PATIENT SELECTION THE RIGHT PATIENT UNDERPROMISE AND OVERDELIVER THE PERFECT SPECTACLE FREE TREATMENT. Desires Less Dependence on glasses

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1 Bilateral TECNIS MF versus Customized TECNIS MF - REZOOM Achieving Spectacle Independence THE PERFECT SPECTACLE FREE TREATMENT PATIENT SELECTION 1.ARE THEY INTERESTED IN BECOMING SPECTACLE FREE? 2.ARE THEY WILLING TO ACCEPT SOME OPTICAL COMPROMISES - GLARE and HALO S? 3.LIFESTYLE-Demanding Tasks? Truck Drivers Hobby s? 4.PERSONALITIES:Cave Engineers Physicists-Obsessive Persons 5.Discuss Laser Enhancement BEFOREHAND THE RIGHT PATIENT Desires Less Dependence on glasses Is willing to be Patient with the process and recognizes that it may take time to adapt to the new visual system Has the means, to PAY for it UNDERPROMISE AND OVERDELIVER MORE PREOP. COUNSELING TIME=LESS POSTOP.. COUNSELING TIME NEVER PROMISE TO BE FREE OF SPECTACLES WILL BE MORE INDEPENDANT WITH MULTIFOCALS AND MOST OF THE TIME THEY ARE SPECTACLE FREE 1

2 Tecnis ZM9 HOW TO MATCH PATIENT NEEDS WITH INTRAOCULAR LENSES The Effect is pupil Independent Diffractive principle Newest generation high-refractive silicone Safe centration due to CapC haptics Near addition +4, D Prolate anterior surface Tecnis ZM9 Light distribution 5/5 +5D to +34D DIFFRACTIVE pattern Sharp optic edge Power add 4D =3.2D spectacle plane Light distribution 5:5 Multifocal IOL at Targets developed by the US Air Force PROLATE Surface NR TECNIS MF IMPLANTED N28 DIOPTERS 7 D 25 D 34D RESULTS ANTWERP EXAMINATION D UNCORR. D BEST CORR. N UNCORR. NEAR UCVA WITH DISTANCE CORRECTION INTERMEDIATE DO YOU EXPERIENCE SIDE-EFFECTS? EFFECTS? 2

3 REFRACTIVE LENSECTOMY HYPEROPIA TECNIS 14 EYES SIMULTANEOUS FUP MEAN 12M D.RANGE CAME IN FOR REFRACTIVE PURPOSES D MEAN SPH.EQ. BEFORE AND AFTER 4,21 PREOP,24 POSTOP 1,9 2/2,8,7,6,5,4,3,2,1 2/1 MONOCULAR DISTANCE UCVA BCVA PRE POST Far UCVA Far BVCA MONOCULAR NEAR UNCORRECTED DISTANCE CORRECTED 1% 9% 8% 7% 6% 5% 4% 3% 2% 1% % Uncorrected 96%Jaeger 1 J 1 J2 _ UCVA NEAR DCVA NEAR PC WORK 3

4 45 PC WORKING DISTANCES MEAN 48 CM PC WORK BINOCULAR 5 CM- DISTANCE CORRECTED 6% Only 3 patients 5% problems 5 4% 43 3% 2% 5 CM Bin.Distance corr. 55 1% 45 % J 1 J2 J3 J5 9% at least J3 52 PATIENTS % OF TIME WITHOUT GLASSES 1% 8% 49/52 PATIENTS NO GLASSES LASIK- LASEK :2 EYES FUNCTIONAL VISION??? Huetz et al; JCRS, 27 Study comparing 2 patients Bilateral Tecnis ZM1 2 patients Bilateral ReStor Reading Acuity and Reading Speed tested with Radner Reading Charts Photopic - Mesopic Dim Light Tecnis 142 w/min Restor 15 READING SPEED TECNIS ZM9 Words Per Minute STRONG POINT Very good distance vision Excellent near vision,-even under low light conditions WEAK POINTS Spectacles sometimes needed for intermediate vision -computer work Huetz jrs 26 4

5 IS THERE SUCH A THING AS A FREE LUNCH? VISUAL DISTURBANCES ONLY TWO PATIENTS: : IMPORTANT NIGHT DRIVING PROBLEMS ALL OF THEM WOULD RECOMMEND THE LENS NOT ONE PATIENT CONSIDERED EXPLANTATION THESE COMPLAINTS IMPROVE OVER TIME Some patients will mention seeing rings from Time to time but are not disturbed Only A MINORITY will still have problems after 6 months 1% 9% 8% 7% 6% 5% 4% 3% 2% 1% % SUBJ COMPLAINTS WHEN ASKED FOR Subj.Complaints Minor Subj.Complaints Moderate Subj.Complaints Major REZOOM Multizonal refractive principle 5 zones Balanced View Optics for near, intermediate and distance vision Hydrophobic acrylate OptiEdge design Near addition 3,5 D 5

