Artificial lenses implanted in the anterior or posterior chamber of the eye in the presence of the natural crystalline lens to correct refractive errors. Phakic IOLs an evolving technique in the field of refractive surgery for the correction of moderate to high refractive errors. Patients with high myopia (above -10 diopters) constitute only about 2% of the myopic population but 13-15% of patients presenting for refractive surgery belong to this group. The increased knowledge on anterior segment anatomy and availability of better imaging technologies along with improved IOL designs and surgical techniques have led to higher success rates with these lenses.
Compared to corneal refractive surgery , phakic IOLs compete favorably for the correction of high ametropias, with excellent predictability, efficacy, safety and quality of vision.
Secondary Piggyback Iol Implantation For Correction Of Residual Refractive Er...Dr. Jagannath Boramani
Presented by- Dr. Hardik Jain, Co-authors- Dr. Mrunal Patil, Dr. Dhiraj Balwir ( Disclosure: Author has no financial interest ) Dr. Vasantrao Pawar Medical College, Nashik
Artificial lenses implanted in the anterior or posterior chamber of the eye in the presence of the natural crystalline lens to correct refractive errors. Phakic IOLs an evolving technique in the field of refractive surgery for the correction of moderate to high refractive errors. Patients with high myopia (above -10 diopters) constitute only about 2% of the myopic population but 13-15% of patients presenting for refractive surgery belong to this group. The increased knowledge on anterior segment anatomy and availability of better imaging technologies along with improved IOL designs and surgical techniques have led to higher success rates with these lenses.
Compared to corneal refractive surgery , phakic IOLs compete favorably for the correction of high ametropias, with excellent predictability, efficacy, safety and quality of vision.
Secondary Piggyback Iol Implantation For Correction Of Residual Refractive Er...Dr. Jagannath Boramani
Presented by- Dr. Hardik Jain, Co-authors- Dr. Mrunal Patil, Dr. Dhiraj Balwir ( Disclosure: Author has no financial interest ) Dr. Vasantrao Pawar Medical College, Nashik
Based in Rockville, Maryland, Dr. Anthony Roberts provides client-centered ophthalmology care for a broad range of eyesight issues such as glaucoma, corneal disease, dry eyes, and diabetic retinopathy. Offering advanced Lasik procedures, Dr. Anthony Roberts provides extended-depth-of-focus (EDOF) intraocular lens (IOL) options to patients with complex vision challenges.
IOLs are typically implanted as part of refractive lens exchange or following cataract extraction, within the surgical treatment of presbyopia. Traditional multifocal IOLs employ diffractive optic lenses and separate light between near, intermediate, and long distances. This means that the user is only able to focus on a single distance at a time, with blur, halo, and glare sometimes occurring due to the multiple focal points.
By contrast, EDOF-IOLs provide a single elongated focal point that seamlessly improves depth of focus and range of vision. This emerging technology is ideal for patients who do not want their functional vision compromised as they shift focus across distances.
Dr. Anthony Roberts, founder of Shady Grove Ophthalmology, provides comprehensive care for diseases and conditions affecting the eyes. Experienced in Lasik surgery, Dr. Anthony Roberts also routinely introduces intraocular lenses (IOLs) to treat cataracts in patients.
Advances in IOL Technology -Muliti-Focal ImpantsRonan Conlon
A slideshow presentation reviewing the features of multi-focal implants. Pertinent information is presented to help eye care providers to help them guide their patients, on the selection of multi-focal implant. Co-management pearls are provided regarding the post operative care of these patients.
La chirurgie des amétropie n'est pas toujours possible avec les laser modernes. On se tourne alors vers les implants qui peuvent corriger de fortes amétropies avec ou sans astigmatismes ou des patients avec des cornées a risques.
Based in Rockville, Maryland, Dr. Anthony Roberts provides client-centered ophthalmology care for a broad range of eyesight issues such as glaucoma, corneal disease, dry eyes, and diabetic retinopathy. Offering advanced Lasik procedures, Dr. Anthony Roberts provides extended-depth-of-focus (EDOF) intraocular lens (IOL) options to patients with complex vision challenges.
IOLs are typically implanted as part of refractive lens exchange or following cataract extraction, within the surgical treatment of presbyopia. Traditional multifocal IOLs employ diffractive optic lenses and separate light between near, intermediate, and long distances. This means that the user is only able to focus on a single distance at a time, with blur, halo, and glare sometimes occurring due to the multiple focal points.
By contrast, EDOF-IOLs provide a single elongated focal point that seamlessly improves depth of focus and range of vision. This emerging technology is ideal for patients who do not want their functional vision compromised as they shift focus across distances.
Dr. Anthony Roberts, founder of Shady Grove Ophthalmology, provides comprehensive care for diseases and conditions affecting the eyes. Experienced in Lasik surgery, Dr. Anthony Roberts also routinely introduces intraocular lenses (IOLs) to treat cataracts in patients.
Advances in IOL Technology -Muliti-Focal ImpantsRonan Conlon
A slideshow presentation reviewing the features of multi-focal implants. Pertinent information is presented to help eye care providers to help them guide their patients, on the selection of multi-focal implant. Co-management pearls are provided regarding the post operative care of these patients.
La chirurgie des amétropie n'est pas toujours possible avec les laser modernes. On se tourne alors vers les implants qui peuvent corriger de fortes amétropies avec ou sans astigmatismes ou des patients avec des cornées a risques.
