Advances in Intraocular lenses Answers for Presbyopia Jim Simms, VP Refractive Products, Lenstec
Why Recommend an IOL for Presbyopia? ALL Clear Vision Near, Far and in-between
You can help your patients with a new answer … The Tetraflex Freedom from Spectacles Cataract and High Refractive Presbyopic Patients Juggle Spectacles
Why We Need Reading Glasses and Develop Cataracts The changes to our eyes usually follow a predictable course … Presbyopia develops in the 40s Cataract formation is noticeable in the 60s
Our Eyes Change As We Age The eye becomes less efficient and can no longer make delicate adjustments and we lose the ability to accommodate. As we age we will notice our vision appears dim or blurry, and colors are not as bright or crisp. As our eye ages we may notice increased headlight glare when driving at night.
What Are Cataracts? Progressive condition: natural lens becomes cloudy and eventually opaque Most common cause is the aging process By the age of 60 half the population develops the early stages of cataract Almost everyone over the age of 70 will show some degree of cataract formation Develop slowly in most people, gradual deterioration in vision becomes more noticeable over time Symptoms Cloudy, fuzzy, or filmy vision Changes in the way we see colors Headlights seem too bright when driving at night Glare from lamps or the sun Double vision
What Is Presbyopia? The inability of the eye to focus sharply on nearby objects
What is The Tetraflex and How Can it Help Your Patients? The natural lens is removed from inside the eye and an IOL is put in its place. Lens surgery is a common surgical procedure performed on millions of patients annually Worldwide to treat cataracts More patients and their doctors are choosing Presbyopic IOLs for Refractive corrections as an alternative to LASIK The Tetraflex Replacing the natural lens, and allows restoration of near, far, and intermediate vision after cataract surgery, and as an alternative for some patients considering refractive surgery (LASIK)
NearClose Far ALL Clear Vision ALL Clear Vision Freedom from glasses for 95% of daily activities Intermediate
Presbyopia is characterized by progressive age related loss of accommodative amplitude Begins early in life and culminates in a complete loss of accommodation by about 50 years of age. Most prevalent of all ocular afflictions eventually affects 100% of the population. Generally results in a need for a near spectacle correction or near addition lenses such as bifocal reading glasses.
Presbyopia: presby (old) + opia (vision) Age AMP of ACCOM Age AMP of ACCOM 1011.00356.5 1510.25405.50 209.50453.5 258.50601.25 307.50701.00 Age Amplitude less than 5 D MyopesHyperopes 380%17% 4023%67% 4257%70% 4475%92% 4582%100% Point where clear or comfortable vision at the desired nearpoint is not obtainable Amplitude of accommodation is less than 5 D Age of onset is variable, but the majority of patients will need near correction by age 45.
Presbyopic IOL 2 Patient Segments Traditional cataract patients who want more than mono-vision from cataract surgery Refractive lens exchange patients who are too old for LASIK but too young for traditional cataract surgery
Presbyopic IOL Cataract Patient Lifestyle Profile Wont settle for less Works hard to take advantage of todays technological advancements: flat-screen plasma TV, home entertainment centers, satellite radio, high speed internet Do not settle for the norm; want advancements to reading glasses. Highest earning years Not a question of being able to afford the cost, but rather the perceived value is equal or greater than the fee If properly informed about the potential benefits of Presbyopic IOLs, these consumers will want them.
Presbyopic IOL Refractive Lens Exchange Patient Profile Middle aged segment of todays population Too old for LASIK and too young for cataract surgery Looking for a superior alternative to reading glasses or bifocals Want to maintain a higher quality of vision throughout their life, despite their age or refractive error This group has impressive outcomes Need more than correction for presbyopia: myopia, hyperopia, or astigmatism. Have reduced vision due to compromised contrast sensitivity. Quality of vision is greatly improved with refractive lens exchange
SURGICAL OPTIONS FOR PRESBYOPIA Accommodative intraocular lens Multi-focal intraocular lens Scleral expansion procedures Multi-focal Lasik Radio Frequency Corneal Inlays Cataract Patients (Premium) & Refractive Surgery
Optometry Response to Presbyopic Treatment Options Source: Review of Optometry Which of the following surgical modalities do you believe holds the most promise for treating presbyopia? A. Multifocal laser ablations 5% B. Scleral expansion surgery 8% C. Multifocal IOLs 32% D. Accommodating IOLs 50% E. Corneal inlays 0%
Why choose Refractive Lens Surgery? An IOL offers significant advantages over other types of refractive surgery Removal of the natural lens means a cataract will not develop as patient becomes older Magnification is at the natural level Full peripheral (side to side) vision Astigmatism can be addressed Minimal risk of glare and halos Permanent or replaceable solution to freedom from spectacles
The next generation of IOL, designed to mimic the Natural Lens. THE COMBINED Effect: The Tetraflex Live... with less dependence on glasses... Liner forward and Back Movement Varies by individual - analogy of a handshake Aggressive readers Radius of curvature changes Subjective abberometor/TRACEY
The Tetraflex Promise The Tetraflex lens is designed to permanently provide excellent distance and intermediate vision along with useful reading vision. Activated by the natural accommodation process of the eye, the lens optimizes the optic for near, intermediate and far vision.
