slide deck for cope course 10 11 2010

AcrySof® IQ Toric IOL

AcrySof® IQ Toric

Astigmatism IOL


Blurred Vision• It’s not what you always think!

• Donny Reeves, M.D.

• The Reeves Eye Institute

• C.O.P.E. # 29494-PO


Perception is different than reality………..


De Lejos Estan Todas Buenas• English literal translation:

• By far(distance) it’s all good!


Financial Disclosures• Alcon Laboratories, Consultant

• Bausch and Lomb, Consultant

• Allergan Inc, Speaker’s Bureau

• Abbott Medical Optics, Investigator


Toric Intraocular LensesWhy should you incorporate them into your practice?


We have to meet or exceed our patients demands for excellent vision

Knowing what is available and how to use it is critical to your practice success

• Cataract surgery is your patients opportunity to enhance their vision lifestyle

• Astigmatism and premium IOLs are available to meet these expectations.


The Question now is….

• Why is it in life that you would never give glasses without correcting the patients astigmatism, but when I do cataract (now) surgery I don’t fix it?


How do we treat it?

So What About Astigmatism?

Vision without astigmatism

Vision with astigmatism 1.5D cyl @ 90 Vision with astigmatism 3.0D cyl @ 90


No astigmatism 1.0 D astigmatism 2.0 D astigmatism

Quality of vision is deteriorated considerably by astigmatism



›Newest monofocal IOL builds on long line of innovation from Alcon

›Takes the trusted platform for precise astigmatism correction and adds the enhanced image quality of an aspheric lens


AcrySof® IQ Toric IOL Specifications


AcrySof® IQ Toric BenefitsOffers combined advantages of toricity and asphericity.

Toricity›Rotational stability›Reduction of residual refractive cylinder›Increased spectacle-independent distance vision ›Wide range of cylinder powers

Asphericity›Enhanced image quality

›Reduction in spherical and total higher order aberrations›Increased contrast sensitivity›Improved functional vision

›Thinner edge profile


Precise Astigmatism Correction

AcrySof® IQ Toric IOL offers cataract surgery patients with astigmatism:

›Reduction of residual refractive cylinder

›Improved uncorrected distance visual acuity

›Increased spectacle-independent distance vision


Reduction of Residual Refractive Cylinder

›63% of patients achieved ≤0.50 diopters of residual refractive cylinder1.

›87% of patients achieved ≤1.00 diopters of residual refractive cylinder1.

†† AcrySof® Single-Piece (SA60AT)


Improved Uncorrected Distance Visual Acuity

›94% of patients implanted achieved uncorrected distance visual acuity of 20/40 or better1.



Spectacle Freedom for Distance

•p<0.0001 CMH testp<0.0001 CMH test

•97% of patients with bilateral AcrySof Toric IOL implantation (N=37)

•*

AcrySof® IQ Toric IOLVisual acuity outcomesMost recent completed patients using IOL master optimized by Holladay II program

Sample size 14

42% were 20/20 UCVA

82% were +/- 0.25D

AcrySof® IQ Toric IOLCummulative Distribution (%) of Eyes

0102030405060708090

100

0 0.25 0.50 0.75 1.00 1.25 1.50 1.75 ≥ 2.00

Absolute Value of Spherical Equivalent Prediction Error (D)

•Toric IOL Master outcomes with Holladay II optimization

•88% are less than <0.50D

•Sample size last 14 patients


Increased Spectacle-Independence for UnilateralDistance Vision

›Approximately 60% of unilateral patients implanted achieved spectacle-independent

distance vision1.



Rotational StabilityIOL rotation can have significant impact on astigmatism correction.

›Generally, for every 1º of IOL rotation, 3.3% of lens cylinder power is lost2.

›A complete loss of cylinder power can occur with a rotation of >30º2.


Rotational Stability, continued

AcrySof® IQ Toric IOL ensures minimal rotation – less than 4º average rotation 6 months afterImplantation1,2.

›81.1% of patients were ≤5º of intended axis2.

›97.1% of patients were ≤10º of intended axis1.