SPOTLIGHT ON THE PREMIUM CHANNEL – AcuFocusHealthegy
Presentation from OIS@ASCRS 2016
Nick Tarantino, OD, Chief Global Clinical & Regulatory Affairs Officer
Video Presentation:
https://www.youtube.com/watch?v=Nc4T9u62rBQ&list=PL1dmdBNnPTZJBhQxPOp0vdNg3s3wtN2yw&index=34
Scleral lens is a large rigid contact lens with a diameter range of 15mm to 25mm. Its resting point is beyond the
corneal borders, and are believed to be among the best vision correction options for irregular corneas. Wearing scleral lens also can postpone or even prevent surgical intervention as well as decrease the risk of corneal scarring.
The Right Contact - Up to date information regarding contact lenses, Hyrid lenses, Soft lenses, button materials, gas permable lens and contact lens care products.
Similar to Lente Fachica da da camera posteriore per correzione miopia Dottor Nicola Canali (20)
Preserflow microshunt per chirurgia filtrante sottocongiuntivale nel glaucoma. DrCanali. Lezione tenutasi il 20marzo2024 a Brescia.
Preserflow microshunt for subconjunctival filtering surgery in glaucoma. DrCanali. Lecture held on 20th March 2024 in Brescia.
KOWA IOL in atigmatismo CORSO_23Feb24 Poliambulanza DrDISALVATORE.pptxNicola Canali
Lente a profondità di fuoco con correzione progressiva dell'astigmatismo in interventi femtocataratta. drDiSalvatore
Depth of focus lens with progressive correction of astigmatism in femtocataract surgeries.
MIX & MATCH drCANALI 23Feb24 POLIAMBULANZA VIIIRefrattivaLive.pptxNicola Canali
Utilizzare un mixed match diffrattivo edoff nella scelta di IOL multifocali nella chirurgia FLAC con femtolaser della correzione di cataratta e di difetti ametropici. Dr.Canali. Use a mixed match IOLS chice with a diffractive iol and a edoff IOL in usage of multifocal IOLs in FLAC surgery with femtolaser for the correction of cataracts and ametropic defects.
Perché come chirurgo scegliere tecniche SMILE SMAL LENTICULE CORSO_23Feb24 Po...Nicola Canali
un vantaggio razionale nell'utilizzo di correzione refrattiva con SMALL LENTICULE SMILE con FEMTOLASER. Dr.Canali.
a rational advantage in the use of refractive correction with SMALL LENTICULE SMILE with FEMTOLASER
Intervento di cataratta e FLAC contemporaneo bilaterale Poliambulanza OCULIS...Nicola Canali
RAzionale e valutazione per un intervento bilaterale contemporaneo di cataratta e facorefrattiva FLAC femtolaser assisted con impianto di IOL multifocali. Drssa Camilla Pagnacco. Rationale and evaluation for simultaneous bilateral cataract and phacorefractive femtolaser-assisted FLAC surgery with multifocal IOL implantation.
Accorgimenti di Correzione Astigmatica 2024 Brescia 23Febbreio DrNOTO-CANA...Nicola Canali
Accorgimenti di chirurgia astigmatica nella chirurgia premium del cristallino in oculistica. Femtocataratta.
Astigmatic surgery measures in premium lens surgery in ophthalmology. Femtocataract.
THE CHALLENGE OF DIABETIC VITREORETINAL INTERFACE ITA DrCanali 20 Aprile23 ...Nicola Canali
A lesson presented in Lugano on the 20 april 2023 at the ESASO vitreoretinal master. Focused on vitreoretinal surgery in diabetic retinopathy and the vitreo retinale interface
Flu Vaccine Alert in Bangalore Karnatakaaddon Scans
As flu season approaches, health officials in Bangalore, Karnataka, are urging residents to get their flu vaccinations. The seasonal flu, while common, can lead to severe health complications, particularly for vulnerable populations such as young children, the elderly, and those with underlying health conditions.
Dr. Vidisha Kumari, a leading epidemiologist in Bangalore, emphasizes the importance of getting vaccinated. "The flu vaccine is our best defense against the influenza virus. It not only protects individuals but also helps prevent the spread of the virus in our communities," he says.
This year, the flu season is expected to coincide with a potential increase in other respiratory illnesses. The Karnataka Health Department has launched an awareness campaign highlighting the significance of flu vaccinations. They have set up multiple vaccination centers across Bangalore, making it convenient for residents to receive their shots.
To encourage widespread vaccination, the government is also collaborating with local schools, workplaces, and community centers to facilitate vaccination drives. Special attention is being given to ensuring that the vaccine is accessible to all, including marginalized communities who may have limited access to healthcare.
Residents are reminded that the flu vaccine is safe and effective. Common side effects are mild and may include soreness at the injection site, mild fever, or muscle aches. These side effects are generally short-lived and far less severe than the flu itself.
Healthcare providers are also stressing the importance of continuing COVID-19 precautions. Wearing masks, practicing good hand hygiene, and maintaining social distancing are still crucial, especially in crowded places.
Protect yourself and your loved ones by getting vaccinated. Together, we can help keep Bangalore healthy and safe this flu season. For more information on vaccination centers and schedules, residents can visit the Karnataka Health Department’s official website or follow their social media pages.
Stay informed, stay safe, and get your flu shot today!
