1. Visual outcome & subjective visual symptoms of the Tecnis ZM900 multifocal intraocular lens in Asian eyes Dr Colin S.H. Tan MBBS, MMed (Ophth), FRCSEd (Ophth)

2. Co-investigators Dr Hung Ming Lee Dr Hung Ming Lee Dr Han Bor Fam Dr Han Bor Fam Dr Alex K.H. Lau Dr Alex K.H. Lau The authors have no financial or proprietary interests in the subject of this presentation

3. Outcomes of cataract surgery Patients expect: Patients expect: –Good functional vision & contrast sensitivity –Increasingly, good distance, intermediate & near vision There is a decrease in image quality with age, which has been attributed to increasing optical aberration There is a decrease in image quality with age, which has been attributed to increasing optical aberration An IOL designed to produce negative spherical aberration may theoretically compensate for the positive spherical aberration of the cornea, much like the crystalline lens in a young person. An IOL designed to produce negative spherical aberration may theoretically compensate for the positive spherical aberration of the cornea, much like the crystalline lens in a young person.

4. Tecnis multifocal intra-ocular lens (IOL) Advanced Medical Optics, Santa Ana, CA Advanced Medical Optics, Santa Ana, CA Based on Tecnis Z9000 IOL Based on Tecnis Z9000 IOL Wavefront designed, modified prolate anterior surface to produce negative spherical abberration Wavefront designed, modified prolate anterior surface to produce negative spherical abberration Diffractive multifocal optic to the posterior surface of the lens Diffractive multifocal optic to the posterior surface of the lens The IOL

5. Objective To evaluate the visual outcome, subjective visual symptoms and patient satisfaction in patients who had implantation of the Tecnis multifocal intraocular lens (IOL) To evaluate the visual outcome, subjective visual symptoms and patient satisfaction in patients who had implantation of the Tecnis multifocal intraocular lens (IOL)

6. Methods Retrospective clinical study Retrospective clinical study Main outcome measures: Main outcome measures: Distance and near visual acuities (VA)Distance and near visual acuities (VA) patient satisfaction with visionpatient satisfaction with vision visual symptomsvisual symptoms spectacles dependencespectacles dependence Parameters were assessed 6 months post- operatively Parameters were assessed 6 months post- operatively

7. Results 72 eyes 72 eyes Mean age: 62.6 yrs (range, 40 – 78) Mean age: 62.6 yrs (range, 40 – 78) Mean postop SE 0.11D (range, -1.00 to +1.00) Mean postop SE 0.11D (range, -1.00 to +1.00)

8. Distance VA

9. Distance & near VA * 100% had unaided near VA of N5

10. Patients’ satisfaction

11. Visual symptoms

12. Contrast sensitivity

13. Discussion Tecnis MF comparable to Array SA40 1 Tecnis MF comparable to Array SA40 1 Tecnis Z9000 (monofocal) had better distance VA and contrast compared to SI40 2 Tecnis Z9000 (monofocal) had better distance VA and contrast compared to SI40 2 Tecnis MF achieved better uncorrected and distance- corrected near vision vs. Array SA40 1 Tecnis MF achieved better uncorrected and distance- corrected near vision vs. Array SA40 1 82.6% reported total spectacle independence for near, compared to 100% for our study 82.6% reported total spectacle independence for near, compared to 100% for our study 1 Mester et al. JCRS 2007 2 Mester et al. JCRS 2002

14. Contrast sensitivity & visual symptoms Tecnis MF had similar photopic contrast sensitivity vs. Array SA40 1 Tecnis MF had similar photopic contrast sensitivity vs. Array SA40 1 Contrast sensitivity at 12 & 18 cpd higher under mesopic conditions Contrast sensitivity at 12 & 18 cpd higher under mesopic conditions 70% had mild to moderate glare; 43.3% had halos 70% had mild to moderate glare; 43.3% had halos Halos reported in 39% of patients with Tecnis ZM900 and in 39.1% - 58.3% of patients with Array SA40 1 Halos reported in 39% of patients with Tecnis ZM900 and in 39.1% - 58.3% of patients with Array SA40 1 1 Mester et al. JCRS 2007

15. Conclusion The Tecnis multifocal IOL achieves good distance and near vision with minimal visual symptoms in Asian eyes The Tecnis multifocal IOL achieves good distance and near vision with minimal visual symptoms in Asian eyes