 IOLMaster/700
> 0.3D difference
Device Comparison of in-vivo Repeatability (1 SD, Range in DPT.)*

5. ZEISS IOLMaster 700 – Helps to visualize unusual
eye structures for better patient selection
5
• The unique Fixation Check supports
to detect poor patient fixation
• It may also help to indicate unusual
eye structures for better patient
selection1
• An incidential finding (e.g. BRVO as
shown here) may prompt for a
comprehensive OCT examination.
1 As the ZEISS IOLMaster 700 is clearly not intended to be used for diagnostics, findings need to be verified and pathologies diagnosed with a dedicated retina OCT
* Image courtesy of Prof. O. Findl, Hanusch Hospital Vienna, Austria
Figure 1. SWEPT Source Biometry of our patient with the IOLMaster 700 showing intraretinal fluid (Fixation Check image on the right)*
Figure 2. SD-OCT image of the left eye of our patient*

6. 1
Visser N, Berendschot T, Bauer NJ, Jurich J, Kersting O, Nuijts RM. Accuracy of toric intraocular lens implantation in cataract and refractive surgery. J Cataract Refract Surg 2011; 37: 1394-1402.
2
Clinical data of Prof. Findl / Dr. Hirnschall presented at ESCRS 2013 – technically verified pre- / intraoperative matching precision ± 1.0° in mean
* Image courtesy of Prof. E. Fabian, Augencentrum Rosenheim, Germany
ZEISS CALLISTO eye – Bring pre-operative
precision into the OR for astigmatism planning
6
• Traditional ink marks may get blurred or may
even disappear leading to an error in IOL
alignment of approx. 5° in mean1
• ZEISS IOLMaster 700 integrates keratometry,
biometry, imaging and a reference image – in
one device!
• The CALLISTO eye matches the reference and
the live image with a technically verified matching
precision of +/- 1.0° in mean for precise2
markerless toric IOL alignment
Figure 3: Blurred ink mark and digital overlay*Figure 1: Ink mark Figure 2: Reference image IOLMaster 700

7. 1
Clinical data of Prof. Findl / Dr. Hirnschall presented at ESCRS 2013 – technically verified pre- / intraoperative matching precision ± 1.0° in mean
2
Elhofi AH, Helal HA, Comparison Between Digital and Manual Marking for Toric Intraocular Lenses - A Randomized Trial, Medicine (Baltimore). 2015 Sep; 94(38): e1618
3
Black D. Evaluation of markerless alignment system for toric IOLs. Paper presented at: ASCRS/ASOA Annual Symposium & Congress; April 20, 2015; San Diego, CA
ZEISS Cataract Suite markerless – Combining
excellent biometry with precision in the OR
7
The number of refractive surprises have decreased substantially with the introduction of new
technologies. Will technology help refractive outcomes to be within +/-0.25D?
• Astigmatism planning and precise alignment
of toric IOLs starts with excellent biometry
• The ZEISS Cataract Suite markerless
combines excellent biometry with precise1
markerless toric IOL alignment
• Achieving up to 99% of patients with post-
operative refractive cylinder within +/- 0.50D3

8. EN_32_150_0032I