The document discusses the comparative performance of two diffractive trifocal intraocular lenses, Acrysof IQ Panoptix and Lisa Tri, focusing on their optical properties, predictability, and patient outcomes after three months. It highlights the advantages of each lens in terms of near and far vision, predictability, and visual quality, while noting comparable levels of halo and glare perception between the two lenses but higher than that of phakic eyes. The study suggests a need for further data to fully assess lens performance and visual outcomes.

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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