Presentazione a cura della dottoressa Francesca Pietrolucci - "Rieteye - L'innovazione in oftalmologia" Rieti 14 settembre 2018

1. Nuova IOL TRIFOCALE:
caratteristiche tecniche
Francesca Pietrolucci
UOC Oftalmologia AUSL/RI

2. Diffractive Trifocal IOLs
the newest option to compensate presbyopia
• Diffractive trifocal pattern
• No clinically significant deterioration of visual quality
• Different models avoidable

3. First Generation
• PhysIOL
• FineVision Micro F – Launched in 2010
• FineVision Toric – Launched in 2014
• Carl Zeiss Meditec
• AT LISA tri 839MP – Launched in 2012
• AT LISA tri Toric 939MP – Launched in 2013
Second Generation
• Alcon
• AcrySof PanOptix IOL – Launched in 2015
• AcrySof PanOptix Toric IOL – Launched in 2017
Evolution of Trifocal IOL’s Design

4. Traditional Trifocal:
• 2 step heights = 2 add powers
• Intermediate focal point of 80 cm to maintain
usable near vision
Quadrifocal Technology:
• 3 step heights = 3 add powers
• Energy evenly distributed among Distance, 120
cm, 60 cm and 40 cm
ENLIGHTEN™ Optical Technology:
• 2 step heights = 2 add powers
• Redirects light from the 1st step height (120 cm)
to Distance
• Light splits three ways: Distance, 60 cm, and 40
cm
Energy
Distan
0th
1/40 1/Focal
2nd distance
Energy
1/120 1/40 1/Focal
3rd
Distance
0th
distance
Energy
1/40 1/Focal
3rd
Dist
0 distance

6. 6 | EMEA 2018 | Jan 2018
In-vitro, bench characterization via MTF
PanOptix IOL vs. ReSTOR +3.0 D IOL Lee et al Clin Ophthalmol. 2016:10 1031–1038
50 lp/mm100 lp/mm

8. 8 | EMEA 2018 | Jan 2018
Multicenter defocus curve evaluation of a novel trifocal presbyopia correcting intraocular lens:
6 months postoperative results. Kohnen T, et al
• Purpose: To determine the binocular defocus curve of the AcrySof IQ PanOptix IOL, at 6 months post-
implantation
• Methods: Prospective, single-arm, non-randomized and multicenter study. A total of 143 subjects were
received PanOptix IOLs in both eyes
• Results: Subjects who received the PanOptix IOL achieved a mean visual acuity of 20/25 or better from +0.50
D to –2.50 D
Kohnen T, et al. Multicenter defocus curve evaluation of a novel trifocal presbyopia correcting intraocular lens: 6 months postoperative results. Free paper
presentation. ASCRS 2017 Los Angeles

9. 9 | EMEA 2018 | Jan 2018
Short term visual outcomes of a new trifocal intraocular lens. Garcia–Perez JL, et al.
• Purpose: to report the short-term visual outcomes of PanOptix IOL
• Methods: 58 patients receiving bilateral implantation of the PanOptix IOL. 1 month follow up
- Three patients (5.1%) reported the need for
spectacle correction for certain activities.
All other patients (94.8%) reported never using spectacle correction.
García-Pérez et al. BMC Ophthalmology (2017) 17:72

10. 10 | EMEA 2018 | Jan 2018
Visual and refractive outcomes following implantation of a new trifocal intraocular lens.
Lawless M, et al.
• Purpose: retrospectively assessment of the predictability, safety and efficacy of PanOptix IOL
following cataract or refractive lens exchange (RLE) surgery.
• Methods: 34 patients were bilaterally implanted with the PanOptix IOL. Follow-up from 4 to 9
weeks
• Results: Mean postoperative UDVA was 0.01 ± 0.10 LogMAR. All patients achieved an unaided
distance acuity of 20/40 or better postoperatively. No intraoperative complications were noted. Five
patients complained of moderate haloes in the early postoperative period
Lawless et al. Eye and Vision (2017) 4:10