The Tetraflex Applied Theory of Accommodation Two forces are activated during accommodation: vitreous movement and ciliary muscle swelling. Both of these forces can move the optic forward and/or backward during accommodation.
The Tetraflex optic is designed to act as a sail, catching the wave of vitreous to provide maximum forward movement for near vision and return to the intended plane in the flat position for clear intermediate and distance vision. Design Applied to Theory Designed with a unique anterior angulations, and patented 5˚ contoured haptic
Evaluation Of The Tetraflex Presbyopic Accommodative IOL Using the iTrace Aberrometer SOURCE: Donald R. Sanders, M.D., PhD., David C. Brown M.D., Deepak Chitkara, M.B., ChB. D.O SOURCE: Donald R. Sanders, M.D., PhD., David C. Brown M.D., Deepak Chitkara, M.B., ChB. D.O.
Normal Accommodation 3D Refraction Map (Vertical) DIFFERENCE NEAR DISTANCE
DISTANCE Mean = +0.4D 1.2DRefractive Range Range Hyperopia Hyperopia Myopia
Normal Accommodation 3D Refraction Map DIFFERENCE Mean = -4.75D 2.4D Refractive Range
With Normal Accommodation and Near Focus - Refraction shifts to More Myopia - Refractive Range Increases
Monofocal IOL 3D Refraction Map DIFFERENCE NEAR DISTANCE
DIFFERENCE No Refractive Difference 0.6D Refractive RefractiveRange
Tetraflex in Other Eye 3D Refraction Map DIFFERENCE NEAR DISTANCE
DISTANCE Mean = +1.6D 4.1DRefractive Range Range +2.8D -1.3D
Tetraflex in Other Eye 3D Refraction Map NEAR Mean = +1.1D 8.6DRefractiveRange +3.8D -4.8D
Summary The Tetraflex Accommodative IOL is associated with a widened refractive range and more myopia with near fixation, which can explain the enhanced near acuity compared to monofocal IOLs.
Global Users Panel ASCRS2005/Washington, D.C Experience with The Tetraflex Sunil Shah: my father has had cataract surgery and this is the lens we put in. He is 20/25 in either eye, and hes about Jaeger 2 unaided Deepak Chitkara: almost 90% 0f patients are getting J3 or better Jorgé Alio: all of my patients are around J3 or J4 or better Jose Rincon: I have Jaeger 1 or better 10%; Jaeger 2 or better 20%; Jaeger 3 or better 60%, Jaeger 4 or better, 100%. Carlos Verges: very nice distance visual acuity; about 20/25; 20/20. And, the near vision acuity is about 20/40, J3/J4 now defined as near social vision acuity
Performance Comparison The Tetraflex vs. Multi-focal Deepak Chitkara: multi-focals have the fundamental issue, that they are an unnatural situation Jorgé Alio: with mulit-focals some patients are unhappy even with good near and far vision because probably their neuro-processing is not ready for multi-focality in every case Carlos Verges: with multi-focal lenses we have to balance between the effective near vision and the secondary problems due to halos, compromised visual quality, and other related problems
Candidates for refractive cataract surgery have high expectations Rosa Braga-Mele, MEd, MD, FRCSC; Hawaiian Eye 2006 A happy patient is better than achieving an arbitrary Snellen acuity value Understanding the patients personality is far more important that the medicine. Patient success : 10% medicine, 90% personality. Easygoing patients may be easier to please than those who are demanding and perfection-oriented. When determining IOL for refractive cataract patients: divide common activities into zones of vision. Zone 1 would include the most demanding of up-close activities, such as reading a drug label or a phone book and sewing. Zone 2 includes reading the newspaper or a menu and using the computer. Zone 3 includes activities such as watching TV, cooking and common household tasks. Zone 4 involves vision used during daylight hours, such as playing golf. Zone 5 includes the most demanding of scotopic vision, such as night driving or dim illumination such as candlelight With current technology, can effectively give patients about three continuous zones of vision: zones 1 to 3, zones 2 to 4, or zones 3 to 5. Multifocal IOLs tend to work better for zones 1 to 3, accommodating IOLs tend to work better for zones 2 to 4, and aspheric monofocal IOLs tend to work better in zones 3 to 5. Understanding which zones are most important to your patient is critical to achieve success with refractive cataract surgery.
GLOBAL VISION ADVANTAGE Near, Far and in-between … Clear Vision Carlos Verges: for me intermediate vision is critical for those people who work with computers, and they have to work with intermediate distance. In this case I think the Tetraflex lens is much better. Jorgé Alio: Tetraflex provides patients a near vision improvement, excellent far vision and intermediate vision, and no visual disturbance. Sunil Shah: I feel the Tetraflex is the best presbyopic lens at the moment and I dont use multi-focal lenses anymore at all.
Patient Education is KEY Ensure they have new knowledge: Qualities of an ideal candidate Realistic expectations for most patients Recovery times Pain and comfort issues Possible risk and complications Understand entire process from workup thru postoperative recovery
Lenstec support Skills/knowledge transfer to surgeon, staff, and referral network. Patient education materials: high image brochures, office posters, PowerPoint presentations for patient and referral education, web site with directory of global users (in development) – directing patients to you! Professional referral program development: education, high profile speakers at societies, regional symposia
Lets us know how we can help you grow your practice, and better serve your patients THANK YOU!