This document summarizes an expert lecture on updates in intraocular lenses (IOLs). It discusses the historical evolution of IOLs from 1949 to present day, with over 298 available IOL options now catalogued online. The main characteristics of IOLs that determine their optical features are reviewed, including refractive power, asphericity, toricity and multifocality. Platform designs and their impact on biocompatibility and postoperative outcomes are also evaluated. Specific IOL types like toric, refractive multifocal, and diffractive bifocal and trifocal lenses are then analyzed in depth for their designs and performance characteristics. Head-to-head comparisons of popular trifocal IOL models are made based on visual ac
Basic overview of phaco dynamics along with all the Newer phacoemulsification techniques available in current practice - a video-assisted the presentation
Basic overview of phaco dynamics along with all the Newer phacoemulsification techniques available in current practice - a video-assisted the presentation
Boris Malyugin, M.D., PhD.'s presentation about Malyugin Ring® pearls. The key learning points of the presentation include the step-wise approach in managing small pupils, the main drivers for the decision to use pupil expander device, and the Malyugin Ring® implantation and removal pearls.
A lecture on the current techniques (mainly surgical) for the correction of Presbyopia. This includes information on static and dynamic surgical and non surgical approaches.
Sesión presentada en el congreso nacional de cirugía refractiva 2016 en Murcia por el Dr Alvaro Rodríguez Ratón. Muestra las diferencias de comportamiento entre las diferentes lentes intraoculares difractivas trifocales
Comunicación presentada en el Congreso Secoir 2010 por el Dr. Francisco Poyales Galán, director médico del Instituto de Oftalmología Avanzada, haciendo referencia al lugar que ocupa finalmente la Lente Fáquica de Apoyo Angular Cachet (Alcon) al relacionarla con el tamaño B/B del Ojo
Boris Malyugin, M.D., PhD.'s presentation about Malyugin Ring® pearls. The key learning points of the presentation include the step-wise approach in managing small pupils, the main drivers for the decision to use pupil expander device, and the Malyugin Ring® implantation and removal pearls.
A lecture on the current techniques (mainly surgical) for the correction of Presbyopia. This includes information on static and dynamic surgical and non surgical approaches.
Sesión presentada en el congreso nacional de cirugía refractiva 2016 en Murcia por el Dr Alvaro Rodríguez Ratón. Muestra las diferencias de comportamiento entre las diferentes lentes intraoculares difractivas trifocales
Comunicación presentada en el Congreso Secoir 2010 por el Dr. Francisco Poyales Galán, director médico del Instituto de Oftalmología Avanzada, haciendo referencia al lugar que ocupa finalmente la Lente Fáquica de Apoyo Angular Cachet (Alcon) al relacionarla con el tamaño B/B del Ojo
SPOTLIGHT ON THE PREMIUM CHANNEL - Abbott Medical OpticsHealthegy
Presentation from OIS@ASCRS 2016
Leonard Borrmann, Divisional VP, R&D
Video Presentation:
https://www.youtube.com/watch?v=02VOUB17Xp8&list=PL1dmdBNnPTZJBhQxPOp0vdNg3s3wtN2yw&index=38
Biometry is the method of measuring various dimensions of the eye, its components and their inter-relationship. Using these data to calculate the idol intraocular lens power. In 1949, 29th November, Harold Ridley implanted the first IOL but his patient had a refractive surprise of -20 D spherical equivalents.
So, It was long way to travel to refined the out comes. Classic keratometry is based on anterior corneal surface measurements.
Whereas this directly measure the anterior and posterior corneal surface to obtain Total keratometry(TK).
Telecentric keratometry of the anterior corneal surface + swept source OCT of the posterior corneal surface= TOTAL KERATOMETRY.
TK measurements are compatible with existing IOL constants plus two exclusive formulas: barrett true K with TK for post LVC eyes and Barrett TK toric.
Richard L. Lindstrom, MD's "Thoughts on Corneal and Lens based Refractive Surgery to Enhance Near Vision in the USA: 2015" presentation from OIS@ASCRS 2015
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.
Th e use of premium IOLs requires more specifically than standard monofocal IOLs a thorough clinical and para clinical examination using modern equipments.