11. 12 | EMEA 2018 | Jan 2018
Trifocal intraocular lenses: a comparison of the visual performance and quality of vision
provided by two different lens designs. Gundersen GK, et al.
• Purpose: To compare PanOptix and FineVision trifocal IOL designs, evaluating longer-term refractive
outcomes, visual acuity (VA) at various distances, low contrast VA and quality of vision.
• Methods: 60 patients binocularly implanted (30 patients per group) were evaluated 6 months to 2 years
after surgery.
• Results:
- BCIVA & UIVA were significantly better for the
PanOptix lens at 60 cm (p<0.01).
- The binocular defocus curves differed −1.0 D
(FineVision better), −1.5 and −2.00 D (PanOptix better)
(figure)
Gundersen GK, et al. Clinical Ophthalmology 2017:11 1081–1087
PanOptix
FineVision
The preferred reading distance was
between 42 and 43 cm for both lenses, with
the VA at the preferred reading distance
slightly better with the PanOptix lens

12. 13 | EMEA 2018 | Jan 2018
Visual performance after bilateral implantation of 2 new presbyopia-correcting intraocular
lenses: Trifocal versus extended range of vision. Monaco G, et al.
• Purpose: To compare the visual outcomes and quality of vision of PanOptix and Symfony IOLs
with those of a monofocal IOL (AcrySof SN60WF)
• Methods: 20 patients in each arm of the study (60 patients,120 eyes) completed the outcome
assessment at 4 months postoperatively
• Results:
- PanOptix had significantly better near VA
(0.02 ± 0.06 logMAR) than Symfony group
(0.07 ± 0.08 logMAR; p=0.05)
- The defocus curve showed PanOptix IOL
had better intermediate/near performance than
the Symfony lens and both multifocal IOLs
performed better than the monofocal IOL (figure)
Monaco G, et al. Cataract Refract Surg 2017; 43:737–747
Continue in the next slide...
Extended Range Of Vision
Trifocal
Monofocal

13. 14 | EMEA 2018 | Jan 2018
Visual performance after bilateral implantation of 2 new presbyopia-correcting intraocular
lenses: Trifocal versus extended range of vision. Monaco G, et al.
• Results:
- Intragroup comparison of the total higher-order aberrations, PSF, MTF, and retinal straylight were not
statistically different.
- The Quality of Vision questionnaire results showed no differences in dysphotopsia between the multifocal
IOL groups; however, the results were significantly higher than in the monofocal IOL group (figure)
Monaco G, et al. Cataract Refract Surg 2017; 43:737–747
Extended Range Of Vision
Trifocal
Monofocal

14. 15 | EMEA 2018 | Jan 2018
A comparative study of the visual outcomes between a new trifocal and an extended depth pf
focus intraocular lens. Ruiz-mesa R, et. al
• Purpose: To evaluate and compare visual outcomes and ocular optical performance of the
PanOptix and Symfony IOLs
• Methods: 34 patients were bilaterally implanted with the PanOptix IOL (20 patients) or with the
symfony IOL (14 patients)
Ruiz-Mesa R, et al. Eur J Ophthalmol 2017 (in press)
Continue in the next slide...
• Results:
- PanOptix showed significantly better near VA (0.04 ± 0.06
logMAR) than Symfony IOL (0.20 ± 0.07 logMAR; p<0.001)
- Similar preferred reading distances were found for both groups,
but PanOptix showed better VA at that distance (p<0.001):
PanOptix: 0.09 ± 0.08 logMAR at 37 cm
Symfony: 0.19 ± 0.08 logMAR at 38.9 cm
- The defocus curve showed significantly better outcomes for the
PanOptix IOL from -2.0 to -4.0 D (figure)

15. 16 | EMEA 2018 | Jan 2018
Ruiz-Mesa R, et al. Eur J Ophthalmol 2017 (in press)
• Results:
- No significant differences were found for contrast sensitivity, halometry, or HOAs between the groups (figure)
A comparative study of the visual outcomes between a new trifocal and an extended depth pf
focus intraocular lens. Ruiz-mesa R, et. al

16. Pazienti con cataratta o presbiopia
motivazione a eliminare o ridurre l’uso degli occhiali
si no
mIOLs IOL monofocale
Motivati Motivati Motivati ma con
con aspettative ma con aspettative aspettative irrealistiche
realistiche molto elevate o con patologie oculari
Pazienti ideali Pazienti difficili
Compromesso
Aspettativa