Ethanol (CH3CH2OH), or beverage alcohol, is a two-carbon alcohol
that is rapidly distributed in the body and brain. Ethanol alters many
neurochemical systems and has rewarding and addictive properties. It
is the oldest recreational drug and likely contributes to more morbidity,
mortality, and public health costs than all illicit drugs combined. The
5th edition of the Diagnostic and Statistical Manual of Mental Disorders
(DSM-5) integrates alcohol abuse and alcohol dependence into a single
disorder called alcohol use disorder (AUD), with mild, moderate,
and severe subclassifications (American Psychiatric Association, 2013).
In the DSM-5, all types of substance abuse and dependence have been
combined into a single substance use disorder (SUD) on a continuum
from mild to severe. A diagnosis of AUD requires that at least two of
the 11 DSM-5 behaviors be present within a 12-month period (mild
AUD: 2–3 criteria; moderate AUD: 4–5 criteria; severe AUD: 6–11 criteria).
The four main behavioral effects of AUD are impaired control over
drinking, negative social consequences, risky use, and altered physiological
effects (tolerance, withdrawal). This chapter presents an overview
of the prevalence and harmful consequences of AUD in the U.S.,
the systemic nature of the disease, neurocircuitry and stages of AUD,
comorbidities, fetal alcohol spectrum disorders, genetic risk factors, and
pharmacotherapies for AUD.
These lecture slides, by Dr Sidra Arshad, offer a quick overview of physiological basis of a normal electrocardiogram.
Learning objectives:
1. Define an electrocardiogram (ECG) and electrocardiography
2. Describe how dipoles generated by the heart produce the waveforms of the ECG
3. Describe the components of a normal electrocardiogram of a typical bipolar leads (limb II)
4. Differentiate between intervals and segments
5. Enlist some common indications for obtaining an ECG
Study Resources:
1. Chapter 11, Guyton and Hall Textbook of Medical Physiology, 14th edition
2. Chapter 9, Human Physiology - From Cells to Systems, Lauralee Sherwood, 9th edition
3. Chapter 29, Ganong’s Review of Medical Physiology, 26th edition
4. Electrocardiogram, StatPearls - https://www.ncbi.nlm.nih.gov/books/NBK549803/
5. ECG in Medical Practice by ABM Abdullah, 4th edition
6. ECG Basics, http://www.nataliescasebook.com/tag/e-c-g-basics
ARTIFICIAL INTELLIGENCE IN HEALTHCARE.pdfAnujkumaranit
Artificial intelligence (AI) refers to the simulation of human intelligence processes by machines, especially computer systems. It encompasses tasks such as learning, reasoning, problem-solving, perception, and language understanding. AI technologies are revolutionizing various fields, from healthcare to finance, by enabling machines to perform tasks that typically require human intelligence.
Title: Sense of Taste
Presenter: Dr. Faiza, Assistant Professor of Physiology
Qualifications:
MBBS (Best Graduate, AIMC Lahore)
FCPS Physiology
ICMT, CHPE, DHPE (STMU)
MPH (GC University, Faisalabad)
MBA (Virtual University of Pakistan)
Learning Objectives:
Describe the structure and function of taste buds.
Describe the relationship between the taste threshold and taste index of common substances.
Explain the chemical basis and signal transduction of taste perception for each type of primary taste sensation.
Recognize different abnormalities of taste perception and their causes.
Key Topics:
Significance of Taste Sensation:
Differentiation between pleasant and harmful food
Influence on behavior
Selection of food based on metabolic needs
Receptors of Taste:
Taste buds on the tongue
Influence of sense of smell, texture of food, and pain stimulation (e.g., by pepper)
Primary and Secondary Taste Sensations:
Primary taste sensations: Sweet, Sour, Salty, Bitter, Umami
Chemical basis and signal transduction mechanisms for each taste
Taste Threshold and Index:
Taste threshold values for Sweet (sucrose), Salty (NaCl), Sour (HCl), and Bitter (Quinine)
Taste index relationship: Inversely proportional to taste threshold
Taste Blindness:
Inability to taste certain substances, particularly thiourea compounds
Example: Phenylthiocarbamide
Structure and Function of Taste Buds:
Composition: Epithelial cells, Sustentacular/Supporting cells, Taste cells, Basal cells
Features: Taste pores, Taste hairs/microvilli, and Taste nerve fibers
Location of Taste Buds:
Found in papillae of the tongue (Fungiform, Circumvallate, Foliate)
Also present on the palate, tonsillar pillars, epiglottis, and proximal esophagus
Mechanism of Taste Stimulation:
Interaction of taste substances with receptors on microvilli
Signal transduction pathways for Umami, Sweet, Bitter, Sour, and Salty tastes
Taste Sensitivity and Adaptation:
Decrease in sensitivity with age
Rapid adaptation of taste sensation
Role of Saliva in Taste:
Dissolution of tastants to reach receptors
Washing away the stimulus
Taste Preferences and Aversions:
Mechanisms behind taste preference and aversion
Influence of receptors and neural pathways
Impact of Sensory Nerve Damage:
Degeneration of taste buds if the sensory nerve fiber is cut
Abnormalities of Taste Detection:
Conditions: Ageusia, Hypogeusia, Dysgeusia (parageusia)
Causes: Nerve damage, neurological disorders, infections, poor oral hygiene, adverse drug effects, deficiencies, aging, tobacco use, altered neurotransmitter levels
Neurotransmitters and Taste Threshold:
Effects of serotonin (5-HT) and norepinephrine (NE) on taste sensitivity
Supertasters:
25% of the population with heightened sensitivity to taste, especially bitterness
Increased number of fungiform papillae
Tom Selleck Health: A Comprehensive Look at the Iconic Actor’s Wellness Journeygreendigital
Tom Selleck, an enduring figure in Hollywood. has captivated audiences for decades with his rugged charm, iconic moustache. and memorable roles in television and film. From his breakout role as Thomas Magnum in Magnum P.I. to his current portrayal of Frank Reagan in Blue Bloods. Selleck's career has spanned over 50 years. But beyond his professional achievements. fans have often been curious about Tom Selleck Health. especially as he has aged in the public eye.
