Crystalens AO: Accommodating, Aberration-Free, Aspheric Y. Ralph Chu, MD Chu Vision Institute Bloomington, MN

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1 Crystalens AO: Accommodating, Aberration-Free, Aspheric Y. Ralph Chu, MD Chu Vision Institute Bloomington, MN

2 Financial Disclosure Advanced Medical Optics Allergan Bausch & Lomb PowerVision Revision Optics Ocusoft Lifeguard Sciences I-Therapeutix

3 Sections 1. Introduction to the AO 2. AO optics - Why AO? 3. Bench Studies & Outcomes 4. When do I use the AO, HD or 5.0?

4 Video Ridley

5 Crystalens AO Introduction 5 th generation Crystalens Lineage: AT-45, AT-45SE, Five-O, HD Aberration free optic design No Spherical aberration Aspheric surface on anterior and posterior surfaces Less sensitive to decentration Improved quality of vision FDA Approved

6 AO built on Crystalens Heritage

7 Long-term Performance

8 Product details Available powers: 10 to 33 D in 0.50-D steps

9 Haptic designed to fold inwards towards optic during folding in an insertion device Injector Friendly

10 Crystalens AO Aberration Free, Aspheric, Accommodating Proprietary optic design modification to improve quality of vision while providing a single image to the retina 360º enhanced barrier for PCO

11 100% of light rays at all distances

12 Quality of Vision with Crystalens AO

13 Quality of Vision with Crystalens AO

14 Review of AO Optics

15 Four Questions 1. Why will AO provide better vision than 5.0? Less SA Greater tolerance to lens decentration and tilt More consistent outcomes 2. Since the AO reduces SA, why doesn t AO compromise depth of field? AO has zero SA, so it doesn t affect the +SA in the cornea Adding more +SA doesn t improve DOF

16 Four Questions 3. How will AO s optics affect accommodation? Not sure, but unlikely to have an adverse effect AO is thinner than 5.0, and this may increase potential for accommodative arching 4. Why didn t B+L put aspheric optics on HD? B+L thoroughly investigated adding aspheric optics to HD Looked at using SA, zero SA and even more +SA Looked at changing the power and diameter of the central zone Fortunately the current bi-spheric design was superior to all iterations, which were more sensitive to residual myopia and lens misalignments

17 Review of Spherical Aberration

18 Spherical Aberration (SA) Spherical IOL SA > 0 Negative-SA Aspheric SA < 0 Aberration-free Aspheric SA = 0 Crystalens 5.0 Power increases from center to edge. AcrySof IQ/Tecnis Power decreases from center to edge. Crystalens AO Power is uniform from center to edge.

19 Dioptric Power Profile Lens Center Lens Edge

20 Diffference in Power Between Center and Periphery (Diopters) SA vs. Lens Power High-power spherical lenses have more SA than low-power lenses All powers of AO lenses have zero SA Spherical Lens Power (Diopters)

21 Effects of Spherical Aberration SA degrades image quality at best point of focus. SA increases depth of field. When a lens with SA is decentered, aberrations are induced, specifically defocus, astigmatism and coma.

22 Effect of SA on Image Quality Spherical aberration degrades retinal image quality. Reduces contrast sensitivity and low-contrast visual acuity High-contrast visual acuity is usually not affected by SA Creates halos SA = 0 SA = mm 20/40 Letter E

23 Effect of SA on Depth of Field Tecnis SA = 0 B&L AO SA = mm Avg. cornea has mm of SA Spherical SA = mm D D 0 D D D 20/40 Letter E, 4-mm Pupil

24 Image Quality Balancing Image Quality & DOF 0 mm +0.1 mm +0.2 mm +0.3 mm Avg. cornea has mm of SA Tecnis IQ AO +0.4 mm +0.5 mm mm