We will only mention micro-incision premium IOLs that are used
in our daily practice. All information regarding the characteristics of all available and especially multifocal IOLs are available in the SFO 2012 Report on presbyopia
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
The Right Contact - Up to date information regarding contact lenses, Hyrid lenses, Soft lenses, button materials, gas permable lens and contact lens care products.
The Right Contact - Up to date information regarding contact lenses, Hyrid lenses, Soft lenses, button materials, gas permable lens and contact lens care products.
Actualización en topógrafos y biómetros 2018
Los topógrafos/tomógrafos se han empleado tradicionalmente para obtener datos queratométricos pero actualmente empiezan a incorporar tecnología para medición de parámetros de longitud axial ocular. Por otro lado, los biómetros que han venido usándose inicialmente para calcular únicamente las medidas axiales; están añadiendo sistemas de medición corneal más avanzados. Se aprecia una tendencia hacia la integración en un solo dispositivo de todas las herramientas de medición ocular para un cálculo preciso de la potencia de la lente intraocular.
Es difícil estar al día de todas las innovaciones tecnológicas, pero en este post pretendemos hacer una actualización a fecha de hoy de los dispositivos más relevantes.
Aunque se acompaña de una presentación más ilustrativa y con referencias bibliográficas relativas a la evidencia científica, me gustaría citar algunas reflexiones personales:
Actualmente, el cálculo queratométrico para casos de córnea irregular más preciso se obtiene mediante Ray Tracing a partir de tomografía. Por ello, este dispositivo sigue siendo complementario al biómetro axial.
Los dispositivos inicialmente tomógrafos con tecnología para medir longitud axial (Pentacam AXL y Galilei G6) miden la córnea de modo diferente a los biómetros tradicionales por lo que debemos usar constantes personalizadas si no queremos inducir un error hipermetrópico
El primer biómetro con capacidad de medir la cara posterior corneal e integrarlo en un valor queratométrico total verdadero, así como un astigmatismo corneal total es el IOLmaster 700. En este caso, sí que pueden seguir usándose las constantes tradicionales del ULIB aunque se requieren estudios validatorios y el lanzamiento comercial se prevé para Septiembre de 2018
Para poder beneficiarse de las fórmulas más precisas (Barrett/Olsen/Hill-RBF), debe recurrirse a un biómetro con medición de grosor cristaliniano. Y la tecnología Swept Source ha demostrado medir en un 99.5% de los casos la longitud axial. Ambas características definen el estándar tecnológico básico
Espero que estas consideraciones y la presentación adjunta puedan seros de utilidad y quedo a vuestra disposición para cualquier consulta
Presentación del Oftalmólogo Dr Alvaro Rodríguez-Ratón (IORR Bilbao Getxo) sobre materiales y plataformas de lentes intraoculares multifocales. Estas lentes se introducen en el ojo tras la cirugía de cristalino transparente o la operación de catarata. Proporcionan capacidad de visión de lejos y de cerca compensando defectos como la miopía, hipermetropía, astigmatismo o presbicia.
Sin embargo, no todos los materiales con los que se hacen estas lentes son iguales; por ello, en esta presentación se resume la evidencia científica sobre las implicaciones clínicas de los diferentes materiales de fabricación.
Se resumen las implicaciones ópticas, biocompatibilidad capsular y uveal, adhesividad y degeneraciones del material como opacificación, glistening, cambio de coloración y surface scattering
Presentation of the Ophthalmologist Dr. Alvaro Rodríguez-Ratón (IORR Bilbao Getxo) on materials and platforms of multifocal intraocular lenses. These lenses are introduced into the eye after Refractive Lens Exchange (ReLEx) or cataract surgery. They provide vision capability from far and near by compensating for defects such as myopia, hyperopia, astigmatism or presbyopia.
However, not all the materials these lenses are made with are all the same; Therefore, this presentation summarizes the scientific evidence on the clinical implications of the different manufacturing materials.
We summarize the optical implications, capsular and uveal biocompatibility, adhesiveness and degenerations of the material such as opacification, glistening, change of coloration and surface scattering
Un breve resumen de la presentación sobre biometría en 2018. Importante predominancia de la fórmula de Barrett en ojos normales, ojos largos, cortos y post-refractivos
Curso impartido en SECOIR 2017 por el Dr Alvaro Rodríguez Ratón actualizando las tecnologías de biometría, topografía y tomografía. Incluye IOLmaster, Lenstar, Aladdin, Pentacam, Sirius, Galilei, Argos ...
