1. Intraocular Lens

2. IOL design IOL material – optic, haptic Ashperic IOL? Multifocal IOL?

3. One piece or three piece
One Piece design
- Easy to handle
Inverted S
ㄱ ㄴ
3 piece design
- stable in the bag
- sulcus fixation
- prone to haptic damage
- haptic malfunction

4. Biovue4 PAL
MI60 B&L
XL Stabi® Zeiss

5. Edge design

6. IOL design IOL material – optic, haptic Ashperic IOL? Multifocal IOL?

7. IOL material PMMA : polymethylmethacrylate Silicone
Acrylic(Hydrophilic, -phobic)
PMMA는 공군 canopy의 재질로 다쳐서 눈에 들어간 사람에게서 이상이 없었기 때문..

8. PMMA : polymethylmethacrylate
Rigid, hard, strong material
Used since 1949
Light durable c specific gravity 1.19
Inert and minimal inflammatory reaction
YAG may damage to PMMA optic
1) hard & rigid (기계적 자극)
2) hydrophobic: endothelium contact → corneal damage
3) large incision 필요
CZ70BD-Alcon

9. Silicone Elastomers Inert and stable at high T, flexible, elastic
No tissue adherence-> unstable fixation
Low refractive index -> thick!
But silicone oil..
Inflammation, pseudoexfoliation, diabetes..
-> acrylic IOL
유연하고 형상기억성이 좋고 biocompatibility가 좋다. Tissue 달라붙지 않는다. 그러나..
달라붙지 않으면
Silicone oil이 들러붙을 수 있다.

10. Hydrophobic Acrylic Negligible water content Less PCO than silicone
Increased flexiblity at typical OR temp.
Glass transition temp.
PMMA: 105℃ Hydrophobic Acrylic: 10-20℃
YA60BB, VA60BB- HOYA Acrysof IQ-Alcon

11. Hydrophilic Acrylic High water content Very soft more PCO
Biovue3 - OII

12. Loop and Haptic Materials
PMMA
Polyamide(nylon) : hydrolysis..
Polyethyleneglycolterephthalate
Dacron : hydrophobic
Polypropylene
Polyimide ( heat sterilized)
Nylon은 hydrolysis되면서 약해 질 수 있는 단점이 있다.
Dacron은 hydrophobic해서 hydrolysis되지는 않으나 less elastic해서 많이 쓰이진 않는다.
Polypropylene이 많이 쓰인다.
안정적이나 complemet를 증가시켜 inflammatory cell을 attract한다.

13. IOL design IOL material – optic, haptic Ashperic IOL? Multifocal IOL?

14. reduced contrast sensitivity or visual function
Spherical Aberration
reduced contrast sensitivity or visual function

15. Spherical IOLs AcrySof (+20D) Silicone (+20D)
The thicker the lens, The greater the potential for spherical aberration to occur Low contrast sensitivity Poor night vision

16. Spherical IOL Vs Aspheric IOL
Cornea
Aspheric IOL
Retina
Light Rays
Spherical IOL
Light Rays
Retina
Cornea

17. Better contrast sensitivity and VA
centeration and tilting..

18. AcrySof IQ (SN60WF) Hydrophobic Acrylic Single-Piece Design
Posterior Aspheric Curvature
Natural Chromophore

19. TECNIS Acrylic IOL 3-piece foldable, UV-blocking hydrophobic acrylic
Patented OptiEdge™ design
Blue, Modified C PMMA haptics
Anterior aspheric design

20. Biovue4 PAL - OII Material : acrylic Overall diameter : 11.0mm
Optic diameter: 6mm
A constant: 118.4
Refractive index : 1.46

21. IOL design IOL material – optic, haptic Ashperic IOL? Multifocal IOL?

22. Human Crystaline Lens A. Distance Observation
Near Power Forms
In-Focus Image on Retina
C. Near Observation
A. Distance Observation
Distance Power Forms
an In-Focus Image On Retina.
B. Intermediate Observation
Intermediate Power Forms

23. Monofocal IOLs Distance image Forms an In-Focus Image On Retina.
Intermediate image Forms
Out-of-focus image on Retina;
A. Distance Observation
Distance image Forms
an In-Focus Image On Retina.
B. Intermediate Observation
C. Near Observation
Near image Forms
Only one focus point usually for distance
Only distance is clear
Manual Camera with only one focus point
Relies on Spectacles for near
Alternative choice: Multifocal

24. Multifocal IOL

25. Optical Principles of Multifocal IOLs
Refractive multizonal design
Refractive power changes from center to periphery of lens ( Bending light )
2 or 3 focus points. Near, Intermediate and Distance
Array, Rezoom(Array II)
Diffractive design
Two primary focal points
One focus by diffraction at an interference grid
( Spreading light )
One focus by refractive base power of the lens
3M , Restor, Aspheri Technis

26. Refractive Multizonal Multifocal Lens
3 focus

27. 2 focus

28. Optical Principles of IOLs
monofocal
far focus
diffractive
near focus
far focus
refractive

29. Concerns with multifocal IOLs
Poor contrast sensitivity
Introduce asphericity into MFIOLs
Tecnis : modified Prolate Anterior Surface
ReZoom: aspherize zone 3
Dysphotopsia
Halos and glare
Redistribute near/intermediate and far in mesopic conditions (refractive IOLs) to reduce haloes
Improve edge design to reduce glare

30. Halos, Glare and reduced contrast sensitivity
A multifocal IOL always produces a sharp and a blurred image, due to the multiple focal points
A blurred light surface causes halos or glare
This is independent of a refractive or diffractive design
Blurred image and reduced light intensity for given focal point results in reduced contrast sesitivity
Add
(range of foci)
Distance Power Forms
an In-Focus Image On Retina.
Near Power Forms
a Weak, Out-of-Focus Image
Of Distant Object On Retina.