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Introduction
Many have been interested in Tom Selleck health. not only because of his enduring presence on screen but also because of the challenges. and lifestyle choices he has faced and made over the years. This article delves into the various aspects of Tom Selleck health. exploring his fitness regimen, diet, mental health. and the challenges he has encountered as he ages. We'll look at how he maintains his well-being. the health issues he has faced, and his approach to ageing .
Early Life and Career
Childhood and Athletic Beginnings
Tom Selleck was born on January 29, 1945, in Detroit, Michigan, and grew up in Sherman Oaks, California. From an early age, he was involved in sports, particularly basketball. which played a significant role in his physical development. His athletic pursuits continued into college. where he attended the University of Southern California (USC) on a basketball scholarship. This early involvement in sports laid a strong foundation for his physical health and disciplined lifestyle.
Transition to Acting
Selleck's transition from an athlete to an actor came with its physical demands. His first significant role in "Magnum P.I." required him to perform various stunts and maintain a fit appearance. This role, which he played from 1980 to 1988. necessitated a rigorous fitness routine to meet the show's demands. setting the stage for his long-term commitment to health and wellness.
Fitness Regimen
Workout Routine
Tom Selleck health and fitness regimen has evolved. adapting to his changing roles and age. During his "Magnum, P.I." days. Selleck's workouts were intense and focused on building and maintaining muscle mass. His routine included weightlifting, cardiovascular exercises. and specific training for the stunts he performed on the show.
Selleck adjusted his fitness routine as he aged to suit his body's needs. Today, his workouts focus on maintaining flexibility, strength, and cardiovascular health. He incorporates low-impact exercises such as swimming, walking, and light weightlifting. This balanced approach helps him stay fit without putting undue strain on his joints and muscles.
Importance of Flexibility and Mobility
In recent years, Selleck has emphasized the importance of flexibility and mobility in his fitness regimen. Understanding the natural decline in muscle mass and joint flexibility with age. he includes stretching and yoga in his routine. These practices help prevent injuries, improve posture, and maintain mobilit
- Video recording of this lecture in English language: https://youtu.be/lK81BzxMqdo
- Video recording of this lecture in Arabic language: https://youtu.be/Ve4P0COk9OI
- Link to download the book free: https://nephrotube.blogspot.com/p/nephrotube-nephrology-books.html
- Link to NephroTube website: www.NephroTube.com
- Link to NephroTube social media accounts: https://nephrotube.blogspot.com/p/join-nephrotube-on-social-media.html
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Lung Cancer: Artificial Intelligence, Synergetics, Complex System Analysis, S...Oleg Kshivets
RESULTS: Overall life span (LS) was 2252.1±1742.5 days and cumulative 5-year survival (5YS) reached 73.2%, 10 years – 64.8%, 20 years – 42.5%. 513 LCP lived more than 5 years (LS=3124.6±1525.6 days), 148 LCP – more than 10 years (LS=5054.4±1504.1 days).199 LCP died because of LC (LS=562.7±374.5 days). 5YS of LCP after bi/lobectomies was significantly superior in comparison with LCP after pneumonectomies (78.1% vs.63.7%, P=0.00001 by log-rank test). AT significantly improved 5YS (66.3% vs. 34.8%) (P=0.00000 by log-rank test) only for LCP with N1-2. Cox modeling displayed that 5YS of LCP significantly depended on: phase transition (PT) early-invasive LC in terms of synergetics, PT N0—N12, cell ratio factors (ratio between cancer cells- CC and blood cells subpopulations), G1-3, histology, glucose, AT, blood cell circuit, prothrombin index, heparin tolerance, recalcification time (P=0.000-0.038). Neural networks, genetic algorithm selection and bootstrap simulation revealed relationships between 5YS and PT early-invasive LC (rank=1), PT N0—N12 (rank=2), thrombocytes/CC (3), erythrocytes/CC (4), eosinophils/CC (5), healthy cells/CC (6), lymphocytes/CC (7), segmented neutrophils/CC (8), stick neutrophils/CC (9), monocytes/CC (10); leucocytes/CC (11). Correct prediction of 5YS was 100% by neural networks computing (area under ROC curve=1.0; error=0.0).
CONCLUSIONS: 5YS of LCP after radical procedures significantly depended on: 1) PT early-invasive cancer; 2) PT N0--N12; 3) cell ratio factors; 4) blood cell circuit; 5) biochemical factors; 6) hemostasis system; 7) AT; 8) LC characteristics; 9) LC cell dynamics; 10) surgery type: lobectomy/pneumonectomy; 11) anthropometric data. Optimal diagnosis and treatment strategies for LC are: 1) screening and early detection of LC; 2) availability of experienced thoracic surgeons because of complexity of radical procedures; 3) aggressive en block surgery and adequate lymph node dissection for completeness; 4) precise prediction; 5) adjuvant chemoimmunoradiotherapy for LCP with unfavorable prognosis.