El Dr Rodríguez Ratón imparte una conferencia sobre cirugía refractiva y sensorialidad en el Hospital Universitario de Alava.
Los métodos de corrección de miopía, hipermetropía, astigmatismo y presbicia pueden alterar el control de los movimientos oculares o la coordinación entre las imágenes percibidas por ambos ojos desde el cerebro.
Por ello es importante una buena exploración previa.
Estudio de la asfericidad corneal y compensación de la aberración esférica mediante el uso de lente intraocular asférica, esférica o neutra
Study of corneal asphericity and compensation of spherical aberration by the usage of aspherical, spherical or neutral intraocular lens
Versión resumida del curso sobre Queratocono (Bilbao 17-3-16). En esta sesión se presentan los conceptos básicos sobre los efectos de los anillos intraestromales en la córnea con queratocono
Charla orientada a residentes. Trata el abordaje del astigmatismo corneal en el contexto de la cirugía de catarata. Se ha impartido en el curso SECOMIR de SECOIR 2014 (Alicante)
Total corneal astigmatism in older adults taking into account posterior corne...Álvaro Rodríguez-Ratón
PURPOSE: To study the composition of corneal astigmatism in older adults, evaluating the difference made by the inclusion of posterior corneal astigmatism in a ray tracing calculation of total corneal astigmatism.
SETTING: Ophthalmology clinic.
METHODS: One hundred consecutive patients aged between 60 and 80 years were included in a prospective descriptive study. Their right eye was analysed by an integrated Placido disk and rotating Scheimpflug camera topographer (CSOTM Sirius). Several parameters were measured: anterior corneal astigmatism (ACA) and posterior corneal astigmatism (PCA), total astigmatism based on anterior topographic data (simK) and total corneal astigmatism (TCA) by merging anterior and posterior astigmatism using ray tracing.
RESULTS: Mean ACA was 1.51 diopters (D) and PCA was 0.38D. ACA was aligned 47% with-the-rule and PCA 87% against-the-rule. Cases with against-the-rule ACA showed low magnitude correlation between anterior and posterior surfaces. TCA had a mean deviation of 0.30D @ 3 over SimK in a vector calculation. Eighteen percent (18%) of cases differed by 0.50 D or more between SimK and TCA magnitude, and 53% had 10 or more degrees of axis discrepancy, the difference being higher at lower magnitudes of astigmatism.
CONCLUSIONS: Anterior WTR astigmatism tends to be compensated by posterior ATR astigmatism in older patients. Nevertheless, the high number of cases largely justifies the use of tomographic technology that takes into account the posterior corneal surface for managing individual total corneal astigmatism.
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
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.
TEST BANK for Operations Management, 14th Edition by William J. Stevenson, Ve...kevinkariuki227
TEST BANK for Operations Management, 14th Edition by William J. Stevenson, Verified Chapters 1 - 19, Complete Newest Version.pdf
TEST BANK for Operations Management, 14th Edition by William J. Stevenson, Verified Chapters 1 - 19, Complete Newest Version.pdf
- 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
Title: Sense of Smell
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 primary categories of smells and the concept of odor blindness.
Explain the structure and location of the olfactory membrane and mucosa, including the types and roles of cells involved in olfaction.
Describe the pathway and mechanisms of olfactory signal transmission from the olfactory receptors to the brain.
Illustrate the biochemical cascade triggered by odorant binding to olfactory receptors, including the role of G-proteins and second messengers in generating an action potential.
Identify different types of olfactory disorders such as anosmia, hyposmia, hyperosmia, and dysosmia, including their potential causes.
Key Topics:
Olfactory Genes:
3% of the human genome accounts for olfactory genes.
400 genes for odorant receptors.
Olfactory Membrane:
Located in the superior part of the nasal cavity.
Medially: Folds downward along the superior septum.
Laterally: Folds over the superior turbinate and upper surface of the middle turbinate.
Total surface area: 5-10 square centimeters.
Olfactory Mucosa:
Olfactory Cells: Bipolar nerve cells derived from the CNS (100 million), with 4-25 olfactory cilia per cell.
Sustentacular Cells: Produce mucus and maintain ionic and molecular environment.
Basal Cells: Replace worn-out olfactory cells with an average lifespan of 1-2 months.
