3The Ideal Multifocal IOL Patient 50’s to the mid 60’sCataract starting to compromise quality of visionActive lifestyleConcerned about their appearance & ‘quality of life’Do not want to ‘get old’Spending on lifestyle enhancing proceduresRealistic ExpectationsMotivatedAsks lots of questions
14The 3.5 D add at the IOL plane provides for fairly good near vision
15Acrysof ReStor IOL (Alcon) Diffractive technologySilicone materialUses “apodization” to soften blur and sharpen visionProvides excellent VA at near, distance and intermediate ranges
16Strengths of the AcrySof ReSTOR IOL High quality uncorrected near and distance vision with 20/40 or better intermediate vision without movement of the IOL80% Overall Spectacle FreedomNearly 94% of patients would have the lens again
18The ReSTOR IOL is an IOL that provides significant magnification. Many patients spend 10 to 15 years gradually holding reading materials farther away. By the time a patient is 55 years old, with 55 to 60 years being the typical age range for presbyopic IOL exchange, the patient is holding reading materials at 14 to 20 inches away from his or her eyes.
19After ReSTOR IOL implantation set at +0. 25 D to +0 After ReSTOR IOL implantation set at D to +0.5 D, a patient has near vision of 9 to 10 inches.However, the ReSTOR IOL does not provide a significant increase in intermediate vision.
20Do We currently have any aspheric multifocal IOLs? Tecnis multifocal (AMO)Sofport AO (Bausch & Lomb)
21Haloes and glaare at night are common- these diminish with time Longer adaptation period – may take weeks or months for patients to accept their “new” visual systemNear vision may be fuzzy to myopesMay need reading specs for prolonged nearpoint work
23In the United States, a new category of intraocular lenses was opened with the approval by the Food and Drug Administration in 2003 of multifocal and accommodating lenses.The aim of the procedure is to allow the eye to focus on near as well as distant objects without regular need to use glasses. These lenses have areas of different refractive powers and allow both near and distant images to be focused on the retina simultaneously. The brain is then able to select the required image for attention.
25Adverse events problems with intermediate vision reduced contrast sensitivityhalosglare‘Vaseline vision’ / waxy visionreduced tolerance to astigmatism
26Clinicians wishing to undertake implantation of multifocal (non-accommodative) IOLs during cataract surgery should ensure that patients understand the risks of the procedure, including the possibilities of halo and glare, and reduced contrast sensitivity. Patients should also be made aware that the lenses may be difficult to remove or replace. They should be provided with clear written information.
27To incorporate the strengths of each type of IOL, some eye surgeons recommend using a multifocal IOL in one eye to emphasize close reading vision and an accommodating IOL in the other eye for further midrange vision. This is called "mix and match." Distance vision is not compromised with this approach, while near vision is optimized.
28The TECNIS® Multifocal IOL Spherical aberration correction to essentially zerochromatic aberration reductionA pupil-independent, full-diffractive posterior surfaceHigh-quality vision in all light conditions28
29TECNIS® Multifocal Acrylic IOL 13.0 mm overall diameterPosterior diffractive surface6.0 mm optic diameterFrosted, continuous 360° posterior square edgeTECNIS® IOL wavefront-designed aspheric surfacePosterior sideAnterior sideHaptics offset for 3 points of fixation29
30TECNIS® Multifocal 1-Piece IOL Specifications Tecnis Multifocal IOL Physician PresentationTECNIS® Multifocal 1-Piece IOL SpecificationsFull diffractive posterior surfacePupil-independentWavefront-designed aspheric anterior surfaceLight distribution 50/50Optical power add +4.0 DTo optimize acuity at preferred reading distance of 33 cm3030
31Important Safety Information Under low-contrast conditions, contrast sensitivity is reduced with a multifocal lens compared to a monofocal lens. Therefore, patients with multifocal lenses should exercise caution when driving at night or in poor visibility conditions.31
33Important Safety Information Precautions: The central one millimeter area of the lens creates a far image focus, therefore patients with abnormally small pupils (~1 mm) should achieve, at a minimum, the prescribed distance vision under photopic conditions; however, because this multifocal design has not been tested in patients with abnormally small pupils, it is unclear whether such patients will derive any near vision benefit.33
34Manual RefractionAutorefractors may not provide optimal postoperative refraction of multifocal patients; manual refraction is strongly recommended.