Couples presenting to the infertility clinic- Do they really have infertility...Sujoy Dasgupta
Dr Sujoy Dasgupta presented the study on "Couples presenting to the infertility clinic- Do they really have infertility? – The unexplored stories of non-consummation" in the 13th Congress of the Asia Pacific Initiative on Reproduction (ASPIRE 2024) at Manila on 24 May, 2024.
These simplified slides by Dr. Sidra Arshad present an overview of the non-respiratory functions of the respiratory tract.
Learning objectives:
1. Enlist the non-respiratory functions of the respiratory tract
2. Briefly explain how these functions are carried out
3. Discuss the significance of dead space
4. Differentiate between minute ventilation and alveolar ventilation
5. Describe the cough and sneeze reflexes
Study Resources:
1. Chapter 39, Guyton and Hall Textbook of Medical Physiology, 14th edition
2. Chapter 34, Ganong’s Review of Medical Physiology, 26th edition
3. Chapter 17, Human Physiology by Lauralee Sherwood, 9th edition
4. Non-respiratory functions of the lungs https://academic.oup.com/bjaed/article/13/3/98/278874
Prix Galien International 2024 Forum ProgramLevi Shapiro
June 20, 2024, Prix Galien International and Jerusalem Ethics Forum in ROME. Detailed agenda including panels:
- ADVANCES IN CARDIOLOGY: A NEW PARADIGM IS COMING
- WOMEN’S HEALTH: FERTILITY PRESERVATION
- WHAT’S NEW IN THE TREATMENT OF INFECTIOUS,
ONCOLOGICAL AND INFLAMMATORY SKIN DISEASES?
- ARTIFICIAL INTELLIGENCE AND ETHICS
- GENE THERAPY
- BEYOND BORDERS: GLOBAL INITIATIVES FOR DEMOCRATIZING LIFE SCIENCE TECHNOLOGIES AND PROMOTING ACCESS TO HEALTHCARE
- ETHICAL CHALLENGES IN LIFE SCIENCES
- Prix Galien International Awards Ceremony
Lente Fachica da da camera posteriore per correzione miopia Dottor Nicola Canali
1.
2.
3.
4.
5. I-CARE (Corneal)
AcrySof Cachet
(Alcon Inc)
Monopezzo, idrofila in
materiale acrilico con quattro
aptiche. Il diametro dell'ottica è
5.75 mm con un diametro
complessivo da 12 mm a 13,5
millimetri
Monopezzo pieghevole, idrofoba in
materiale acrilico, con diametro dell'ottica di
6,0 millimetri, lunghezza complessiva da
12,5 a 14,0 mm. Le anse sono progettate per
consentire la stabilità lente senza creare una
forza eccessiva che potrebbe causare danni
ai tessuti angolari o ovalizzazione pupillare.
Introdotta in camera anteriore con un
iniettore. Non è necessaria iridectomia
6. Worst nel 1978 ideò l’iris-claw o "lobsterclaw" per la
correzione dell’afachia, una IOL complanare monopezzo
in PMMA che veniva posizionata in camera anteriore
ancorandola in una piega dello stroma medio-periferico
dell’iride (parte meno vascolarizzata e meno reattiva)
Nello stesso anno (1986) in cui Baikoff impiantò la sua
prima lente con ottica biconcava, Fechner in Germania
eseguì l’impianto della prima iris-claw per correggere una
miopia elevata con cristallino in situ
7. Nel 1998 viene commercializzata dalla ditta Ophtec B.V. con il nome di
Artisan, in Europa, e Verisyse negli Stati Uniti. Nel 2003 sono entrate
sul mercato le IOL pieghevoli Artiflex Piol (Ophtec B.V.), Veriflex negli
Stati Uniti con ottica in silicone convesso-concava con diametro di 6
mm, aptiche in PMMA e lunghezza complessiva di 8,5 mm. Il
vantaggio della Artiflex, flessibile rispetto all'Artisan, è la piccola
incisione attraverso cui può essere inserita (3,2 mm), diminuendo
l'astigmatismo indotto chirurgicamente
La lente Artisan è una monopezzo in PMMA con lunghezza totale di
8,5 mm e ottica di 5 o 6 mm di diametro in base al potere
9. Nel 1986 Fyodorov impiantava la prima lente fachica
con aptiche in camera posteriore e ottica in campo
pupillare: la “collar button” o lente a fungo
La lente era monopezzo in silicone con
piccola zona ottica (3-4 mm) a
superficie concava, posizionata in
campo pupillare e veniva mantenuta in
sede dai movimenti della pupilla
10. Nel 1990 nasce la prima lente fachica
da camera posteriore (PCP-IOL)
Ottica biconcava con diametro
utile di 4,5 mm, parte aptica piatta
e rettangolare (plate aptic) di 6
mm di larghezza e lunghezza
variabile
11. L’unica lente fachica in silicone ancora in commercio ma in attesa
del FDA approval è la Medennium Phakic Lens (MPL), evoluzione
della Phakic Refractive Lens (PRL-CP - Carl Zeiss Meditec)
Lenti da camera posteriore
In silicone di seconda generazione con indice
refrattivo elevato (n=1.46), superficie
posteriore concava con raggio di 10,0 mm
che imita la curvatura anteriore del
cristallino
Lente pieghevole con minima induzione di astigmatismo. Grazie al
materiale idrofobo non viene a contatto con la capsula anteriore del
cristallino né sviluppa sinechie anteriori
12. Nel 1994 la Staar sviluppa una lente da camera posteriore e
annuncia il primo impianto in Argentina eseguito dal dottor
Zaldivar. In realtà questa fase sa di italiano perché il primo
chirurgo ad impiantare un ICL fu il dottor Pesando nel settembre
del ’93 seguito poche ore dopo dal dottor Assetto e nel
nell’autunno ‘94 dal dott. Caramello
La lente è chiamata ICL (Implantable Collamer Lens)
Visian ICL V4c
13. La ICL è costruita con un materiale detto “Collamer” formato da
0.2% di collagene di origine porcina, 63% di componente acrilica
(idrossietilmetacrilato), 33% di acqua e la restante percentuale da
benzofenone che presenta un’elevatissima biocompatibilità
performance ottica
Nel 2003 l’FDA statunitense approva l’ICL per la correzione
miopica.