Rotational Stability, continued

Proven biomechanics and biomaterial ensureAcrySof® IQ Toric IOL stays right where you want it.

›STABLEFORCE® haptics keep IOL highly stable and centered in capsular bag2.

›Flexible haptic design provides optimal placement in capsular bag, regardless of size2.

›AcrySof® lens materials binds to fibronectin.

» Ensures adhesion to anterior/posterior capsule3


Cylinder PowersAcrySof® IQ Toric IOL is designed to accommodate a variety of cataract patients with astigmatism.


Cylinder Powers, continuedA wide range of cylinder powers means more candidates can benefit from AcrySof® IQ Toric IOL.


Benefits of AcrySof® Aspheric Optics

Clinical improvements demonstrated over spherical control lens:

› Improved Functional vision

› Increased Contrast Sensitivity

›Reduction of spherical aberration and total high order aberrations (HOAs)


›This region of defocused light can reduce image quality.

Spherical Aberration

The Problem: Occurs when light rays are over-refracted at periphery of optics.


›This results in enhanced clarity and image quality.

Aspheric Optics

The Solution: Negative spherical aberration aligns the light rays to compensate for positive spherical aberration.


Reduction in Spherical Aberrations

›AcrySof® IQ Toric IOLs aspheric design** offers statistically significant reduction in both spherical and total higher order aberrations4.

Differences favor AcrySof® IQ IOL overall and at each visit (p<0.0001).


Contrast SensitivityThe aspheric design of AcrySof® IQ IOL offers improved contrast sensitivity – vital for visual performance.

AcrySof® IQ IOL showed statistically significant improvement4 in mesopic contrast sensitivity over the control lens in situations with and without glare at 6 cycles per degree (cpd) using the Vector Vision CSV-1000§**.

*Contrast sensitivity was measured using Vector Vision CSV-1000. §At 3 cpd, there was no significant change in mesopic contrast sensitivity.


Alcon data on file.

MTF Values5 mm Aperture.

Data for the SN6AT5, with cylinder power of

› 3.0 D at IOL plane

› 2.1 D at corneal plane

Contrast SensitivityThe aspheric design of AcrySof® IQ IOL offers Improved

contrast sensitivity – for improved image quality.


Alcon data on file.

MTFs for 21.0-D IOLs:

3 mm Aperture.

Data for the SN6AT5, with cylinder power of

› 3.0 D at IOL plane

› 2.1 D at corneal plane


1. Awwad ST, et al. J Refract Surg 2008;24:619.2. Pandita D, et al. J Cataract Refract Surg 2007;33:603.3. Tzelikis PF, et al. J Cataract Refract Surg 2007;33:1918.

AcrySof® IQ Aspheric IOLs

› With the spheric to aspheric monofocal IQ evolution,» MTF improved (shown here)» Contrast sensitivity under mesopic conditions improved1-3

› With the Toric to IQ Toric evolution,» MTF similar to AcrySof® IQ (non-toric monofocal IOL)» Contrast sensitivity under mesopic conditions is being tested


Enhanced Image Quality

IOLs that correct some (but not all) sphericalaberration result in vision similar to a young, natural crystalline lens.

Spherical aberration in human eyes:›0.08 microns for populations with normal vision5.

AcrySof® IQ IOL:›Corrects about .20 microns of spherical aberration.›Designed to leave a residual ~0.08 microns.

AcrySof® IQ Toric IOL is designed with a similar level of spherical aberration correction.


Contrast Sensitivity, continuedAcrySof® IQ IOL improves contrast sensitivity in both well-lit and low-light conditions4.

›Virtually the same image quality** whether aperture size is 3 or 5 mm.

Image quality was characterized by measuring modular transfer function (MTF) in a model eye utilizing simulated cornea with typical adult human spherical aberration.


Improved Functional VisionThe aspheric design of the AcrySof® IQ IOLprovides improved functional vision in challenging, low-visibility environments.

›Allows patients to more quickly detect and identify objects.

›Allows for greater reaction time.

›May increase patient safety.


Functional Vision StudyPatients were tested monocularly in a night driving simulator in simulated city and rural settings under normal, glare and fog conditions.