31. The Multifocal IOL: Refractive Error and Blur Circles
Myopic Post-Op Refraction
distance and near blur circles large (compared to emmetropia)
potential halos at night
Blur Circle from Add Portion
(cross-hatched circle; large but faint) .
Add
(range of foci)
Blur Circle from Distance Portion
(solid circle; small but intense)
Recommended Refraction: Emmetropic to Slightly Hyperopic
clearly reduced near blur circle size (compared to myopic)
minimal halos at night
minor defocus at distance
Blur Circle from Add Portion
(cross-hatched circle) .
Add
(range of foci)
Blur Circle from Distance Portion
(solid circle)
Hyperopic Post-Op Refraction
near-equal size distance and near blur circles
minimal halos at night
however, distance blur and less useable near range
Add
(range of foci)
Blur Circle from Add Portion
(cross-hatched circle, inner)
Blur Circle from Distance Portion
(solid circle)

32. Multifocal IOL
Array- ReZoom
Restor
Technis-multi

33. ReZoom™ Hydrophobic acrylic material Features Balanced View Optics
Patented OptiEdge™ triple edge PC IOL design
Three-piece design
PMMA capsule fit haptics
6.0 mm optic, 13 mm IOL

34. ReZoom – Refractive multifocal
Zones proportioned to provide good visual function across a range of distances in varying light conditions.
Five concentric refractive zones create true multifocal vision
Zones 1, 3 and 5 are distance dominant
Zones 2 and 4 are near dominant
Aspheric transition between zones provides balanced intermediate vision
Near-dominant zones provide +3.5 D near add power at the IOL plane
Provides near add greater than the 2.0 D needed by most adults over 50*

35. Strengths and Limitations of ReZoom™ IOL
Very good distance vision; similar to monofocal lens at small pupil size
Good intermediate vision
Good spectacle independence
Limitations
Spectacles sometimes needed for prolonged reading or small prints

36. Restor SN60D3 Material : acrylic Optic Diameter: 6.0mm
Optic Type: Apodized diffractive Optic
Diffractive Power:+4.0 add at lens plane,
(equal to +3.2 at spectacle plane)
Haptic: 0 degree, Modified L
(STABLEFORCE®)
A-Constant: for a-scan
118-5 for IOL Master
(recommend SRK-T, Hagis, Holliday 2)
Refractive Index: 1.55
Diopter Range: 7.0 to diopter
(0.5D increments)
Filtration: UV and blue light

37. Central 3.6 mm apodized diffractive
AcrySof ReSTOR IOL
Step heights decrease peripherally from 1.3 – 0.2 microns
A +4.0 add at lens plane equaling +3.2 at spectacle plane
Central 3.6 mm apodized diffractive
structure
Provides a full
range of vision

38. Apodized Diffractive Optic
Precise reduction in diffractive step heights from center to periphery of 3.6 mm diameter diffractive region
steps reduce from 1.3 to 0.2 microns
larger steps direct more light to near at center
smaller steps direct more light to distance at edge
gradual energy blend between powers
Unique to AcrySof® ReSTOR® IOL
1.3 micron
step
1.5 mm
Original magnification 80 X

39. Apodized Diffractive Optic
Apodized diffractive structure blends into peripheral refractive region
Gradually emphasizes energy going to distance vision with larger pupil sizes
Nighttime visual disturbances minimized by directing more light to distance when pupils are larger
Near vision image quality enhanced by ReSTOR® apodized design
3.6 mm
Blending to a point where the step heights blend to a refractive lens

40. TECNIS ZM900 Multifocal IOL
Full diffractive posterior surface
Modified prolate anterior surface
Light distribution 50/50
+5D to +34D in 0.5D increments
Sharp optic edge
Approved for distribution outside the US 18 Feb, Revised 01 Mar, 2005.

41. TECNIS ZM900 Multifocal IOL
3-piece IOL
Modified prolate anterior surface
UV-absorbing high refractive silicone with cut-off at 392 – 394 nm
Total diameter 12 mm
Optic diameter 6 mm
Sharp optic edge
Refractive index: 37°C
Haptic: PVDF; 6° angulation, Cap-C
Near add: +4 D
Available diopter range: +5 to +34 D
A-constant 119.0; ACD: 5.55 mm
Approved for distribution outside the US 18 Feb, Revised 01 Mar, 2005.

42. The “Right” Patient
The ideal patient - Cataract Patients (Not good vision at all) Presbyopic patients (PRELEX) - Hyperopes - High Myopes - Emmetropes, Mild Myopes Refractive lens exchange patients (RELEX)
More
Ideal Patients

43. Not “Right” patients Emmetropes and Mild Myopes Ocular defects
Good distance and near vision
Ocular defects
corneal scarring, retinal diseases
Uncorrectable post-op astigmatism
Having monofocal IOL in fellow eye
Patients with high expectations and high visual demands
Patients who are content with reading glasses
Less than optimal capsular support
( Zonulysis, PCR or decentered capsulorhexis)

44. Accomodative IOL
Crystalens
1CU