25 Eye Decentered Optical System The pseudophakic eye is not a centered optical system. Visual axis does not pass through center of cornea, pupil or lens. Decentration between visual axis and pupil = 0.34 ± 0.27 mm. Decentration between IOL and pupil = 0.36 ± 0.22 mm. TEMPORAL Cornea Pupillary Axis Iris IOL 0.36 ± 0.22 mm 18 studies Fovea 5 Mean Optical Decentration 0.5 mm NASAL 0.34 ± 0.27 mm Rynders, JOSA (1995) Retina

26 Effect of IOL Decentration IOLs are perfectly centered. B&L AO Ocular SA = Corneal SA + Lens SA Ocular SA = = micron Tecnis Monofocal Ocular SA = Corneal SA + Lens SA Ocular SA = = 0 micron 20/20 Letter E, 4-mm Pupil

27 Effect of IOL Decentration IOLs are decentered 1.0 mm. B&L AO Ocular SA = Corneal SA + Lens SA Ocular SA = = micron Tecnis Monofocal Ocular SA = Corneal SA + Lens SA Ocular SA = = 0 micron 20/20 Letter E, 4-mm Pupil

28 Effect of Lens Tilt Crystalens 5.0 Tilt = 0º Tilt = 5º Tilt = 10º Crystalens HD Crystalens AO Tilt = 0º Tilt = 5º Tilt = 10º Tilt = 0º Tilt = 5º Tilt = 10º

29 Displacement (mm) 3. How will AO s optics affect accommodation? Percentage Increase (%) Not sure, but unlikely to have an adverse effect AO is thinner than 5.0, so this may increase potential for accommodative arching % 9% 8% 7% 6% 5% 4% 3% 2% 1% Early Clinical Results for Total Accommodation AO ~ 1.7 D (N = 105) 5.0 ~ 1.4 D (N = 587) HD ~ 1.7 D (N = 419) 0 AT50-SE-22D AT50-SE-33D AT50-AO-22D AT50-AO-33D 22D Difference 33D Difference 0%

30 4. Why didn t B+L put aspheric optics on HD? B+L thoroughly investigated adding aspheric optics to HD Looked at using SA, zero SA and even more +SA Looked at changing the power and diameter of the central zone Fortunately, the current bi-spheric design was superior to all iterations, which were more sensitive to residual myopia and lens misalignments

31 The measure of optic advancement The only IOL approved by the Federal Aviation Association, Crystalens HD demonstrates premium visual quality at average pupil size ReSTOR requires pupil enlargement With a 3 mm pupil at plano refraction, Crystalens HD demonstrates superior distance image quality 10

32 So when do I use the AO or HD or 5.0?

33 Bench Measurements of AO, 5.0 and HD

34 USAF Target Images Crystalens AO Crystalens 5.0 AO provides better contrast & resolution. 20-D, 5-mm Aperture

35 Resolution Efficiency Resolution Efficiency 100% 90% 80% 70% 60% 50% 40% 30% 20% AO s imaging quality is superior for all lens powers and apertures. AO s imaging quality doesn t vary with lens power nor aperture. AT50SE 10-D AT50SE 20-D AT50SE 30-D AT50AO 10-D AT50AO 20-D AT50AO 30-D 10% 0% Spherical lens imaging quality decreases as lens power and aperture increase. 3 mm 4 mm 5 mm Aperture Diameter Resolution Efficiency = Measured Resolution Maximum Resolution

36 MTF Curves

37 Through-Focus Imaging

38 Frequency Refractive Stability Refractive Stability (N = 105) 40% 39% Mean % Std Dev % 25% 26% Min Max Within +/ D 81.0% 20% 20% Within +/- 0.5 D 94.3% 15% 10% 8% 5% 4% 0% 1% 1% 2% 0% < to to to to to to SE Difference Between 2w and 1m Visits to >

39 Crystalens Platform 1. AO = GoTo Lens 2. HD for pts requiring stronger reading and have enhance-ability factor 3. AO dominant eye, HD non-dominant eye? 4. Post-LVC eyes? 5. Preop corneal Q values?

40 What Crystalens will be your lens of choice? 1. Crystalens Crystalens HD 3. Crystalens AO 4. None-I prefer multifocal IOLs 5. None- I prefer monofocal IOLs

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