Bowman’s Gland: Secretes mucus.
Stimulation of Olfactory Cells:
Odorant dissolves in mucus and attaches to receptors on olfactory cilia.
Involves a cascade effect through G-proteins and second messengers, leading to depolarization and action potential generation in the olfactory nerve.
Quality of a Good Odorant:
Small (3-20 Carbon atoms), volatile, water-soluble, and lipid-soluble.
Facilitated by odorant-binding proteins in mucus.
Membrane Potential and Action Potential:
Resting membrane potential: -55mV.
Action potential frequency in the olfactory nerve increases with odorant strength.
Adaptation Towards the Sense of Smell:
Rapid adaptation within the first second, with further slow adaptation.
Psychological adaptation greater than receptor adaptation, involving feedback inhibition from the central nervous system.
Primary Sensations of Smell:
Camphoraceous, Musky, Floral, Pepperminty, Ethereal, Pungent, Putrid.
Odor Detection Threshold:
Examples: Hydrogen sulfide (0.0005 ppm), Methyl-mercaptan (0.002 ppm).
Some toxic substances are odorless at lethal concentrations.
Characteristics of Smell:
Odor blindness for single substances due to lack of appropriate receptor protein.
Behavioral and emotional influences of smell.
Transmission of Olfactory Signals:
From olfactory cells to glomeruli in the olfactory bulb, involving lateral inhibition.
Primitive, less old, and new olfactory systems with different path
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!
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
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Explore natural remedies for syphilis treatment in Singapore. Discover alternative therapies, herbal remedies, and lifestyle changes that may complement conventional treatments. Learn about holistic approaches to managing syphilis symptoms and supporting overall health.
3. 298 available IOL at ULIB
Colaborative online free resource
TAKE HOME MESSAGE
ULIB
http://ocusoft.de/ulib/c1.htm
DR. ALVARO R. RATON LECTURE AT OVIEDO, EMYO 2016
4. Main IOL characteristics
Optical features Determines
Refractive power Defocus (myopia/hyperopia)
Asphericity LSA (Longitudinal Spherical Aberration)
Toricity Astigmatism
Multifocality Distance-independent VA
Platform Design Determines
Material Biocompatibility, glistening
Border Design PCO
Haptic Refractive stability, rotation
DR. ALVARO R. RATON LECTURE AT OVIEDO, EMYO 2016
5. Platform and Toricity
Variable cylinder correction range
Platform stability
Controlled 1 year follow up (SN6AT, 100 eyes)
◦ Final axis-intented axis 3.2±3 ( 1>15º)
◦ Relocation needed 1%
ANSI standard for stability (≥ 90% of eyes with ≤ 5° of rotation between visits)
TAKE HOME MESSAGE
Toric IOL
Great rotational stability
DR. ALVARO R. RATON LECTURE AT OVIEDO, EMYO 2016
9. MplusX refractive map
(NIDEK OPD3 Aberrometer)
DR. ALVARO RGUEZ. RATÓN. SECOIR 2014
DR. ALVARO R. RATON LECTURE AT OVIEDO, EMYO 2016
10. Refractive multifocal IOL:
mPlus Vs mPlus X
0.00
0.05
0.10
0.15
0.20
0.25
0.30
0.35
0.40
0.45
-4 -3.5 -3 -2.5 -2 -1.5 -1 -0.5 0 0.5 1 1.5
Mplus
MplusX
DR. ALVARO R. RATON LECTURE AT OVIEDO, EMYO 2016
11. Diffractive multifocal IOL
Step design
◦ Wide determine focal length
◦ Height determines light energy
Counterpart
◦ Glare and Halo increase1
◦ Decrased Contrast Sensitivity2
1BJO. 2015. Visual outcomes in eyes with a distance-dominant diffractive multifocal intraocular lens with low near addition power. Hayashi K
2Aberration and contrast sensitivity comparison of aspherical and monofocal and multifocal intraocular lens eyes. Clin Exp Ophthalmol. 2007
One-step structure: Bifocal Design
DR. ALVARO R. RATON LECTURE AT OVIEDO, EMYO 2016
12. Trifocal diffractive IOL
Combining two bifocal structures
◦ Constructive interference between
near add of both structures
◦ Intermediate 2nd order interferes with near
second order
◦ Creates an intermediate focus
without optical quality loss1
1Comparative analysis of the visual performance after cataract surgery with implantation of a bifocal or trifocal diffractive IOL. JRS 2014
Two structures: Trifocal Design
0
1
2
3
4
5
6
A B C D E
TRImedia
ZMB
*own data
DR. ALVARO R. RATON LECTURE AT OVIEDO, EMYO 2016
13. Bifocal difractive IOL
optimizing the near add
1Clinical Outcomes Following Implantation of Diffractive Multifocal Intraocular Lenses With Varying Add Powers
2IOVS 2015. Halo and Through-Focus Performance of Four Diffractive Multifocal Intraocular Lenses.
