The document discusses the AcrySof IQ ReSTOR Multifocal Toric IOL. It provides details on the product timeline and design features, including its apodized diffractive optic and toric posterior surface. Clinical data shows the IOL provides good distance and near vision with reduced spectacle dependence. It can correct presbyopia and astigmatism in a single procedure. Ideal patients are those without ocular issues and realistic expectations about potential visual disturbances.

1. AcrySof® IQ ReSTOR® Multifocal Toric IOL Con Moshegov Sydney

2. AcrySof ® MultiPiece 1994 2000 2003 2004 2005 2006 AcrySof ® TORIC AcrySof ® Single Piece AcrySof ® Product Portfolio / Timeline AcrySof ® IQ ReSTOR ® +3 2008 +3 “ Refractive” Optics

3. Presbyopia Correcting -IOLs Most Often Used 2009 Source: 2009 Leaming Survey

4. ReSTOR ® & Crystalens ® US Market Share Trends Source: 3Q09 Market Scope Quarterly Cataract Update +28.2pt 29.3% 57.5% 45.7% 44.5% Q4-07 Q4-08 Q4-09 30 35 40 45 50 55 60 -1.2pt

6. Overall Spectacle Wear Portion of Time Wearing Glasses Binocular – 6 Months Post op

7. Overall Spectacle Wear Binocular – 6 Months Post op

8. 13.0 mm Anterior Apodized Diffractive Optic 6.0 mm 6.0 mm Symmetric Biconvex Anterior Aspheric Optic Anatomy of the Apodized Diffractive Technology

9. AcrySof ® IQ ReSTOR ® IOL SN6AD3 Add Power: +4.0 D Spectacle Plane: +3.2 D Range: +10.0 D to +34.0 D A-Constant: 118.9 SN6AD1 Add Power: +3.0 D Spectacle Plane: +2.5 D Range: +10.0 D to +34.0 D A-Constant: 118.9

10. 26 28 30 32 34 36 Uncorrected Centimeters (cm) ~6-7 cm difference Source: AcrySof ® IQ ReSTOR ® IOL Package Insert 38 Average Near Best Distance IQ ReSTOR ® IOL +4.0 D [N=131] IQ ReSTOR ® IOL +3.0 D [N=138]

11. Moshegov Best near focus with ReSTOR +4: 32cm (median 34cm) Best near focus with ReSTOR +3: 37cm (median 40cm)

13. Night Vision Problems Halos Glare AcrySof ReSTOR +4 6 months AcrySof ReSTOR +3 3 months Moderate None, Mild Severe Visual Disturbances

14. Toric IOL Preferred 2009 Source: 2009 Leaming Survey

15. IOL Design – Rotational Stability Adhesive nature of AcrySof ® Toric IOL material provides high level of rotational stability STABLEFORCE ® haptic design allows the IOL to conform to the capsular bag Promotes optimal placement and centration in different sized capsular bags Average rotation of less than 4° at six months post-op

17. Measuring axis post-op

18. IOL rotation Follow-up: I month post op n = 38 92% < 5 ° (highest was 7.5 °) Direction: equal clockwise and anticlockwise

19. For every 1°of rotation, 3.3% of the lens cylinder power is lost For 30° of rotation there is a complete loss of astigmatic correction Additional astigmatism or visual problems with greater than 30° of rotation

21. Post op: Toric vs. LRI Acrysof Toric SN60AT + LRIs >/= 6/6 56% 24% >/= 6/12 93% 85% Post-op refractive cyl 0.48 D 0.97 D Mean SE -0.45 -0.575

22. The Latest Advance in AcrySof® Technology Australian launch: November 2010

23. AcrySof ® IQ ReSTOR® Multifocal Toric IOL Single surgical procedure for presbyopia correction and corneal astigmatism management Reduce or eliminate need to refine residual cylinder with LRI, LASIK, or PRK

24. Cylinder Distribution Cylinder D ( < ) % of Patients N = 10,411 Moderate 1.0 – 2.0D 25% Severe >2.0 D 10%

25. Corrective Cylinder Power

26. Anterior Apodized Diffractive Aspheric Surface Same design as current AcrySof® IQ ReSTOR® +3.0D 9 apodized diffractive steps for +3.0D add power Negative spherical aberration factor corrects for the positive spherical aberration of the cornea AcrySof® IQ ReSTOR® Multifocal Toric IOL Product Evolution Posterior Toric Lens Surface Same design as current AcrySof® Toric IOLs Posterior toric axis marks Posterior toric surface

27. Cylinder Powers Detail (Models SND1T2 – T5) * Based on an average pseudophakic human eye IOL Model Cylinder Power @ IOL Plane Cylinder Power @ Corneal Plane* Diopter Power Available** 0.5D increments (Spherical Equivalent) SND1T2 1.00 0.68 6.0 to 34.0D SND1T3 1.50 1.03 6.0 to 34.0D SND1T4 2.25 1.55 6.0 to 34.0D SND1T5 3.00 2.06 6.0 to 34.0D