35Emmetropia should be targeted as this lens is designed for optimum visual performance when emmetropia is achieved. Care should be taken to achieve centration.
36Spherical Aberration Correction Correcting spherical aberration (SA) to zero results in sharper focus of light and therefore sharper vision at both near and distance.**TECNIS® Multifocal IOLReSTOR® +3.0 IOL36*In the average cataract patient
37Spherical Aberration Correction There is a measurable differenceAn IOL that fully corrects spherical aberration can provide a 13% increase in contrast over an IOL that leaves +0.1 residual spherical aberration37
38Combining Spherical and Chromatic Aberration Correction Several studies have shown the correction of chromatic aberration and spherical aberration together is more beneficial than the sum of the two individual corrections.38
39TECNIS® Multifocal IOL Full Diffractive vs. Apodized Diffractive Effect in Low Light ConditionsAs the pupil widens in mesopic conditions:TECNIS® Multifocal IOL is pupil-independent so light is still distributed equally to near and distance focal points, retaining high-quality near visionThe apodized design functions as a monofocal lens on the outer perimeter, therefore distributing more light to distance and degrading the quality of near visionTECNIS® Multifocal IOLReSTOR® +3.0 IOL39
40Rayner Intraocular Lenses Ltd The Rayner M-flex™Multifocal IOL
43M-flex™ is a multi-zoned, refractive, aspheric multifocal intraocular lens (MIOL) indicated for those patients requiring a degree ofpseudoaccommodation.
44M-flex™M-flex™ is a single-piece, hydrophilic acrylic injectable MIOLwhich can be considered to be the multifocal analogue of Superflex™, having an optic diameter of 6.25mm and an overall length of 12.50mm
45Good Optic DesignM-flex™ is based on multi-zoned refractive aspheric optics with either 4 or 5 refractive zones (depending on base power), providing an additional +3.0D of refractive power in the IOL plane, which isequivalent to +2.25D in the spectacle planeThe refractive zones around the central (1.75mm) distance zone areannular and alternate between distance and near focuswith a 60:40 split (Distance:Near)
47AVH™ Technology 10.5mm 10.0mm 9.5mm The outer haptics begin to take up thecompression due to capsular contractionProgressive resistance to the compressionforces is generated as the outer and innerhaptics engage1) The outer and inner haptics lock together2) The IOL assumes an oval configuration3) The haptic dynamics change, increasinghaptic rigidity and providing superiorcapsular stability10.5mm10.0mm9.5mm
48Note the perfectly symmetrical haptic compression
51Power options M-flex™ (630F) Sphere + 14.0D to D in 1.0D increments+ 18.0D to D in 0.5D incrementsPower addition+3.0D
52Patient Selection for Multifocal IOLs: Tecnis Multifocal IOL Physician PresentationPatient Selection for Multifocal IOLs:No contraindicationse.g., recurrent severe inflammation or uveitisBilateral implantationPostoperative astigmatism <0.75 DPostoperative emmetropia or max. <0.75 D hyperopiaPatient motivation (e.g., high diopter glasses, hyperopia, spectacle independence)Visual expectations of the patient5252
53Tecnis Multifocal IOL Physician Presentation Exclusion CriteriaMacular pathologies, glaucoma with severe visual field lossMonofocal IOL already in one eye (relative exclusion)Unrealistic visual expectationsHappy with reading glassesSurgical complications, such as capsulorhexis tear, capsular folds, fixation in sulcusPatient is at risk for developing PCO5353