Diffractive Optics. Multifocal Lenses. Correction of Pseudophakic Presbyopia with Multifocal IOLs. Basic Designs

Transcription

1 Correction of Pseudophakic Presbyopia with Multifocal IOLs GEORGE H.H. BEIKO, B.M.,B.Ch.,FRCSC ST. CATHARINES, CANADA ASSIST PROF, MCMASTER UNIV AMO Tecnis MFIOL Alcon ReSTOR Aspheric AMO ReZoom Alcon ReSTOR AMO Array Multifocal Lenses Basic Designs Diffractive-only bifocal Refractive- bifocal and multifocal Diffractive Optics Huygens-Fresnel Principal The bending of light around steps or corners Light waves bend at grooves in lens Bent light undergoes constructive or destructive interference to form two foci, near and distance 1

2 Diffractive Optics Huygens-Fresnel Principal The bending of light around steps or corners Diffractive Optics Huygens-Fresnel Principal The bending of light around steps or corners Bent light undergoes constructive or destructive interference to form two foci, near and distance Diffraction Single slit: diffraction Diffraction Single slit: diffraction Double slit: diffraction and interference Diffractive Bifocal Design Diffractive Design Diffractive Bifocal Design Diffractive Design Distance Refractive Focus 41% of Light Multiple, Sharp Interruptions of Light Surface Cause Light Diffraction Light waves bend at grooves in lens Multiple, Sharp Interruptions of Light Surface Cause Light Diffraction Light waves bend at grooves in lens 2

3 Diffractive Bifocal Design Diffractive Design Diffractive Bifocal Design Diffractive Design High Order Images 18% of Light Near Diffractive Focus - 41% of Light Near Diffractive Focus - 41% of Light Distance Refractive Focus 41% of Light Multiple, Sharp Interruptions of Light Surface Cause Light Diffraction Light waves bend at grooves in lens Distance Refractive Focus 41% of Light Multiple, Sharp Interruptions of Light Surface Cause Light Diffraction Light waves bend at grooves in lens Refractive Bifocal Lens ADD Refractive Multifocal Lens Progressive-addition lens DEPTH OF FOCUS N F F A refractive bifocal IOL has concentric rings which produce distance and near foci Progressive-addition IOL incorporates a range of foci from near to distance Optical Principles of IOLs monofocal far focus Optical Principles of IOLs monofocal far focus diffractive near focus far focus Terwee, ESCRS 24 Terwee, ESCRS 24 3

4 Optical Principles of IOLs monofocal far focus Optical Principles of IOLs monofocal far focus diffractive diffractive near focus far focus near focus far focus refractive refractive depth of focus near focus far focus Terwee, ESCRS 24 near focus far focus Terwee, ESCRS 24 Refractive Multifocal Lenses- AMO Array The AMO Array Foldable Silicone Multifocal IOL Model SA4N TM 5 concentric zones Zone 1 Zone 2 Zone 3 Zone mm 2.1 to 3.4 mm 3.4 to 3.9 mm 3.9 to 4.6 mm Zone 1 Zone 2 Zone 3 Zone mm 2.1 to 3.4 mm 3.4 to 3.9 mm 3.9 to 4.6 mm Zone to 4.7 mm Zone to 4.7 mm The center of each zone is powered for distance or near vision The aspheric transition between zones provides intermediate vision 4

5 Theoretical Energy Balance Zonal Refractive Optic Distance 1 Near 2.1 mm 2.1 to 3.4 mm AMO Array- Distance Vision Similar to Monofocal IOL Fractional Energy Distance Near to 3.9 mm Distance Near 3.9 to 4.6 mm 4.6 to 4.7 mm Distance Mean Decimal SCVA Multifocal IOL Monofocal IOL Steinert et al, 1999 Arens et al, 1999 Vaquero- Ruano et al, 1998 Pupil Diameter (mm) Mean Uncorrected Near VA (Decimal) AMO Array- Near Vision Superior to Monofocal IOL Multifocal IOL Monofocal IOL Steinert et al, 1999 Arens et al, 1999 Vaquero- Ruano et al, 1998 Percent of Patients AMO Array- Decreased Need for Spectacles Significantly more multifocal than monofocal IOL patients never wore glasses (P<.1) 5 25 Always Occasionally Never Multifocal Monofocal Javitt J, et al, J Cataract Refract Surg,, 2 Comparative Nighttime Images (5 mm Aperture, IOL in Wet Cell) AMO Array - 75% pts with bilateral Array had UCDVA 2/4 or better and UCNVA J3 or better Monofocal AMO Array 5