6 Independence From Glasses 7 SPECTACLE INDEPENDENCE WITH ReZoom B. Dick Cataract & Refractive Surgery 6/25 Percentage of Patients Always Occasionally Never Multifocal Monofocal 92% of ReZoom patients never or occasionally wear glasses.* No. of Patients, % distance intermediate near *Javitt JC. Opthalmology 2;17: UNCORRECTED INTERMEDIATE ACTIVITIES REZOOM Tecnis ZM9 ReZoom ReStor No. of Patients, % J1+ J2+ J3+ J4+ J5+ J6+ J7+ J8+ STRONG POINTS Very good distance vision Good intermediate visio WEAK POINTS Spectacles sometimes needed for prolonged reading or small prints Akaishi (Eyeworld 8/26) HOW CAN WE IMPROVE??? THE MATRIX PATIENT LIFESTYLE ASSESSMENT Desire for Spectacle Independence Desire to Work on a Computer Without Glasses Need for nicht driving Sharp Distance Vision Requirement No Specific Needs; Happy to Wear Glasses Eye Health / Attitude Eye Health / Attitude Eye Health / Attitude Healthy Eye Personality Unsuitable Photosensitivity Retinal Disease "Normal" or Prior Hyperopic Corneal Refractive Surgery Near Vision Dominance All-rounder Intermediate and Far Vision Dominance Tecnis Wavefront - Designed IOL Sensar or ClariFlex IOL Tecnis ZM9 Mix & Match ReZoom 6

7 CUSTOM MATCH Patient Lifestyle determines the Choice of lens "CUSTOMIZE AND MATCH" You have the choice between Bilateral Refractive MIOL Bilateral Diffractive MIOL Mix of Both optical principles EXAMPLES Professional car driver during day and night Tecnis Monofocal Bookworm Tecnis Multifocal Nature lover -Golfer- Gary Player ReZoom Wish for less spectacle dependence Mix & Match CUSTOMIZING HAS IT BEEN DONE BEFORE? Günenc (Turkey;; ASCRS 23) Akaishi & Fabri (Brasil; ASCRS 26) Bucci (USA; ASCRS 26) Kairala (Brasil; ASCRS 26) Milne (USA; ASCRS 26) Goes Prospective study CUSTOM MATCH FRANK BUCCI Jr GREEN BETTER OR IDEM AAO 26 Bilateral Intermediate Bilateral Near Voluntary Complaints Intermediate Bilateral ReSTOR N=55 J=3,81 1, 27,3% ReZoom + ReSTOR n=39 J=2,39 1,6 % Near vision Intermed.. v. Far vision Akaishi & Fabri (26) GREEN BETTER OR IDEM Bilateral ReSTOR n=1 J 1.4 (3 cm) J Bilateral ReZoom n=1 J 2.3 (38 cm) J ReSTOR & ReZoom n=88 J 1.5 (39 cm) J Tecnis MF + ReZoom n=15 J 1.1 (42 cm) J Lopez Castro ESCRS 26) 1 Year fup Near MESOPIC Intermediate mesopic Distance mesopic No glare-halo fup GREEN BETTER OR IDEM Bilateral MIOLS (36) J 4,1 J 5,3 J1,18 64% Tecnis Rezoom n=31 J2,4 J 4,2 1,17 86% Reading speed Never Glasses 81% 85% No glasses 89% 75% 1% 1% Halos 1+ Potsdam

8 NEAR VISION INTERMEDIATE VISION 27/28 TECNIS EYES COULD READ J1 15/28 REZOOM EYES COULD READ J1 18/28TECNIS COULD READ J5 27/28 REZOOM COULD READ J5 SUBJECTIVE COMPLAINTS ONLY 2/28 PATIENTS DISTURBING SUBJECTIVE COMPLAINTS CUSTOMIZING TECNIS -REZOOM Antwerp 3 M FUP MINOR COMPLAINTS IMPROVED OVER TIME 28 PATIENTS IN THE STUDY ALL SPECTACLE FREE SATISFACTION DEGREE VERY HIGH ++ ALL DISTANCES COVERED REZOOM IS MY COMPUTER EYE IMPORT. SUBJ COMPLAINTS MINIMAL 2/28 CUSTOMIZING IN ORDER TO OBTAIN EXCELLENT VISION AT ALL DISTANCES WE WANT HAPPY PATIENTS FAR INTERMEDIATE NEAR ELIMINATE COMPLAINTS OF GLARE AND HALOS GLARE AND HALOS 8

9 HOW CAN WE IMRPOVE THIS??? WE WANT HAPPY PATIENTS 1% OF TIME 9