Dopo la prima autorizzazione l’FDA richiede un cambiamento del
nome della lente per la tutela del paziente: da Implantable Contact
Lens a Implantable Collamer Lens per evitare che il paziente
ritenesse la procedura non invasiva
Dal 2003 la ICL è la lente fachica più utilizzata
14. • Foldable
• Posterior chamber sulcus-located
• Made of Collamer®: Proprietary material to
STAAR
• State-of-the-art patented technology:
Manufactured by STAAR
• Wide range of prescriptions
Myopia, hyperopia, astigmatism (range dependent on
local approvals)
• Excellent quality of vision with many clinical
studies
16. Current Visian ICL situation
CONFIDENTIAL 16
This material is for ICL proctors ONLY
• Over 650,000 Visian ICLs have been implanted. Over
10,000 of these have been in eyes for 15 years or more.
• Included in these numbers are over 130,000 Toric ICLs
and >200,000 Visian CentraFLOW lenses implanted.
• The Visian ICL is the fastest growing refractive technology
in the world.
• STAAR R&D is working on a pipeline of products including
preloaded ICLs and ICLs that treat presbyopia.
17. Exceptional Patient Satisfaction
2. Sanders D, Schneider D, Martin R, Brown D, Dulaney D, Vukich J, Slade S, Schallhorn S. Toric Implantable Lens for Moderate to High
Myopic Astigmatism. Ophthalmology 2007; 114: 54-61
3. UV-absorbing collamer implantable lens (ICL) for the correction of myopia. PMA# P030016. Presentation to the Ophthalmic Devices
Advisory Panel. October 2003.
This material is for ICL proctors
ONLY
18. • Behind the iris
– Far from the endothelium
– Excellent cosmesis (invisible to the eye)
– Close to the Nodal points of the eye
– Greater effective Optical Zone (at the corneal plane)
• Sulcus located
– Stable location (allows for Toric design with same platform)
– Easy to remove/exchange
– No fixations into tissues (iris)
– Does not alter shape/remove tissue of
the cornea
Posterior Chamber Concept
19. Made of Collamer material
• Collagen & HEMA copolymer
– Excellent biocompatibility -
“quiet eye“
– Excellent transmittance and
low reflectance patterns
– Very flexible (foldable, small incision,
easy to inject and remove)
– YAG friendly
– Easy to lathe: wide range of prescriptions possible
– Best material for a phakic IOL, long-term safety
and tolerance proven
– Available only from STAAR
This material is for ICL proctors
ONLY
20. Collamer Summary
• Hydrophilic: no glare
• Affinity for fibronectin: Biocompatibility
• Refractive index = 1.45
• Elastic: Gentle unfolding
• Tensile strength: Strong, Resists Tearing
• UV Chromophore (covalently bound)
This material is for ICL proctors
ONLY
21. COMPARISON V3 & V4 and MODELS
Includes V4b and V4c models
Design features:
This material is for ICL proctors
ONLY
22. ICL V4 ICL V4B & V4c
11.0 11.6
11.5 12.1
12.0 12.6
12.5 13.2
13.0 13.7
Hy
p
My
op
This material is for ICL proctors ONLY. Not for MDs
Lens Length:
This material is for ICL proctors
ONLY
23. The Design of the Visian ICL CentraFLOW
with KS- Aquaport – The Port
• 360µm port in the center of the
optic.
• Designed to restore more natural
aqueous flow and eliminate the
need for iridotomies.
• 360µm Peri-optic ports are
designed to facilitate OVD removal
and provide redundancy for the
central optic port. V4c model available for the
myopic spheric and myopic toric
lens versions
This material is for ICL proctors
ONLY
25. The images below represent simulation of quality of vision
having equal treatment with the ICL and LASIK based on
higher order aberrometry (-7.0D treatment)
After ICL After LASIK
This material is for ICL proctors
ONLY
26. Visual Performance After Posterior Chamber Phakic Intraocular Lens Implantation
and Wavefront-Guided Laser In Situ Keratomileusis for Low to Moderate Myopia.
