1. USAMA MOURIS BEBAWY, MB MBCh CLINICAL FELLOW, MCMASTER UNIV No Financial Disclosure GEORGE H.H. BEIKO, B.M.,B.Ch.,FRCSC ST. CATHARINES, CANADA ASSIST PROF, MCMASTER UNIV LECTURER, UNIV OF TORONTO Consultant to AMO Patient Satisfaction and Visual Performance After Bilateral Implantation of Multifocal IOLs: Prospective Study

2. Tecnis TM Multifocal Multicentre Trial - Evaluation Parameters Goal to enroll 250 patients to be bilaterally implanted with the Tecnis Multifocal IOL, at 25 sites Method: Pre and post-op patient qualitative questionnaires on freedom from glasses at different distances, and on dysphotopic phenomenom Pre and post-op surgeon qualitative and quantitative questionnaires on refraction and uncorrected visual acuity for Far, Intermediate and Near distance Assessments at pre-op, one and six months post-op

3. Patient Selection Criteria Male and female adult patients with presbyopia for which bilateral cataract surgery or clear lensectomy and posterior chamber IOL implantation is indicated. Good candidate for multifocal vision, i.e. motivated, desires spectacle independence and understands the trade-off of improved near vision to possible unwanted visual sensations. Visual potential of 20/25 or better in each eye after cataract extraction and IOL implantation. Patient dissatisfaction with their uncorrected or best corrected vision such that they desire surgery. Naturally dilated pupil size (in dim light) > 3.5 mm (with no dilation medications) for both eyes. IOL power available for both eyes being treated

4. Patient Exclusion Criteria Patients with history of prior refractive surgery. Patient has ocular or systemic disease, or ocular trauma that may confound the outcome; (e.g. uncontrolled diabetes mellitus, prior ocular surgery, recurrent inflammatory conditions, or macular degeneration). Capsule or zonular abnormalities that may affect postoperative centration or tilt of the lens (e.g. severe pseudoexfoliation syndrome, Marfan’s syndrome). Pupil abnormalities that prevent pupil from dilating at least 3.5 mm under mesopic/scotopic conditions. Patients with forme fruste keratoconus or keratoconus. Patients with visually significant macula or retina disease

5. Preliminary Results as of Oct. 1, 2010 # of surgeons participating in the trial: 15 G Beiko BM, BCh, FRCS(C)M Boileau MD, FRCS(C) C Ferremi MD, FRCS(C) M M Gagnon, MD, FRCS(C) L Lalonde MD, FRCS(C) C Menard, MD, FRCS(C) T Nagy, MD, FRCS(C)C Perreault MD, FRCS(C) S Shaver MD, FRCS(C) S Somai MD, FRCS(C)R Swieca MD, FRCS(C)Z Tadrous, MD, FRCS(C) E Tam MD, FRCS(C)B Teboul MD, FRCS(C)D Yan MD, FRCS(C) # of patients having completed pre-op questionnaire: 136 # of patients having completed 1 month post-op follow- up: 78 # of patients having completed 3 month post-op follow- up:63

6. Patient Profile: MyopesHyperopes Number6076 Age (yrs)61.67 +/- 8.8466.84 +/- 9.48 % Female61.6764.47 Photopic Pupil3.83 +/- 1.353.52 +/- 1.03 Mesopic Pupil3.99 +/- 1.433.65 +/- 1.10 Pre-op Refraction (D)-4.30 +/- 2.97+2.04 +/- 1.54 Target Refraction (D)+0.09 +/- 0.11+0.18 +/- 0.17 Results: MyopesHyperopes Target Refraction (D)+0.09 +/- 0.11+0.18 +/- 0.17 Achieved Refraction (D) 1 month 0.48 +/- 0.440.40 +/- 0.29 Achieved Refraction (D) 3 month 0.45 +/- 0.370.27 +/- 0.25

7. Vision, Both Eyes, Distance, Best Corrected:

8. Vision, Both Eyes, Intermediate, Best Distance Corrected:

9. Vision, Both Eyes, Near, Best Distance Corrected:

10. Patient Reading Distance Comfort: Very ComfortableVery Uncomfortable

11. Spectacle Independence: Almost AlwaysNever

12. Post-op target refraction was achieved and stable to 3 month visit Hyperopic patients tend to have better uncorrected and distance corrected VA for distance, intermediate and near Hyperopic patients have more comfortable reading vision and greater spectacle independence Canadian Tecnis TM Multifocal Multicentre Trial