evaluation of the tetraflex and crystalens accommodative iols using the itrace aberrometer donald r....

Evaluation Of TheEvaluation Of The Tetraflex Tetraflex and Crystalens and Crystalens

Accommodative IOLs Using the Accommodative IOLs Using the iTrace AberrometeriTrace Aberrometer

Donald R. Sanders, M.D., PhD.Donald R. Sanders, M.D., PhD.David C. Brown M.D.David C. Brown M.D.

Deepak Chitkara, M.B., ChB. D.O.Deepak Chitkara, M.B., ChB. D.O.

DIFFERENCEDIFFERENCE

Normal Accommodation – 30 Y/ONormal Accommodation – 30 Y/O Refraction MapRefraction Map

NEARNEARDISTANCEDISTANCE NEARNEAR

Normal Accommodation Normal Accommodation 3D Refraction Map (Tilted)3D Refraction Map (Tilted)

DIFFERENCEDIFFERENCE

NEARNEARDISTANCEDISTANCE

Normal Accommodation Normal Accommodation 3D Refraction Map (Vertical)3D Refraction Map (Vertical)

DIFFERENCEDIFFERENCE

NEARNEARDISTANCEDISTANCE

Normal Accommodation Normal Accommodation 3D Refraction Map (Vertical)3D Refraction Map (Vertical)

DISTANCEDISTANCE

Mean = +0.4DMean = +0.4D

1.2D 1.2D RefractiveRefractive

RangeRange

HyperopiaHyperopia

MyopiaMyopia

Normal Accommodation Normal Accommodation 3D Refraction Map (Vertical)3D Refraction Map (Vertical)

NEARNEAR

Mean = -4.2DMean = -4.2D3.5D 3.5D Refractive Refractive

RangeRange

Normal Accommodation Normal Accommodation 3D Refraction Map (Vertical)3D Refraction Map (Vertical)

DIFFERENCEDIFFERENCE

Mean = -4.75DMean = -4.75D

2.4D Refractive Range2.4D Refractive Range

With Normal Accommodation With Normal Accommodation and Near Focusand Near Focus

- Refraction shifts to More MyopiaRefraction shifts to More Myopia

- Refractive Range IncreasesRefractive Range Increases

Monofocal IOL Monofocal IOL 3D Refraction Map (Vertical)3D Refraction Map (Vertical)

DIFFERENCEDIFFERENCE

NEARNEARDISTANCEDISTANCE

Monofocal IOL Monofocal IOL 3D Refraction Map (Vertical)3D Refraction Map (Vertical)

DIFFERENCEDIFFERENCE

No Refractive No Refractive DifferenceDifference

0.6D0.6D Refractive Refractive

RangeRange

MONOFOCALMONOFOCALPSF @ 33 cm.PSF @ 33 cm.

DISTANCEDISTANCEACCOMMODATIVE ACCOMMODATIVE

EFFORTEFFORT

NO DIFFERENCE IN PSFNO DIFFERENCE IN PSF

MONOFOCALMONOFOCALImage SimulationImage Simulation

View @ 33 cm.View @ 33 cm.

DISTANCEDISTANCEACCOMMODATIVE ACCOMMODATIVE

EFFORTEFFORT

NO DIFFERENCE IN IMAGENO DIFFERENCE IN IMAGE

Pupil Size Same for Distance & NearPupil Size Same for Distance & Near

DIFFERENCEDIFFERENCE

NEARNEARDISTANCEDISTANCE

Pupil Size Same for Distance & NearPupil Size Same for Distance & Near

DIFFERENCEDIFFERENCE

NEARNEARDISTANCEDISTANCE

Tetraflex in Other Eye Tetraflex in Other Eye 3D Refraction Map3D Refraction Map

DIFFERENCEDIFFERENCE

NEARNEARDISTANCEDISTANCE

Tetraflex in Other Eye Tetraflex in Other Eye 3D Refraction Map3D Refraction Map

DISTANCEDISTANCE

Mean = +1.6DMean = +1.6D4.1D 4.1D RefractiveRefractive

RangeRange

+2.8D+2.8D

-1.3D-1.3D

Tetraflex in Other Eye Tetraflex in Other Eye 3D Refraction Map3D Refraction Map

NEARNEAR

Mean = +1.1DMean = +1.1D

8.6D 8.6D Refractive Refractive

RangeRange

+3.8D+3.8D

-4.8D-4.8D

Tetraflex in Other Eye Tetraflex in Other Eye 3D Refraction Map3D Refraction Map

DIFFERENCEDIFFERENCE

Mean = -0.4DMean = -0.4D5.5D 5.5D RefractiveRefractive

RangeRange

+1.1D+1.1D

-4.5D-4.5D

TETRAFLEXTETRAFLEXPSF @ 33 cm.PSF @ 33 cm.

DISTANCEDISTANCEACCOMMODATIVE ACCOMMODATIVE

EFFORTEFFORT

SUBSTANTIAL CHANGE IN PSFSUBSTANTIAL CHANGE IN PSF

TETRAFLEXTETRAFLEXImage SimulationImage Simulation

View @ 33 cm.View @ 33 cm.

