2. Introduction
The MAST Study demonstrated that the
nanoFLEX (STAAR aspheric single piece
collamer iol) provided optimal vision at
intermediate and satisfactory at near
Intermediate (80cm) binocular DCVA = 20/24
Near (40cm) binocular DCVA = 20/50
Present study designed to evaluate how best to
utilize the intrinsic properties of the nanoFLEX
to optimize visual outcomes
3. All Lenses
Distance-Corrected Bilateral Average Near &
Intermediate VA
0
10
20
30
40
50
60
Near Intermediate
SnellenAcuity20/-
NanoFLEX (n=63)
AMO Tecnis
sililcone aspheric 3
piece iol (n=61)
20/50
20/24
20/28
20/52
p = 0.832
p = 0.072
4. Binocular VA at Near (40 cm): All Lenses
0%
10%
20%
30%
40%
50%
60%
70%
80%
90%
100%
20/40 or
Better
20/50 or
Better
20/63 or
Better
20/80 or
Better
32%
71%
95%
100%
46%
72%
79%
93%
%ofPatients
NanoFLEX (n=63)
AMO Tecnis sililcone aspheric 3
piece iol (n=61)
p = 0.006
p = 0.112
5. Binocular VA at Intermediate (80 cm): All
Lenses
0%
10%
20%
30%
40%
50%
60%
70%
80%
90%
100%
20/20 or Better 20/25 or Better 20/32 or Better 20/40 or Better
35%
79%
100% 100%
34%
74%
82%
93%
%ofPatients
NanoFLEX (n=63)
AMO Tecnis sililcone aspheric 3
piece iol (n=61)
p = <0.001
6. Purpose
To evaluate the visual outcomes of
patients undergoing routine cataract
surgery with phacoemulsification
followed by bilateral implantation of
aspheric (nanoFLEX) intraocular lenses
(IOLs) using blended vision.
7. Methods
Prospective evaluation of patients who had undergone
bilateral phacoemulsification with implantation of nanoFLEX
IOLs.
All patients with a DCVA 20/25 or better in each eye
underwent ETDRS testing under controlled lighting utilizing
the Functional Vision Analyzer (Stereo Optical) for binocular
UCDVA and UCNVA and repeated for the dominant eye.
MN Reading Cards were used to measure binocular UCNVA
and UCIVA and reading speed.
Patient satisfaction questionnaire administered
IRB approval obtained
8. Key Inclusion/Exclusion
Inclusion Criteria:
DCVA of 20/25 or better in both eyes
Spherical equivalent in the dominant eye to be
± 0.50 or less and in the nondominant eye
between -0.88 and -1.87 and cyl ± 0.75 both eyes
Exclusion Criteria:
No amblyopia or tropias or posterior capsular
opacification
All other ocular pathology allowed as long as DCVA
≤ 20/25 and no significant visual field loss
No LVC pre-op or post-op
9. Patient Baseline Characteristics
13 pts (ongoing study)
6 to 20 months post-op
69% male
Mean age 64 (52-73)
Pathology: dry eye, paracentral full thickness corneal
scar, ABMD, AMD
Post Operative Refractions (means)
Mean Spherical Equivalent
• Dominant = +0.02 D
• Non-dominant = -1.23 D
Mean Cylinder
• Dom = 0.44 D
• Non-dom = 0.42
Mean Corrected Distance Vision (BCDVA)
• Dom= 20/16.8
• Non-dom = 20/18.6
10. Binocular UCVA
0%
20%
40%
60%
80%
100%
20/15 or Better 20/20 or Better 20/25 or Better 20/32 or Better 20/50 or Better
15%
38%
69%
85%
100%
61%
92%
100%
54%
100%
%ofPatients
Near (40cm) Mean = 20/25
Intermediate (80cm) Mean = 20/16
Distance Mean = 20/19
12. Reading Speed
Reading Speed of at least 80 wpm:
○ The lower limit for comfortable recreational
reading (Radner, Richter-Mueksch, Rubin, West)
Maximum reading speed beyond
approximately 150 WPM is likely more a
measure of brain function than optical acuity
.4 LogMAR (20/50)
○ Reading speed at this print size commonly
reported because it is newspaper print size.
14. How Often do You Wear Glasses?
0%
10%
20%
30%
40%
50%
60%
70%
80%
Never/Almost Never Sometimes
55%
18%
27%
%ofPatients
73% Never or Almost Never
15. Patient Satisfaction with Near Vision
0.0
0.5
1.0
1.5
2.0
2.5
3.0
3.5
4.0
4.5
Reading
Newspapers
Computer Medicine
Bottles
Shaving/Doing
Make-up
Cooking/Sewing
3.4
3.6
2.5
4.0
3.5
Mean
Score
No
Difficulty
Extreme
Difficulty
4= Very good / 3= good / 2 = poor / 1 = very poor
16. Patient Satisfaction with Distance Vision
0.0
0.5
1.0
1.5
2.0
2.5
3.0
3.5
4.0
4.5
Day Driving Night Driving Difficult Weather
Driving
TV Out of home
activities
4.0
3.4 3.5
4.0
3.9
Mean
Score
4= Very good / 3= good / 2 = poor / 1 = very poor
No
Difficulty
Extreme
Difficulty
17. Stereopsis
Mean NC Far Stereo = 51 sec arc
Mean UC Far Stereo = 154 sec arc
Mean NC Near Stereo= 64 sec arc
Mean UC Near Stereo= 278 sec arc
○ Dropping 1 patient with abnormal near stereo with NC mean: 221
Visual Disturbance with Depth
Perception
Scale 0-4 (Severe to None) = 3.9
Stereopsis in other Pseudophakic Blended Vision Studies:
○ Zhang JCRS 3/11: Mean Near Stereopsis= 127
○ Finkelman JCRS 6/09 Mean Near Stereopsis=176
18. nanoFLEX Blended Vision
Patient Satisfaction
0%
10%
20%
30%
40%
50%
60%
70%
80%
90%
100%
Would recommend to family/friendsWould have blended vision again
100% 100%
% Patients
Responding
Positively
19. Patient Satisfaction
nanoFLEX
Blended
Vision
ReStor D1 Investigator
Vision without
Eyeglasses – Very
Good
100% Lipstock
Would have Blended
Vision Again
100% Lipstock
Would recommend BV
to Family/Friend
100% Lipstock
Would have the
Procedure Again
94%
Maxwell
JCRS 12/09
20. Extreme Difficulty
nanoFLEX ReStor D1 Crystalens
Night Vision 0% 2%* 2%***
Driving in
Difficult
Weather
0% 4%** -
* Maxwell JCRS 12/09
** Kohnen JCRS 12/09
*** FDA Crystalens Study
21. Conclusions
Blended Vision (moderate monovision)
with STAAR Collamer Monofocal one piece IOL (nanoFlex) offers:
Excellent distance acuity
Good reading acuity
Excellent intermediate reading acuity
Comfortable reading speed for newspaper print size
High rate of spectacle independence
Extremely high patient satisfaction
nanoFLEX Blended Vision can be offered to patients with pre-op
pathologies such as dry eye, ABMD and AMD – more importantly, unlike
multifocal iols, if new ocular pathologies occur over time BCVA can
always be obtained with eyeglasses
Pan-focal visual outcomes comparable to “premium IOLs”
Reduced Cost to Patient
Great option for patients who can’t afford “premium IOL” presbyopic
corrections