Near Visual Quality
outperforms +4.00 Tecnis1
+2.50 Restor and LISA TRI2
DR. ALVARO R. RATON LECTURE AT OVIEDO, EMYO 2016
14. Bifocal difractive IOL
optimizing the near add
1Clinical Outcomes Following Implantation of Diffractive Multifocal Intraocular Lenses With Varying Add Powers
DR. ALVARO R. RATON LECTURE AT OVIEDO, EMYO 2016
15. But still bifocal IOL…
0.00
0.10
0.20
0.30
0.40
0.50
0.60
-4 -3.5 -3 -2.5 -2 -1.5 -1 -0.5 0 0.5 1 1.5
Bifocal IOL
Trifocal IOL
DR. ALVARO R. RATON LECTURE AT OVIEDO, EMYO 2016
16. Trifocal difractive IOL
getting the best at all distances
1. Zeiss LISA TRI
2. Alcon PANOPTIX
3. PhysIOL FINEVISION
DR. ALVARO R. RATON LECTURE AT OVIEDO, EMYO 2016
17. Zeiss LISA TRI
Pupil independent
◦ Loss of optical quality at bigger pupils1
Central 4.3mm trifocal design
◦ Bifocal periphery
1Invest Ophthalmol Vis Sci. 2015. Halo and Through-Focus Performance of Four Diffractive Multifocal Intraocular Lenses. Vega F
DR. ALVARO R. RATON LECTURE AT OVIEDO, EMYO 2016
18. Zeiss LISA TRI
Pupil independent
◦ Loss of optical quality at bigger pupils1
Central 4.3mm trifocal design
◦ Bifocal periphery
1Invest Ophthalmol Vis Sci. 2015. Halo and Through-Focus Performance of Four Diffractive Multifocal Intraocular Lenses. Vega F
DR. ALVARO R. RATON LECTURE AT OVIEDO, EMYO 2016
19. Alcon PANOPTIX
Central 4.5mm trifocal design
◦ Monofocal periphery
EnLighEn design
◦ Non apodized
◦ High distance and intermediate light energy
◦ Lower loss of light energy (12%)
DR. ALVARO R. RATON LECTURE AT OVIEDO, EMYO 2016
20. PhysIOL FINEVISION
100% trifocal optic
Convoluted
◦ Apodized
◦ Reduces step height
Platform
◦ Micro
◦ Pod
BMC Ophthalmol. 2015. Visual outcomes after bilateral trifocal diffractive intraocular lens implantation. Carballo-Alvarez J
DR. ALVARO R. RATON LECTURE AT OVIEDO, EMYO 2016
21. Differential characteristics
ZEISS
AT LISA TRI (0-32)
ALCON
PANOPTIX (13-34)
Finevision
Micro (10-35)Pod(6-35)
Intermediate (D) +1.66 +2.17 +1.75
Near (D) +3.33 +3.25 +3.50
Distance Light Energy 42.85% 44% 43%
Intermediate Light Energy 17.14% 22% 15%
Near Light Energy 25.71% 22% 28%
Lost Light Energy 14.3% 12% 14%
Matherial Hydrophilic (25% water)
hydrophobic surface
Hydrophobic1,2 Hydrophilic (25% water)
LSA (μm) -0.09 -0.20 -0.113
Diameter Optic 6 mm
Plate 11 mm
Optic 6 mm
Total 13 mm
Optic 6.15mm (6)
Total 10.75mm (11.4)
Difractive system Smooth Micro Phase EnLighten Convoluted
1Evaluation of loss in optical quality of multifocal intraocular lenses with glistenings. JCRS 2016
2 Lens epithelial cell growth on the anterior optic of 2 hydrophobic intraocular lens models. JCRS 2016
3Clinically Relevant Optical Properties of Bifocal, Trifocal, and Extended Depth of Focus Intraocular Lenses. JRS 2016
DR. ALVARO R. RATON LECTURE AT OVIEDO, EMYO 2016
22. LISA TRI / PANOPTIX / FINEVISION
BCVA 3 foci
(logMAR. Distance/Intermediate/Near)
