Presentation on theme: "Advances in Intraocular lenses"— Presentation transcript:
1 Advances in Intraocular lenses Answers for PresbyopiaJim Simms, VP Refractive Products, Lenstec
2 Why Recommend an IOL for Presbyopia? ALL Clear Vision™Near, Far and in-between
3 You can help your patients with a new answer … Cataract and High Refractive Presbyopic Patients Juggle SpectaclesYou can help your patients with a new answer …The Tetraflex™Freedom from Spectacles
4 Why We Need Reading Glasses and Develop Cataracts The changes to our eyes usually follow apredictable course …Presbyopia develops in the 40sCataract formation is noticeable in the 60s
5 Our Eyes Change As We Age As our eye ages we may notice increased headlight glare when driving at night.The eye becomes lessefficient and can no longermake delicate adjustmentsand we lose the ability toaccommodate.As we age we will notice ourvision appears dim or blurry,and colors are not as brightor crisp.
6 What Are Cataracts? Symptoms Cloudy, fuzzy, or filmy vision Changes in the way we see colorsHeadlights seem too bright when driving at nightGlare from lamps or the sunDouble visionProgressive condition: natural lens becomes cloudy and eventually opaqueMost common cause is the aging processBy the age of 60 half the population develops the early stages of cataractAlmost everyone over the age of 70 will show some degree of cataract formationDevelop slowly in most people, gradual deterioration in vision becomes more noticeable over time
7 What Is Presbyopia?The inability of the eye to focus sharply on nearby objects
8 What is The Tetraflex™ and How Can it Help Your Patients? 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)The natural lens is removed frominside the eye and an IOL is putin its place.Lens surgery is a commonsurgical procedure performedon millions of patients annuallyWorldwide to treat cataractsMore patients and their doctorsare choosing Presbyopic IOL’s forRefractive corrections as analternative to LASIKThe Tetraflex™
9 Freedom from glasses for 95% of daily activities ALL Clear Vision™NearCloseIntermediateFarFreedom from glasses for 95% of daily activities
11 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.
12 Presbyopia: presby (old) + opia (vision) AgeAMP of ACCOM1011.00356.51510.25405.50209.50453.5258.50601.25307.50701.00Amplitude less than 5 DMyopesHyperopes380%17%23%67%4257%70%4475%92%82%100%Point where clear or comfortable vision at the desired nearpoint is not obtainableAmplitude of accommodation is less than 5 DAge of onset is variable, but the majority of patients will need near correction by age 45.
13 Presbyopic IOL 2 Patient Segments Traditional cataract patients who want more than mono-vision from cataract surgeryRefractive lens exchange patients who are too old for LASIK but too young for traditional cataract surgery
14 Presbyopic IOL Cataract Patient Lifestyle Profile Won’t settle for lessWorks hard to take advantage of today’s technological advancements: flat-screen plasma TV, home entertainment centers, satellite radio, high speed internetDo not settle for the “norm”; want advancements to reading glasses.Highest earning yearsNot a question of being able to afford the cost, but rather the perceived value is equal or greater than the feeIf properly informed about the potential benefits of Presbyopic IOL’s, these consumers will want them.
15 Presbyopic IOL Refractive Lens Exchange Patient Profile Middle aged segment of today’s populationToo old for LASIK and too young for cataract surgeryLooking for a superior alternative to reading glasses or bifocalsWant to maintain a higher quality of vision throughout their life, despite their age or refractive errorThis group has impressive outcomesNeed more than correction for presbyopia: myopia, hyperopia, or astigmatism.Have reduced vision due to compromised contrast sensitivity.Quality of vision is greatly improvedwith refractive lens exchange
17 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%
18 Why choose Refractive Lens Surgery? An IOL offers significant advantages over othertypes of refractive surgeryRemoval of the natural lens means a cataract will not develop as patient becomes olderMagnification is at the natural levelFull peripheral (side to side) visionAstigmatism can be addressedMinimal risk of glare and halosPermanent or replaceable solution to freedom from spectacles
19 Live... with less dependence on glasses... The Tetraflex™The next generationof IOL, designed tomimic the NaturalLens.THE COMBINEDEffect:Liner forward and Back MovementVaries by individual - analogy of a handshakeAggressive readersRadius of curvature changesSubjective abberometor/TRACEYLive... with less dependence on glasses...
20 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.