Am J Ophthalmol 2012;153:1178 –1186. KAZUTAKA KAMIYA, AKIHITO IGARASHI, KIMIYA SHIMIZU, KAZUHIRO MATSUMURA, AND
MARI KOMATSU
• 30 eyes of 20 patients undergoing ICL implantation and 64 eyes of 38
patients undergoing WFG-LASIK for the correction of low to
moderate myopia (manifest spherical equivalent -3.00 to -5.88 D).
• Ocular higher order aberrations (HOAs) and contrast sensitivity (CS)
function were measured at 4 and 6 mm pupil.
4 mm pupil 6 mm pupil
27. CONCLUSIONS:
ICL implantation appears to induce significantly fewer ocular HOAs than WFG-guided LASIK.
Thus, even in the correction of low to moderate myopia, ICL implantation appears to be
superior in visual performance to WFG-LASIK, suggesting that it may be a viable surgical
option for the treatment of such eyes.
ICL WFG-LASIK
28. Summary of ICL characteristics
• Single piece foldable design
• Behind the iris/sulcus located
• Made of a proprietary material COLLAMER, highly
biocompatible, foldable, with excellent optical properties
• Long-term proven history, optimised to enhance safety and
outcomes
• Wide range of prescriptions: full range of correction from -18 to
+ 10 D with or without astigmatism up to 6 D
• Removable/exchangable
• Excellent Quality of Vision (Untouched cornea and tear film)
with fast visual recovery
• Cannot be seen by casual observer – cosmetically attractive for
patients
This material is for ICL proctors
ONLY
29. ™
™
+
Introduzione a EVO+ Visian ICL
Il disegno della EVO+ Visian ICL introduce un incremento dell’ottica
portando il diametro del piatto ottico ad un diametro con un range da 5.0
mm a 6.1 mm nelle lenti sferiche con potere da -0.5 D a -14.0 D
inizialmente nel mercato Europeo, seguito da un sistematico lancio nei
mercati internazionali.
Nel mercato Europeo, EVO+ è stata introdotta con l’obiettivo di aumentare
l'apprezzamento dei pazienti Millennial.
Confidential. Internal Purposes Only. Do Not Distribute.
Enlarged optical zone.
with an overall gain in optical surface
(5.0 mm – 6.1 mm optic diameter depending on Diopter)
30. ™
™
+
Confidential. Internal Purposes Only. Do Not Distribute.
Value Proposition
EVO+ Visian ICL con il diametro del piatto ottico allargato è disegnata
per aumentare ulteriormente le prestazioni, oramai collaudate,
delle Visian ICL soprattutto per i pazienti con pupilla larga.
Una superficie allargata di tutta l’area refrattiva con una ottima qualità
ottica è un evidente benefit per i giovani pazienti o per quelli con
pupilla più larga.
Una correzione refrattiva con zone ottiche più larghe sono auspicabili
perchè riducono la possibilità che la luce possa passare
attraverso aree ottiche non trattate refrattivamente o in aree di
transizione, perché questo determina una qualità visiva più bassa
ed effetti indesiderati quali gelare, halos, o aberrazioni di alto ordine
(HOA).
31. JCRS Article on EVO+ Visian ICL
JCRS Article1 compared the optical quality (in vitro) of EVO Visian ICL (V4c)
and EVO+ Visian ICL (V5) at 4 different spherical powers and 3.0, 4.5 and 5.5 mm
optical apertures. EVO + lenses were assessed also at largest optical aperture of
6.0 mm.
RMS of HOAs up to the 7th order, trefoil, coma, tetrafoil, secondary astigmatism,
and spherical aberration showed no statistical differences between models for
any power and optical aperture
Patients with larger pupil diameters could benefit from the EVO+ Visian ICL
(V5) because the EVO+ Visian ICL (V5) model showed “excellent” in vitro
optical quality with a larger optical diameter than the EVO Visian ICL (V4c)
model.
33. Patients Age Range 21 – 45 years have mean and
maximum pupil diameter under night driving
conditions of 5.4 mm and 5.2 mm, respectively2.
Between a mesopic pupil size and pIOL optic diameter a
possible risk factor for night-vision disturbances exists
such as halos.3
10. Koch DD, Samuelson SW, Haft EA, Merin LM. Pupillary size and
responsiveness; implications for selection of a bifocal intraocular
lens. Ophthalmology 1991; 98:1030–1035
Average Pupil Size by Age Group
34. ™
™
+
Confidential. Internal Purposes Only. Do Not Distribute.
Expanded Optical Zone Comparison
Una zona ottica allargata nelle diottrie <-14.5 mantenendo
lo stesso spessore della lente.