0.00
0.05
0.10
0.15
0.20
0.25
0.30
0.35
6m 66cm 33cm
TRILISA
PANOPTIX
FINEVISION
*own data
DR. ALVARO R. RATON LECTURE AT OVIEDO, EMYO 2016
23. Defocus curve
LISA TRI / PANOPTIX / FINEVISION
0.00
0.10
0.20
0.30
0.40
0.50
0.60
-3.5 -3 -2.5 -2 -1.5 -1 -0.5 0 0.5 1
MediaTRI
Panoptix
Pod
*own data
DR. ALVARO R. RATON LECTURE AT OVIEDO, EMYO 2016
24. Monofocal control / LISA TRI / PANOPTIX / FINEVISION
Contrast Sensitivity Test
(Vistech, mesopic)
0.0
1.0
2.0
3.0
4.0
5.0
6.0
7.0
1 2 3 4 5
SA60AT
TRI LISA
Panoptix
Pod
*own data
DR. ALVARO R. RATON LECTURE AT OVIEDO, EMYO 2016
25. Photic phenomena
*own data: 10 patients/group: LISA - 2 eyes (1 patient) / PAN - 0 / F - 0
DR. ALVARO R. RATON LECTURE AT OVIEDO, EMYO 2016
26. Photic phenomena
208 eyes implanted TRISA TRI1
◦ 20% halo
◦ frecuent
◦ persistant
FINEVISION
◦ No Halo report 2,3
Comparative study4
1Evaluation of visual outcomes and patient satisfaction after implantation of a diffractive trifocal intraocular lens. JCRS 2016
2Visual outcomes after bilateral trifocal diffractive intraocular lens implantation. BMC Oph 2015
3Visual and refractive outcomes after implantation of a fully diffractive trifocal lens. Clin Ophthalmol. 2012
4Comparison of visual outcomes of 2 diffractive trifocal intraocular lenses. JCRS 2015
LISA TRIFINEVISION
DR. ALVARO R. RATON LECTURE AT OVIEDO, EMYO 2016
27. Difractive trifocal IOL
strength and weaknesses
Strength Weaknesses
Zeiss LISA TRI Optical performance Halos
Plate
Hydrophilic
Alcon PANOPTIX C-loop platform
Hydrophobic
Low near performance
Physiol FINEVISION Optical performance
Low Halo
Hydrophilic
DR. ALVARO R. RATON LECTURE AT OVIEDO, EMYO 2016
28. Conclusions
1. Wide portfolio of IOLs; shared constants (ULIB)
2. Toric IOL show great rotational stability despite of chosen platform
3. Multifocal IOL
◦ Refractive depend on pupil size and centration
◦ Difractive designs
◦ Bifocal – VARIABLE NEAR ADITION
◦ Trifocal – VARIABLE DESIGN AND PLATFORM
DR. ALVARO R. RATON LECTURE AT OVIEDO, EMYO 2016
It more difficult than ever to kkep updated in medicine
This resource may be useful to deal with unknown IOL as optimized constants are neccesary to obtain accurate refractive outcomes
Eyes with ATR astigmatism or long eyes aremore prone to rotate
Zeiss 1-12 TORBI (multifocal +1, +4)
Alcon 1.5-6
AMO 1.5-6
Finevision 1-6
Leave a gap
Sentido de bifocal es por la noche conducir bien o leer bien
Sentido de bifocal es por la noche conducir bien o leer bien
Ref 1: Mathematical modeling showed that glistenings in multifocal IOLs lead to a reduction in MTF of the IOL and the pseudophakic eye. The relative loss of MTF in multifocal IOLs was more significant than in monofocal IOLs because of the nature of the design.
Ref 2: Lens epithelial cell growth on the anterior optic of 2 hydrophobic intraocular lens models. Mas ACO en nueva acrysof respecto AMO