6 Comparative Nighttime Images (5 mm Aperture, IOL in Wet Cell) Monofocal AMO Array Refractive Multifocal Lenses- AMO ReZoom AMO ReZoom Specifications Hydrophobic acrylic material Three-piece design PMMA capsule fit haptics 6. mm optic, 13 mm OL +6. to dioptres of reading power Features Balanced View Optics OptiEdge triple edge PC IOL design ReZoom ReZoom Zones Zone 1, 3, and 5 are distance vision dominant Zones 2 and 4 are near vision dominant Provides good near, intermediate and distance vision ReZoom Zones vs. Array Zones Change in Zone Area ReZoom AMO ReZoom less glare and halo compared to AMO Array Rau, ASCRS 25 Under low light or large pupil conditions, the amount of light that goes to the near foci is reduced and redistributed to distance; thus reducing the out of focus light on the retina Less out of focus light on the retina leads to less halos and glare 6

7 OptiEdge Triple Edge Design Patented design minimizes PCO Lowest reported incidence of visual aberrations compared with those associated with double-square edge barrier designs ReZoom TM Canadian Multicentre Trial 16 surgeons across Canada R. Baldassare MD, FRCS(C) G. Beiko BM, BCh, FRCS(C) R. Braga-Mele MD, FRCS(C) L. Brierley MD, FRCS(C) L. Corriveau MD, FRCS(C) P. Faber MD, FRCS(C) S. Fanous MD, FRCS(C) J. Gohill MD, FRCS(C) M. Laflamme MD, FRCS(C) S. Lahoud MD, FRCS(C) F. Law MD, FRCS(C) B. Nicholls MD, FRCS(C) D. Nixon MD, FRCS(C) C.Perreault MD, FRCS(C) M. Pop, MD, FRCS(C) T. Rabinovitch MD, FRCS(C) ReZoom TM Multicentre Trial - Evaluation Parameters Goal to enroll 1-15 patients to be bilaterally implanted with the ReZoom Multifocal IOL Method: Pre and post-op patient qualitative questionnaires on freedom from glasses at different distances Pre and post op patient questionnaire to evaluate Halos and Glare before and after surgery, and potential neuro adaption between 6 week and 6 month follow-up visits Pre and post-op surgeon qualitative and quantitative questionnaires on refraction and uncorrected visual acuity for Far, Near, and Intermediate distance Patient Selection Criteria Cataract Hyperopic Presbyopic Astigmatism that can be corrected High myopes (surgeon preference) Patient Exclusion Criteria Significant dry eye Corneal scarring Mild to moderate myopia Pupil size <2.5 mm Monofocal implant in first eye Uncorrected post-op astigmatism >.5 D Unstable capsular support Target Emmetropia Post-op refraction was targeted at emmetropia to +.5 D Aim for patient to be plano to slightly hyperopic to provide good distance vision for driving 7

8 Preliminary results: Excluded Patients # of surgeons participating in the trial: 16 # of patients having completed pre-op questionnaire: 159 # of patients having completed 6 week post-op follow-up: 16 # of patients having completed 6 month post-op followup: 98 Received non-rezoom lens in 2 nd eye 22 ReZoom not implanted 7 Lost to follow-up 6 Surgery cancelled 2 Unilateral ReZoom 2 No information Patient distribution by age Patient distribution by gender 6-WEEK FU 6-WEEK FU Population: 16 patients Population: 98 patients Pre and post-op op uncorrected distance visual acuity 6-WEEK FU VS. PRE-OP Pre and post-op op uncorrected intermediate visual acuity 6-WEEK F.U. VS PRE-OP 8