22 Specifications Simple-to-use lens Injectable via a 1.6mm cartridge Optic Size: mmOptic Type: EquiconvexLength: mmHaptic Style: TetraflexAngulation: DegreesConstruction: PiecePositioning Holes: 0Optic Material: Acrylic(26% Water Content)A Constant:A/C Depth:Diopter Increments:Whole: to +36.0Half: to to +30.00.2: to +25.0Simple-to-use lensInjectable via a 1.6mm cartridgeNo variation in surgeons standard phaco techniqueMinimal learning curveDoes not to require patients adopation of unnatural multi-focal duality
28 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.
29 Design Applied to Theory Designed with a unique anterior angulations, and patented 5˚ contoured hapticThe 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.
30 Evaluation Of The Tetraflex Presbyopic Accommodative IOL Using the iTrace Aberrometer We would like to describe for you the Refractive effects measured with the Tracey iTrace aberrometer and observed with the Tetraflex and Crystalens Accommodative IOLs.SOURCE: Donald R. Sanders, M.D., PhD., David C. Brown M.D., Deepak Chitkara, M.B., ChB. D.O.
31 Normal Accommodation 3D Refraction Map (Vertical) NEARDISTANCEDIFFERENCEThe map can be tilted a full 90° so that one can view the map vertically. When this is done it is easier to appreciate the range of refractive error encompassed in each map which may be a reasonable measure of depth of focus of the eye. We will look at each of these maps in greater detail.
32 Normal Accommodation 3D Refraction Map (Vertical) DISTANCEHyperopiaMean = +0.4DHere is the vertical 3D map of the patient viewing a distance target. In this view hyperopic corrections are on top of the graph, emmetropic corrections are in the middle and myopic corrections are on the bottom of the graph. In this case the patient has a mean refractive error of +0.40D and a refractive range of 1.2D when viewing a distant target.1.2DRefractiveRangeMyopia
33 Normal Accommodation 3D Refraction Map DIFFERENCEThe difference map (near minus distance) looks very similar to the near map showing that the change with accommodation results in induced myopia and an increased refractive range.Mean = -4.75D2.4D Refractive Range
34 With Normal Accommodation and Near Focus Refraction shifts to More MyopiaRefractive Range IncreasesThus with normal accommodation, the refraction map of the eye shifts to more myopia and an increased refractive range.
35 Monofocal IOL 3D Refraction Map NEARDISTANCEDIFFERENCEHere is a refraction map focusing on a distance and near target after implantation of a standard monofocal IOL. Note that the distance and near refraction maps look virtually identical with very little difference observed in the difference map.
36 Monofocal IOL 3D Refraction Map DIFFERENCENo Refractive DifferenceA close view of the difference map shows essentially no refractive difference and a small 0.6D refractive range.0.6DRefractiveRange
37 Tetraflex in Other Eye 3D Refraction Map NEARDISTANCEDIFFERENCEThe other eye of this patient with the monofocal IOL had a Tetraflex accommodative IOL implanted. We will go over the maps in detail but what is obvious is that relative to the distance map, the near and difference maps show a larger refractive range, largely due to more myopic refractions.
38 Tetraflex in Other Eye 3D Refraction Map DISTANCE+2.8D4.1DRefractiveRangeMean = +1.6DHere is the distance refraction map in this case. The mean refraction is +1.6D with a refractive range of 4.1D from the most hyperopic point to the most myopic point in the refraction map. The most myopic point is only -1.3D.-1.3D
39 Tetraflex in Other Eye 3D Refraction Map NEAR+3.8DMean = +1.1D8.6DRefractiveRangeHere is the near refraction map. The mean refraction is 1.1D, only 0.5D more myopic than the distance refraction. However the refractive range is over twice that of the distance map, and while the most myopic portion of the distance map was -1.3D, it is -4.8D in the near map.-4.8D
40 SummaryThe 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.
41 Global Users Panel ASCRS2005/Washington, D 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 he’s 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”
42 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”
44 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 patient’s 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 candlelightWith 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.
45 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 don’t use multi-focal lenses anymore at all.”
46 Patient Education is KEY Ensure they have new knowledge:Qualities of an ideal candidateRealistic expectations for most patientsRecovery timesPain and comfort issuesPossible risk and complicationsUnderstand entire process from workup thru postoperative recovery
47 Lenstec supportSkills/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
48 Lets us know how we can help you grow your practice, and better serve your patients THANK YOU!