28. AcrySof® IQ ReSTOR® Multifocal Toric IOL (Model SND1TT) Product Characteristic Summary Table Internal Use Only – For Sales Training Purposes Model Numbers Product Characteristic SND1T2 * SND1T3 SND1T4 SND1T5 Optic Type Biconvex Apodized Diffractive Aspheric Toric Material Ultraviolet and blue light filtering Acrylate / Methacrylate Copolymer Optic Diameter (mm) 6.0 Overall Length (mm) 13.0 Haptic Angle 0° IOL Powers (spherical equivalent diopters) Current availability is 10.0 to 30.0 D ( 0.5D increments) IOL Cylinder Powers (IOL Plane) 1.00 D 1.50 D 2.25 D 3.00 D IOL Cylinder Powers (Corneal Plane) † 0.68 D 1.03 D 1.55 D 2.06 D Add Power +3.0 D Add Power at Spectacle Plane +2.5 D Suggested A-Constant 118.9 † Based on average pseudophakic human eye * Model number SND1T2 not currently available.

29. Product Characteristics Light Transmission Curve

30. AcrySof® IQ ReSTOR ® IOL +3.0 D Theoretical Total Energy Balance S ource: Data on file. Alcon, Inc. R&D Technical Report Product Performance AcrySof® IQ ReSTOR® IOL

31. Refraction (D) AcrySof® IQ ReSTOR ® IOL +3.0 D [N=117] Mean Defocus Curve for AcrySof® IQ +3.0 D ReSTOR® IOL Binocular, Best Case, 6 Months Postoperative S ource: AcrySof ® IQ ReSTOR ® IOL Package Insert 70 cm 50 cm 40 cm 33 cm ∞ 20/25 20/32 20/40 20/50 20/63 20/80 20/100 20/20 +1.00 +0.50 0.00 -0.50 -1.00 -1.50 -2.00 -2.50 -3.00 -3.50 -4.00 Product Performance: IQ ReSTOR® Double Peaked Defocus Curve

32. Updated Online Calculator www.acrysoftoriccalcular.com

33. ASICO instruments

34. PRE-OP TORIC REFERENCE MARKER A. AE-2791 Marking Eye with Patient Sitting Up B. Patient Lying Down AE-2791

37. Marking of the Eye – Axis Marking

38. INTRA-OP MARKER A. AE-2792 Aligned to Steepest Meridian B. Marks on Steepest Meridian AE-2792

39. 62 yr old female +2.00/-2.00x5 +2.50/-0.50x180 42.50/44.0x90 42.75/44.0x87 +22.0 ReSTOR T4 BE 2.2mmx135 2.2mmx30 [email_address] [email_address] Assume +0.50D SIA At 1 week: 6/7.5 6/9 J4 at 43cm 42.50/44.25x83 and 42.25/43.75x85

40. 52 yr old Indian male restauranteur +1.75/-0.75x80 +1.25/-0.25x100 42.88/43.90x165 43.32/44.5x15 +22.0 ReSTOR T3 BE 2.2mmx170 2.2mmx30 At 1 month: 6/6 6/6 J1 at 43cm

41. ReSTOR +3D Toric

42. The majority work very well but.. Success with the ReSTOR requires: Careful patient and doctor/practice selection Good patient counseling Accurate preoperative biometry Careful surgical technique Attention to astigmatism

43. Concerns Optometrists will stop referring patients if I use ReSTOR

44. Concerns Patients don’t mind wearing glasses

45. Concerns Glare and halos are a big problem with multifocals

46. Concerns Multifocals may need to be explanted

47. Ideal patients for the ReSTOR

48. Ideal patients for the ReSTOR Patients with no other ocular pathology Patients in line for bilateral surgery People with easy going personalities, realistic expectations and not too obsessive Care with engineers, high school teachers, pharmacists and accountants

49. Bad patients for the ReSTOR

50. Intra-operative Exclusion Criteria Exclusion during surgery Significant vitreous loss Damage to zonules Pupil trauma

51. Preoperative counseling Patient Information video Can’t compete with young crystalline lens Explain inevitability of faint halo around letters and lights ReSTOR will give excellent distance vision and excellent near vision, the new +3 gives good intermediate vision You may be more comfortable using magnifiers for computers or reading under poor light

52. Preoperative counseling But You won’t have to struggle with your bifocal or multifocal glasses You’ll love being able to see your watch, mobile phone, prices in stores, menu in restaurants and be able to put on makeup These lenses will free you up!

53. IQ ReSTOR® Toric Conclusions AcrySof® IQ ReSTOR® Toric has been designed to perform at all distances for patients with and without astigmatism Gives surgeon the ability to reduce or eliminate the need to correct residual cylinder with LRI, LASIK, or PRK. Allows single surgical procedure for presbyopia correction and corneal astigmatism management It increases the number of patients who can be considered for multifocal IOL implantation .