9 Pre and post-op op uncorrected near visual acuity 6-WEEK FU VS PRE-OP Spectacle independence of patients Pre-op patient responses on Importance of NOT wearing glasses Spectacle independence for distance vision 6-WEEK FU VS. PRE-OP 97% of patients never or seldom wear glasses for distance vision 97.1% of patients never or seldom wear glasses for distance vision Spectacle independence for intermediate vision 6-WEEK FU VS. PRE-OP 87% of patients never or seldom wear glasses for intermediate vision 88.6% of patients never or seldom wear glasses for intermediate vision Spectacle independence for near vision 6-WEEK FU VS. PRE-OP 77% of patients never or seldom wear glasses for near vision 57.1% of patients never or seldom wear glasses for near vision Overall spectacle Independence with ReZoom 6-WEEK FU 94.3% of patients never or seldom wear vision correction glasses 91.% of patients never or seldom wear vision correction glasses 9

10 Spectacle independence vs age Dysphotopsias 86% 7% 5% 65% 52% Bother from halos 6-WEEK FU VS. PRE-OP 77% of patients have none to mild bother from halos 82.% of patients have none to mild bother from halos Improvement with Halos Since Right After Surgery 67.% of patients have reported improvement with halos between the 6-week and 6-month follow-ups 82% of patients have none to mild bother from glare Bother from glare 6-WEEK FU VS. PRE-OP 87.% of patients have none to mild bother from glare Improvement with Glare Since Right After Surgery 66.% of patients have reported improvement with glare between the 6-week and 6-month follow-ups 1

11 Bother from Ghosts/Double Vision - 6 Month Follow Up 6-WEEK FU VS. PRE-OP 96% of patients have none to mild bother from ghosts/double vision 97.% of patients have none to mild bother from ghosts/double vision Improvement with Ghosts/Double Vision Since Right After Surgery 67.% of patients have reported improvement with ghosts/double vision between 6-week and 6-month follow-ups Patient satisfaction with ReZoom after bilateral implantation 6-WEEK FU Dysphotopsias Dysphotopsias Surgeon factors of importance in selecting a Multifocal IOL 11

12 Post-operative operative surgeon evaluation of ReZoom performance Pre-op factors of importance 1st criterion of importance Surgeon satisfaction with ReZoom 1% of surgeons will continue to use ReZoom TM 6th criterion of importance 5th criterion of importance 3th criterion of importance 2nd criterion of importance 4th criterion of importance Conclusions Ongoing study ReZoom provides excellent distance & intermediate vision and satisfactory near vision Significant improvement in distance, intermediate and near vision at 6 months post-op Dysphotopic phenomena were not significant and improved by 6 months 9% patients were spectacle independent; 9% were satisfied at 6 months Younger patients more likely to be spectacle independent Diffractive Bifocal Lenses AcrySof ReSTOR IOL Diffractive Structure 3.6 mm center of optic; refractive peripheral area Incorporates +4. add at lens plane equaling +3.2 at spectacle plane Apodized diffractive optic to decrease halos Step heights peripherally decreasing microns, peripherally decreasing widths Apodization Diffractive Optic Gradual decrease in step heights creating a smooth transition of light between focal points (1.3 to.4 microns) Responsible for reduction in photic phenomenon such as glare and halos. Unique to AcrySof ReSTOR IOL Magnification = 8X 1.3 micron step 12

13 Apodization is routinely used in microscopy and astronomy to reduce diffractive halos and improve resolution. Apodization No Apodization Sonine Apodization AcrySof ReSTOR IOL Utilizes diffractive and refractive optics with apodization Allocating appropriate light energy according to an activity and light levels Minimizing photic issues through specialized optic design Separation of images AcrySof ReSTOR IOL Near VA of first 45 ReStor pts, (greater than 6 months) results for UCNVA Monocular Results AcrySof ReSTOR IOL Near VA of first 45 ReStor pts, (greater than 6 months) results for UCNVA Monocular Results Binocular Results 2/16 or better: 9% 2/2 or better: 44% 2/25 or better: 84% 2/3 or better: 99% 2/16 or better: 9% 2/2 or better: 44% 2/25 or better: 84% 2/3 or better: 99% 2/16 or better: 2% 2/2 or better: 82% 2/25 or better: 96% 2/3 or better: 1% Dick Mackool Dick Mackool AcrySof ReSTOR IOL Near VA of first 45 ReStor pts, (greater than 6 months) results for UCNVA Monocular Results 2/16 or better: 9% 2/2 or better: 44% 2/25 or better: 84% 2/3 or better: 99% Binocular Results 2/16 or better: 2% 2/2 or better: 82% 2/25 or better: 96% 2/3 or better: 1% With best spectacle correction for distance, reading binocularly, 9% were 2/2 or better and 1% were 2/25 or better Dick Mackool Mean Rating Visual Disturbances Pilot Study Results glare ReSTOR Array p<.5 night vision halos glare night vision halos 1 month post-op 6 months post-op 13