›Patients with AcrySof® IQ IOL performed functionally better than the control lens in 34 of 36 conditions tested4.


Functional Vision Study, cont’dAcrySof® IOL aspheric design makes a difference, performing better in 34 of 36 conditions.


AcrySof® IQ Toric

Surgical Planning and Procedural Considerations


AcrySof® Toric IOL Procedural Considerations

› Surgeon performs standard cataract procedure from capsulorhexis through phacoemulsification

› AcrySof® Toric IOL implantation requires only minor variation from standard procedure:

1. IOL calculation

2. Marking of the eye

3. IOL alignment (on-axis)


Patient Selection (minimum criteria)

› Regular corneal astigmatism

› Intact capsule

› Continuous curvilinear capsulotomy (CCC)

› In the bag lens placement


IOL Calculation

Step I: › Determine required spherical power using preferred

biometric method

Step II:› Utilize AcrySof® Toric IOL Calculator to determine:

»The recommended IOL model, and»Optimal axis location of the IOL in the capsular bag


AcrySof® IQ Toric IOL CalculatorMakes precise surgical planning easy!

Intuitive input› Patient data› Keratometry› IOL spherical power› Surgically induced astigmatism› Incision location

Powerful output› Recommended IOL model andspherical equivalent power

› Optimal axis placement› Magnitude and axis of anticipatedresidual astigmatism


IOL AlignmentI. Gross Alignment

›Rotate IOL clockwise to approximately 15 degrees short of desired position

›Completed while the IOL is unfolding in the capsular bag

›Can be rotated after IOL has unfolded, if needed, but take care to have capsular bag inflated with OVD


IOL AlignmentII. Stabilize IOL During OVD Removal

› Take care to prevent IOL from rotating past intended axis during OVD removal

»2nd instrument»Silicone I/A tip


IOL AlignmentIII. Final Alignment

› Carefully rotate IOL clockwise onto the intended axis of alignment

› Tap IOL down into capsular bag to seat lens in place


Discussion points• Show them the astigmatism and take it out

of the phoropter

• Use a vision questionnaire to determine their spectacle needs


They are your patient, they love you!• This is an opportunity to educate them

about their visual function and get to know them better.

• Use of a portable DVD in your practice is a great option!– Educational DVDs are free– Eyemaginations

• Financing options


• 1.50 dioptors or more equals Toric in my practice (experience from multifocals)


Dealing with the unhappy patient• I have very few in this group!

• Patients accept residual astigmatism

• 20/Happy!


Discussion points• LASIK enhancements are an option

• Toric outcomes for FDA is much better than LASIK and PRK

• “I would never give you a spectacle or contact lens prescription that did not treat your astigmatism.”


Practice builder for you….90% of LASIK patients buy an expensive pair of sunglasses

Options of plano progressive lenses.

If they are happy they are going to tell other patients about your practice!

Reimbursement is $110.00/eye in addition to standard co-management reimbursement through insurance (~150.00).


Summary• This astigmatism type Premium IOL is

very forgiving!

• All you have to say is, “You have a lot of astigmatism! Your surgeon is going to discuss with you about your astigmatism and ways to address it.”

• Recommend!


References

1. Based on unilateral clinical study results (Models SA60T3, SA60T4, SA60T5). See package insert.2. Data on file. Alcon, Inc.3. Linnola RJ, Sund M, Ylönen R, Pihlajaniemi T. Adhesion of soluble fibronectin, lamin, and collagen type IV to intraocular lens materials. J Cataract Refract Surg. 1999;25:1486-1491.4. Results of a controlled, randomized, double-masked, multicenter, contralateral implant clinical study of the AcrySof® IQ IOL versus an AcrySof® Single-Piece IOL (SA60AT). See Directions for Use.5. Cheng X, Bradley A, Hong X, Thibos LN. Relationship between refractive error and monochromatic aberrations of the eye. Optom Vis Sci. 2003;80:43-49.** The effects of this aspheric design have been clinically assessed on

AcrySof® IQ IOL Model SNW60WF (See Directions for Use)

)

slide deck for cope course 10 11 2010

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