DISTANCEDISTANCEACCOMMODATIVE ACCOMMODATIVE

EFFORTEFFORT

SUBSTANTIAL IMPROVEMENT IN NEARSUBSTANTIAL IMPROVEMENT IN NEAR

Tetraflex Accommodative IOL Tetraflex Accommodative IOL 3D Refraction Map3D Refraction Map

DIFFERENCEDIFFERENCE

NEARNEARDISTANCEDISTANCE

Tetraflex Accommodative IOL Tetraflex Accommodative IOL 3D Refraction Map3D Refraction Map

DISTANCEDISTANCE

Mean =+1.3DMean =+1.3D1.9D 1.9D

RefractiveRefractive RangeRange

2.1D2.1D

0.2D0.2D

Tetraflex Accommodative IOL Tetraflex Accommodative IOL 3D Refraction Map3D Refraction Map

NEARNEAR

Mean = +1.2DMean = +1.2D5D 5D RefractiveRefractive

RangeRange

2.6D2.6D

-2.4D-2.4D

Tetraflex Accommodative IOL Tetraflex Accommodative IOL 3D Refraction Map3D Refraction Map

DIFFERENCEDIFFERENCE

Mean = 0.1DMean = 0.1D4.2D 4.2D

Refractive Refractive RangeRange

1.4D1.4D

-2.8D-2.8D

Tetraflex Accommodative IOL Tetraflex Accommodative IOL 3D Refraction Map3D Refraction Map

DIFFERENCEDIFFERENCE

NEARNEARDISTANCEDISTANCE

-3.8D-3.8D-5.5D-5.5D

-5.2D-5.2D

Widened Widened Refractive Range Refractive Range and More Myopia and More Myopia at Near and in at Near and in Difference MapDifference Map

Tetraflex Accommodative IOL Tetraflex Accommodative IOL 3D Refraction Map3D Refraction Map

DIFFERENCEDIFFERENCE

NEARNEARDISTANCEDISTANCE

-3.5D-3.5D

-5.2D-5.2D

-3.1D-3.1D

Widened Widened Refractive Range Refractive Range and More Myopia and More Myopia at Near and in at Near and in Difference MapDifference Map

Tetraflex Accommodative IOL Tetraflex Accommodative IOL 3D Refraction Map3D Refraction Map

DIFFERENCEDIFFERENCE

NEARNEARDISTANCEDISTANCE

-0.6D-0.6D

-1.4D-1.4D

-2.1D-2.1D

Widened Widened Refractive Range Refractive Range and More Myopia and More Myopia at Near and in at Near and in Difference MapDifference Map

SummarySummary

The Tetraflex Accommodative The Tetraflex Accommodative IOL is associated with a widened IOL is associated with a widened refractive range and more myopia refractive range and more myopia with near fixation, which can with near fixation, which can explain the enhanced near acuity explain the enhanced near acuity compared to monofocal IOLs. compared to monofocal IOLs.

Patient AB – OD CrystalensPatient AB – OD Crystalens3D Refraction Map3D Refraction Map

DIFFERENCEDIFFERENCE

NEARNEARDISTANCEDISTANCE

-3.5D-3.5D

-3.5D-3.5D

Patient GB – OD CrystalensPatient GB – OD Crystalens3D Refraction Map3D Refraction Map

DIFFERENCEDIFFERENCE

NEARNEARDISTANCEDISTANCE

-2.3D-2.3D

Patient GB – OS CrystalensPatient GB – OS Crystalens3D Refraction Map3D Refraction Map

DIFFERENCEDIFFERENCE

NEARNEARDISTANCEDISTANCE

Patient RC – OD CrystalensPatient RC – OD Crystalens3D Refraction Map3D Refraction Map

DIFFERENCEDIFFERENCE

NEARNEARDISTANCEDISTANCE

-2.3D-2.3D

-2.8D-2.8D

Patient DB – OD CrystalensPatient DB – OD Crystalens3D Refraction Map3D Refraction Map

DIFFERENCEDIFFERENCE

NEARNEARDISTANCEDISTANCE

Patient DB – OS CrystalensPatient DB – OS Crystalens3D Refraction Map3D Refraction Map

DIFFERENCEDIFFERENCE

NEARNEARDISTANCEDISTANCE

Patient GF – OD CrystalensPatient GF – OD Crystalens3D Refraction Map3D Refraction Map

DIFFERENCEDIFFERENCE

NEARNEARDISTANCEDISTANCE

-1.3D-1.3D

-1.4D-1.4D

Patient PS – OS CrystalensPatient PS – OS Crystalens3D Refraction Map3D Refraction Map

DIFFERENCEDIFFERENCE

NEARNEARDISTANCEDISTANCE

-2.5D-2.5D

Patient ER – OD CrystalensPatient ER – OD Crystalens3D Refraction Map3D Refraction Map

DIFFERENCEDIFFERENCE

NEARNEARDISTANCEDISTANCE

Patient ER – OS CrystalensPatient ER – OS Crystalens3D Refraction Map3D Refraction Map

DIFFERENCEDIFFERENCE

NEARNEARDISTANCEDISTANCE

Patient BV – OD CrystalensPatient BV – OD Crystalens3D Refraction Map3D Refraction Map

DIFFERENCEDIFFERENCE

NEARNEARDISTANCEDISTANCE

Patient MA – OS CrystalensPatient MA – OS Crystalens3D Refraction Map3D Refraction Map

DIFFERENCEDIFFERENCE

NEARNEARDISTANCEDISTANCE

SummarySummary

The Crystalens Accommodative The Crystalens Accommodative IOL is associated with a widened IOL is associated with a widened refractive range and more myopia refractive range and more myopia with near fixation in some cases. with near fixation in some cases. In others no clear accommodative In others no clear accommodative effect is obvious effect is obvious