14 Mean Rating Visual Disturbances Pilot Study Results glare ReSTOR Array p<.5 night vision halos glare night vision halos 1 month post-op 6 months post-op AcrySof ReSTOR IOL intermediate VA improves significantly at one year time in ReStor patients (Robert Kaufer) AMO Tecnis Multifocal Lens Diffractive posterior surface Modified prolate anterior surface +4.D near addition; Effective add of 3. D Light distribution 5/5 5D to 34D in.5d increments 32 concentric zones Equal near/far split in effective light distribution Pupil size independent far and near functionality in all light conditions +4 D near add (IOL plane); +3. add (spectacle plane) Comparison of 2 Diffractive IOLs Theoretical Energy Balance ReSTOR Tecnis MF IOL Tecnis multifocal IOL Diffractive High refractive index silicon Aspheric Posterior surface Alcon ReSTOR SA6D3 IOL Refractive/diffractive Acrylic Spheric Anterior surface Relative Energy Pupil Diameter 55 nm Distance Focus Near Focus Relative Energy Pupil Diameter (mm) Pupil Diameter (mm) 14

15 USAF Target Projection Terwee, ESCRS 24 Terwee, ESCRS 24 Tecnis Array Terwee, ESCRS 24 Terwee, ESCRS 24 Terwee, ESCRS 24 15

16 Terwee, ESCRS 24 Tecnis MF IOL MONOCULAR NEAR 1% 9% 8% 7% 6% 5% 4% 3% 2% 1% % Uncorrected 96%Jaeger 1 J 1 J2 _ UCVA NEAR DCVA NEAR F GOES Uncorrected Distance Vision Both Eyes Uncorrected Near Vision (At 4 cm, Both Eyes) 6/1.25 5/ p<.1 p<.1 4/.5 no. of letters 3/.32 2/.2 1/.13 day 1-2 day 3-6 day ZM 9 Array 5/.4 no. of letters 4/.25 3/.16 2/.1 2 1/.6 pre-op day 3-6 day ZM 9 Array Mester et al (JCRS) Mester et al (JCRS) Study Design prospective, randomized study 6 patients = 12 eyes Group 1: Array SA 4 N LogRAD Score Snellen / 4 cm,45.4,4 Reading Acuity 1 cd/m² 6 cd/m² Group 2: Tecnis ZM 1 Group 3: Acrysof Restor Inclusion Criteria age > 5 years cataract OU Otherwise healthy eyes Keratometric astigmatism < 1. diopter 2/4 J3.5 2/3 J2.63 2/25 J1.8 2/2 1. J1+,35,3,25,2,15,1,5 no correction best far correction best near correction no correction best far correction best near correction Array Tecnis Restor Courtesy of Werner W. Hütz, ESCRS 25, Lisbon (no financial interest). Courtesy of Werner W. Hütz, ESCRS 25, Lisbon. 16

