New Versus Former-Generation Diffractive Trifocal Intraocular Lens, presented at ASCRS 2018, by Timon Ax, D. Breyer, H. Kaymak, K. Klabe, P. Hagen, F. Kretz, G. Auffarth

1. New Versus Former-Generation
Diffractive Trifocal Intraocular Lens
Timon Ax, D. Breyer, H. Kaymak, K. Klabe, P. Hagen, F. Kretz, G. Auffarth

2. Financial Disclosure
Breyer, Kaymak & Klabe Eye Surgery and Premium Eyes are Consulting, Study Center & MAB for:
Abott, Alcon, AlimeraSciences, Allergan, AMO, Bayer, Carl Zeiss Meditec, Ellex, Fluoron,
Geuder, iOptics, LensAR, Medicem, Novartis, Oculentis, Oertli, Revision Optics,
Santen, Staar Surgical, Sifi Medtech, Thea, Topcon, Visufarma, Ziemer

3. AcrySof IQ PanOptix: Properties
• Material: Copolymer
• UV- und blue light filter (cut off at 401 nm)
• Diameter (optic): 6 mm
(total): 13 mm
• Intermediate addition: +2.17 D
Near addition: +3.25 D
In vivo

4. AcrySof IQ PanOptix: Optical Principle
• Diffractive, aspheric optic
• 3 alternating ring structures
(in general: n ring structures  n+1 foci)
• “ENLIGHTEN technology”:
Configuration of the rings is chosen, such
that light of the first order diffraction
coincides with the zeroth (distance)
Trifocal optic
Quadrifocal optic
+ “Enlighten technology“
= effectively a trifocal optic

5. equal phase
zones  2 foci
2 alternating phase
zones  3 foci
AT LISA tri: Properties and Optical Principle
• Diffractive surface profile:
• Trifocal optic over 4.34 mm
+3.33 D addition for near vision
+1.66 D addition for intermediate vision
• Bifocal optic from 4.34 mm to 6.0 mm
In vivo

6. Materials and Methods: Preoperative Patient Data
Mean ± SD
AT LISA tri
Carl Zeiss Meditec
AcrySof IQ PanOptix
Alcon
Number of eyes 372 20
M:F [%] 34:66 50:50
Age [years] 59.2 ± 10.7 64.4 ± 7.2
SE [D] -0.4 ± 3.9 0.4 ± 3.8
Cylinder [D] -1.1 ± 1.0 -0.4 ± 0.3
CDVA [logMAR] 0.20 ± 0.18 0.15 ± 0.20
UDVA [logMAR] 0.62 ± 0.40 0.71 ± 0.32
IOL-Power [D] 20.6 ± 5.2 22.2 ± 3.9
Target SE [D] -0.13 ± 0.20 -0.13 ± 0.25

7. 0%
25%
50%
75%
100%
(-oo, -1) [-1, -0.5) [-0.5, 0.5] (0.5, 1] (1, oo)
Percentageofeyes[%]
∆SE [D]
Predictability: SE(post) - SE(target)
Results: Predictability
• Comparable deviation from
target refraction after 3 months
• Light but significant (p<0.05)
undercorrection in case of
PanOptix
( more date needed)
MIOL # eyes ∆SE [D]
|∆SE| ≤
0.5 D 1.0 D
LISA tri 269 0.08 ± 0.62 66.2% 93.3%
PanOptix 20 -0.19 ± 0.54 70.0% 90.0%

8. Monofocal IOL (mon, cc)
PanOptix (mon, cc, n=13)
Lisa Tri (mon, cc, n=18)
Reference Curve VA=1,0 (mon, sc)
0.00
0.25
0.50
0.75
1.00
1.25
-3.0
-2.5
-2.0
-1.5
-1.0
-0.5
0.0
DecimalVA
Defocus [D]
Results: Monocular Defocus Curves
• PanOptix significantly (p<0.05) better at: -2.0 D (intermediate)
AT LISA tri significantly better at: -1.0 D and -0.5 D (far)
• Comparable MIOL capacities
80%
43%
100%
83%
MIOL capacity:
Area under the curve
from -3.0 D to 0.0 D
PanOptix:
Comparable
to published
data
(58 patients)
Defocus [D]
DecimalVA
n = number of eyes
mon = monocular
cc = corrected

9. Monofocal IOL (mon, cc)
PanOptix (bin, sc, n=10)
Lisa Tri (bin, sc, n=36)
Reference Curve VA=1,0 (mon, sc)
0.00
0.25
0.50
0.75
1.00
1.25
-3.0
-2.5
-2.0
-1.5
-1.0
-0.5
0.0
DecimalVA
Defocus [D]
Results: Binocular Defocus Curves
n = number of eyes
bin = binocular
sc = uncorrected
94%
43%
100%
88%
MIOL capacity:
Area under the curve
from -3.0 D to 0.0 D
• PanOptix significantly
(p<0.05) better at -3.0 D
(near vision)
• LISA tri with better far vision
• Comparable MIOL capacities

10. Halo & Glare Simulator
Simulation software from CZM:
• Subjective matching of patient‘s photopsia via a graphic user interface
• Binocular and uncorrected
• 4 categories:
„none“
„severe“„moderate“
„mild“

11. Results: Halo & Glare Simulator
0%
25%
50%
75%
100%
"none" "mild" "moderate" "severe"
PercentageofEyes[%]
Strength of Halo&Glare
Halo & Glare Simulator Phakic Eyes (n=126)
LisaTri EV (n=52)
PanOptix EV (n=12)
n = number of eyes
Phakic Eyes = employees
(age: 16-60)
EV = Emmetropic Vision
• First results: PanOptix comparable to LISA tri
• Both distributions show more Halo & Glare than phakic eyes of employees (age: 16-60)

12. Conclusion and Outlook
• Knowledge of MIOL capacity is essential to meet patients visual needs
• 3-month results: Broad range of good binocular vision:
LISA tri slightly better at far
PanOptix slightly better at near + intermediate
(in agreement with optical bench measurements)
Diffractive
trifofal IOL
Binocular visual acuity [logMAR] MIOL-capacity [%]
Halo&Glare
strength [%]
UDVA UIVA UNVA mono cc bino sc
LISA tri -0.03 ± 0.10 0.08 ± 0.08 0.10 ± 0.10 83 88 57 ± 11
PanOptix 0.01 ± 0.06 0.02 ± 0.02 0.05 ± 0.10 80 94 54 ± 11

13. Conclusion and Outlook
• Halo & Glare comparable for
PanOptix and LISA tri
but significantly stronger than for
phakic eyes
(30% ± 16%).
• Cave: Postoperative period of
several months
for satisfying neuroadaption.

14. Thank you very much for your attention!
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