1. Disclosure of finanacial interest * Author has no financial interest in this paper. ** Author's research is partially funded by Imperial Medical Technologies Cartersville GA, USA who produced, developed and supplied the product presented. Slimming diet for a Multifocal IOL Peculiarities of Models Micro-Incision vs. Modified “C” Slimming diet for a Multifocal IOL Peculiarities of Models Micro-Incision vs. Modified “C” G. Gallo M.D.* G. Rubiolini M.D.** Italy www.grvision.com

2. The Micro-Incision Phaco procedure is widely becoming the “Standard” for Cataract surgery. This means ALL Multifocal IOLs “Diffractive” & “Refractive” must be injected with a <2.2mm Corneal Tunnel. Due to their “Optical Geometry” Diffractive lenses have dominated because Modified “C” lenses can have problems with cartridges of <2.75mm. - PURPOSE -

3. Contd. Contd. Can a new Refractive, “Progressive” Multifocal, Micro-Incision Plate style IOL using new “Optical Geometry” be implanted using a <2.2mm tunnel and be as successful as a Modified “C” IOL using a 2.75mm corneal tunnel ?

4. - MATERIALS AND METHODS - HP60CM – Hydrophilic Progressive – Multifocal Mod. “C” with “Refractive” optics. Mod. “C” with “Refractive” optics. HP60CM – Hydrophilic Progressive – Multifocal Micro-Incision with “Refractive” optics. Micro-Incision with “Refractive” optics. IOL CHARACTERISTICS Mod “C” Optic: 6.00mm Total Length: 12.00mm AC - Depth: 5.30mm A - Constant: 118.4 Suggest Formula: SRK/T Micro Plate: 6.00mm Total Length: 11.00mm AC - Depth: 5.30mm A - Constant: 118.4 Suggest Formula: SRK/T

5. PRESBIOPTICx TM by Imperial Medical, Cartersville, GA USA. The characteristic absence of lines is an IMT - Patent Pend. THE IMT SOLUTION - NO LINES

6. EMPLOYING “THREE DIMENTIONAL CLOTHOID CURVE” TECHNOLOGY Engineers reduced the thickness of the optic disc. Eliminated areas for Halos & Glare. Maintained the visual outcomes of the Mod “C” version. Patent Pend.

7. IMT’s Slimming Diet PRESBIOPTICx Micro Incision PRESBIOPTICx Modified “C”

8. - IMPLANT STRATEGY - Progressive addition of multifocality with the customized option with the with the customized option with the second IOL implant. second IOL implant. First lens Implanted – If emmetropia & First lens Implanted – If emmetropia & near vision achieved the second lens is near vision achieved the second lens is identical or… identical or… First lens implanted – If near vision is First lens implanted – If near vision is not achieved the second lens can easily not achieved the second lens can easily correct the problem. correct the problem.

9. -MODIFIED “C”- VS. -MICRO INCISION- 35 Patients - 20F & 15M Avg. 56yrs. Bilateral Progressive Multi-Focal IOL implants with a non-linear reading add from +3.6D to +4.5D (Progressive) during surgery. PRESBIOPTICx C-LOOP by IMT. Exclusion criteria included but not limited to astigmatism >1D, dia- betic retinopathy, maculopathy & previous ocular surgery. 17 patients - 8F & 9M Avg. 52yrs. Bilateral Progressive Multi-Focal IOL implants with a non-linear reading add from +3.6D to +4.0D (Progressive) during surgery. PRESBIOPTICx Micro by IMT Exclusion criteria included but not limited to astigmatism >1D, dia- betic retinopathy, maculopathy & previous ocular surgery.

10. -MODIFIED “C”- VS. -MICRO INCISION- Total freedom from glasses 28 patients (>80%) w/ two similar near addition implants. 5 patients received an extra 0.30D addition for the 2 nd eye Total – 33 (95%) achieved J2 best uncorrected near visual acuity with bilateral vision. 100% of the patients achieved 20/25 or better uncorrected visual acuity for distance. 2 Patients (60-90days) complained some temporary night vision problems such as glare, halos and sparkles (5,7%). Total freedom from glasses 15 patients (>88%) w/ two similar near addition implants. 2 patients received an extra 0.20D addition for the 2 nd eye. Total – 17 (100%) achieved J2 best uncorrected near visual acuity with bilateral vision. 100% of the patients achieved 20/25 or better uncorrected visual acuity for distance. 2 Patients (30-60days) complained some temporary night vision problems such as glare, halos and sparkles (11,7%).

12. RESULTS MODIFIED “C” MICRO INCISION >2.75mm CORNEAL TUNNEL <2.2mm Excellent NEAR VISUAL ACUITY Excellent Excellent DISTANT VISUAL ACUITY Excellent 5.7% 75days TEMPORARY HALOS & GLARE 11.7% 45 days

13. - CONCLUSION - The Micro-Incision version (HP60PM) of the IMT HP60CM, “Progressive” Refractive Multifocal IOL provides an excellent visual acuity for distance & near and it can be customized in the 2 nd eye to achieve a full range of vision. Full range of vision can be achieved in 100% of the cases. <2,2mm corneal tunnel can be successfully used for this IOL due to a slimming diet from the original Mod-C version IOL.

14. Thank You

15. 2.75mm 1.9mm Modified-C Micro Incision 2.75mm 1.9mm Modified-C Micro Incision