17 Multifocal Optics Mix & Match Technologies Spectacle independence can be achieved Reasonable expectations Halos Improvements continue for 12+ months Diffractive & refractive both work well Differences reside in the details Customize for the individual patient BILATERAL RESTOR 1 patients (binocular implant) Mean follow-up: 4 months Average NVA: J 1.4 (3cm) Average IVA: J 3.85 Average DVA: 2/25 Average reading speed (wpm): 165 with 3.5 mm pupil Average spectacle independence: 89% Halos/Glare: (1+) MTF at 1 c/mm:.12 BILATERAL REZOOM 1 patients (binocular implant) Mean follow-up: 4 months Average NVA: J 2.3 (38 cm) Average IVA: J 2.15 Average DVA: 2/2 Average reading speed (wpm): 125 with 3.5 mm pupil Average spectacle independence: 75% Halos/Glare: (2+) MTF at 1 c/mm:.2 Print size LOG RAD / Measured by I-Tracey (5 mm pupil) For internal AMO use only Non published data Akaishi & Fabri, Feb 26 Mix & Match Technologies Why Mix? Get the maximum strength from refractive and diffractive technologies Mix & Match Technologies Why Mix? Get the maximum strength from refractive and diffractive technologies Strengths Strengths Strengths Strengths Excellent Intermediate Vision Excellent Intermediate Vision Excellent Near Vision Refractive 1% Transmission of light Excelent Distance Vision Weaknesses Good Near Vision Lower reading speed Pupil dependent Diffractive Weaknesses Refractive 1% Transmission of light Excelent Distance Vision Weaknesses Good Near Vision Lower reading speed Pupil dependent Diffractive Good reading speed Pupil independent Weaknesses Lack of Intermediate Vision Loss of transmitted light Loss of contrast sensitivity For internal AMO use only Non published data Akaishi & Fabri, Feb 26 For internal AMO use only Non published data Akaishi & Fabri, Feb 26 Mix & Match Technologies Why Mix & Match? Get the maximum strength from refractive and diffractive technologies and get a binocular vision with: Excellent Near Vision + reading speed Excellent Intermediate Vision Excellent Distance Vision Greater spectacle independence Fulfilling all Lifestyle expectations Mix & Match Technologies RESTOR N Dominant + 58 patients (M&M implant) Mean age: 55 years old Mean follow-up: 2 months REZOOM Dominant Average Binocular NVA: J 1.5 (39 cm) Average Binocular IVA: J 2.3 Average Binocular DVA: 2/2 Average Binocular reading speed (wpm): 155 with 3.5 mm pupil Halos/Glare: (1+) MTF at 1 c/mm:.18 Average spectacle independence: 1% For internal AMO use only Non published data Akaishi & Fabri, Feb 26 Print size LOG RAD / Measured by I-Tracey (5 mm pupil) For internal AMO use only Non published data Akaishi & Fabri, Feb 26 17

18 Mix & Match Technologies Mix & Match Technologies TECNIS MF + REZOOM TECNIS MF + REZOOM 15 patients (M&M implant w/lifestyle dominance) Mean age: 59 years old Mean follow-up: 1 month Average Binocular NVA: J 1.1 (42 cm) Average IVA: J 2.1 Average DVA: 2/2 Average reading speed (wpm): 185 with 3.5 mm pupil Halos/Glare: (1-) MTF at 1 c/mm:.38 Average spectacle independence: 1% 15 patients (M&M implant w/lifestyle dominance) Mean age: 59 years old Mean follow-up: 1 month First Impressions: Less halos and glare than ReSTOR + ReZoom Less light needed to bilateral near vision More comfortable reading distance More bilateral contrast sensitivity Less spherical aberration (Tecnis MF eye) Average spectacle independence: 1% Print size LOG RAD / Measured by I-Tracey (5 mm pupil) For internal AMO use only Non published data Akaishi & Fabri, Feb 26 For internal AMO use only Non published data Akaishi & Fabri, Feb 26 Akaishi & Fabri (26) Akaishi & Fabri (26) Bilateral ReSTOR n=1 Bilateral ReZoom n=1 ReSTOR & ReZoom n=88 Tecnis MF + ReZoom n=15 Bilateral ReSTOR n=1 Bilateral ReZoom n=1 ReSTOR & ReZoom n=88 Tecnis MF + ReZoom n=15 Near vision J 1.4 (3 cm) Near vision J 1.4 (3 cm) J 2.3 (38 cm) Intermed. v. J 3.85 Intermed. v. J 3.85 J 2.15 Far vision.8 Far vision.8 1. Reading speed 165 Reading speed No glasses 89% No glasses 89% 75% Halos 1+ Halos Akaishi & Fabri (ASCRS 26) Akaishi & Fabri (ASCRS 26) Akaishi & Fabri (26) Akaishi & Fabri (26) Bilateral ReSTOR n=1 Bilateral ReZoom n=1 ReSTOR & ReZoom n=88 Tecnis MF + ReZoom n=15 Bilateral ReSTOR n=1 Bilateral ReZoom n=1 ReSTOR & ReZoom n=88 Tecnis MF + ReZoom n=15 Near vision J 1.4 (3 cm) J 2.3 (38 cm) J 1.5 (39 cm) Near vision J 1.4 (3 cm) J 2.3 (38 cm) J 1.5 (39 cm) J 1.1 (42 cm) Intermed. v. J 3.85 J 2.15 J 2.3 Intermed. v. J 3.85 J 2.15 J 2.3 J 2.1 Far vision Far vision Reading speed Reading speed No glasses 89% 75% 1% No glasses 89% 75% 1% 1% Halos Halos Akaishi & Fabri (ASCRS 26) Akaishi & Fabri (ASCRS 26) 18