EVO (-14.5 D to -18.0 D)
EVO+ (-0.5 D to -14.0 D)
35. Methods• Retrospective evaluation of safety and efficacy
on patients with hyperopia and myopia
implanted with Implantable Collamer Lens (ICL)
version V4 between 2011 and 2016. Follow up
goes up to 5 years
• Multicentre study involving 5 surgeons from 5
different sites. The sites shared their data in a
cohort of 586 eyes
Doctor ICL Toric ICL hyperopes V4B V4C Total
Cochener 88 114 18 21 169 208
Fournie 13 11 0 6 18 24
Lesueur 15 16 5 8 18 31
Levy 34 172 21 33 152 206
Assouline 47 36 4 22 60 117
586
Number of eyes 586
Age (mean) 37
SEQ -8.59
Anterior Chamber
depth (mm)
3.19
White to White
(mm)
11.84
Intraocular
pressure (mmHg)
14.5
Endothelial Cell
Count
2726
36. Mean uncorrected Visual Acuity (UCVA)
myopes and hyperopes combined
Monocular:
• Stable UCVA: average 0.89
(P>0.05)
• Significant increase in UCVA
between 3 and 4 years (P<0.05)
Binocular:
• Stable UCVA over years:
average 1.01
(P> 0.05)
0.00
0.20
0.40
0.60
0.80
1.00
1.20
1.40
1 yr n=177 2 yrs n=96 3 yrs n=64 4 yrs n=32 5 yrs n=13
Visualacuity
Monocular Binocular
37. Mean Spherical Equivalent (SEQ) myopes and
hyperopes
• Mean SEQ postoperatively: -0.57 D
-2.00
0.00
2.00
4.00
6.00
8.00
preop n=42 1 year n=19 2 years n=8 3 years n=6
Hyperopes
• Mean SEQ postoperatively: 0.30 D
-10.00
-8.00
-6.00
-4.00
-2.00
0.00
2.00
Preop
n=493
1 yr
n=145
2 yrs
n=94
3 yrs
n=59
4 yrs
n=30
5 yrs
n=15
Diopters
Myopes
38. Mean Best Corrected Visual Acuity (BCVA)
myopes and hyperopes
0.00
0.20
0.40
0.60
0.80
1.00
1.20
Preop n=43 1 year n=14 2 years n=7 3 years n=2
Hyperopes
0.00
0.20
0.40
0.60
0.80
1.00
1.20
Preop
n=485
1 yr
n=119
2 yrs
n=86
3 yrs
n=63
4 yrs
n=24
5 yrs
n=16
Visualacuity
Myopes
Slight gain in BCVA from preop (average 0.86) to 5
years after surgery (average 0.92)
BCVA preop average 0.94 and postop average 0.92
39. Change in Best Corrected Visual Acuity (lines)
myopes and hyperopes combined
The average over 5 years
follow up:
• 4% lost one or more lines
• 46% had no change
• 50% gained one or more
lines
0
10
20
30
40
50
60
70
1 year n=128 2 years n=82 3 years n=63 4 years n=29 5 years n=11
Proportionofeyes
Lost one or
more lines
No change
Gained one or
more lines
40. Mean Endothelial Cell Count (ECC) myopes and
hyperopes
Percentage
loss
1 year 2 years 3 years 4 years 5 years
-5.65% 0.20% 2.31% 0.94 1.70
1500
2000
2500
3000
3500
preop n=37 1 year n=37 1 year n=8 2 years n=2
Hyperopes
Percentage
loss
1 year 2 years 3 years 4 years
-3.13% 5.48% -5.73% 3.87%
1500
2000
2500
3000
3500
Preop
n=448
1 yr
n=117
2 yrs
n=72
3 yrs
n=64
4 yrs
n=28
5 yrs
n=14
ECC
Myopes
41. Mean Intraocular Pressure (IOP) myopes and
hyperopes
6
8
10
12
14
16
18
20
Preop
n=353
1 yr
n=161
2 yrs
n=92
3 yrs
n=61
4 yrs
n=37
mmHg
Myopes
• The mean Intraocular pressure is well controlled over time (P>0.05)
6
8
10
12
14
16
18
20
preop
n=18
1 year
n=14
2 years
n=8
3 years
n=4
Hyperopes
42. Cataract
Only 1 case of cataract has been reported
A 24 year old patient developed a subcapsular
cataract after one year that required cataract
surgery:
Patient was preop high myopic: S-16.75 C-3.00
Patient received an ICL version V4b (without Central Hole)
13 patients developed asymptomatic subcapsular
opacifications:
9 patients with ICL version V4b (without Central Hole)
7 myopes (average SEQ -10.34 D) and 5 hyperopes (average SEQ +6.73 D). Average age 41 years old
Average time of occurrence: 1.8 years
Efficacy index: 1.16
Safety index: 1.24
43. VICMO DFU – example of labeled
complications
• Adverse reactions and complications due to, or following surgery and implantation
of any VTICL may include, but are not limited to: Hyphema, Non-reactive Pupil, Pupillary
• Block, Vault, Additional YAG Iridotomy, Secondary Glaucoma, Cataract, Intraocular
Infection, Uveitis/Iritis, Retinal Detachment, Vitritis, Corneal Edema, Macular Edema,
Corneal Decompensation, Over/Under Correction, Significant glare and/or halos (under
night driving conditions), hypopion, increased astigmatism, loss of BSCVA,
rotation/decentration/subluxation, IOP elevation from baseline (potentially related to
angle closure or from pigment occlusion of the trabecular meshwork or pigment
occlusion of the central hole), corneal endothelial cell loss, severe intraocular
inflammation, secondary surgical intervention to remove/replace the lens, synechia to
implant, Conjunctival Irritation, Vitreous Loss.
Be familiar, read and understand all current DFUs for each model
44. Summary of ICL Complications
• Preop
– Power
– Size
• Intraop
– Wound Construction
– Loading
– Insertion
• Early Postop
– Elevated IOP
– Pupil block / angle closure
– Traumatic cataract
– Over or under-sizing
• Late Postop
– Glare, halo
– Iris transillumination
– cataract (?)
– Glaucoma(?)
• Atypical long-term findings
– Pupil Ovalization
– Iris transillumination
– Pigment on lens