19 MILNE 26 Far vision very satisfied/satisfied neutral unsatisfied Near vision very satisfied/satisfied neutral unsatisfied Bilateral ReSTOR 75% % 26% 83% % 17% ReZoom + ReSTOR n=2 96% 4% % 96% 4% % Studies have shown that the MF IOL s provide distance, intermediate and near vision; but what is the quality of this vision? Independence of glasses 65% 94% Milne (ASCRS 26) Presbyopia and Cataract Surgery Photic Phenomena-ReSTOR Refracting/Diffracting Lenses glare and halos are common complaints loss of contrast sensitivity % Subjects ReStor Control Glare ReStor Control Night Vision Problems Halos ReStor Control None Mild Moderate Severe ReSTOR vs Acrysof SA6AT 6 month comparison BCVA.9 or better in 94% ReSTOR and 96% monofocal 92% ReSTOR were spectacle independent Halos (22% vs 15%) and glare (28% vs 12%) higher in ReSTOR PCO rate higher (32% vs 18%) in ReSTOR AMO Array decreased contrast sensitivity, compared to monofocal, of 35-4%, which improves to 2-25% with neuroadaptation Holladay Grenga PL et al, 27, unpublished 19

20 AMO Array decreased contrast sensitivity, compared to monofocal, of 35-4%, which improves to 2-25% with neuroadaptation Holladay ReSTOR- Decreased Contrast Sensitivity ReSTOR vs Acrysof SA6AT 6 month comparison BCVA.9 or better in 94% ReSTOR and 96% monofocal 92% ReSTOR were spectacle independent Halos (22% vs 15%) and glare (28% vs 12%) higher in ReSTOR PCO rate higher (32% vs 18%) in ReSTOR Static photopic measurements same in both groups; dynamic photopic measurements sig. less (p <.5) in ReSTOR Grenga PL et al, 27, unpublished Contrast Sensitivity Declines with Age Spherical Aberration- Visual Effects Glasser and Campbell. Vision Res 1998 DeValois, DeValois. Oxford Univ Press, 1988 Contrast Sensitivity Function with 4 mm Pupil Photopic Contrast Sensitivity Log CSF age 2-3 age 6-7 IOL subjects Spatial Frequency (cycles/degree) Contrast Sensitivity Spatial Frequency (c/deg) P<.5 Tecnis SA6AT Nio, Jansonius, Fidler, Geraghty, Norrby, Kooijman Bellucci et al., 22 2

21 Mesopic Contrast Sensitivity Contrast Sensitivity Spatial Frequency (c/deg) P<.5 Tecnis SA6AT Bellucci et al., 22 Other Studies Comparing Tecnis and Acrysof Packer, 22 Meester, 23; Packer, 23; Kershner, 23 Bellucci, 24; Ricci, 24; Kennis, 24; Piers et al, 24 Bellucci, 25; Casprini, 25; Martinez, Palmer 25 Photopic Contrast Sensitivity Photopic Contrast Sensitivity SA.37/Tecnis Tecnis nonsel P<.5 P<.1 ReZoom SA.37/Tecnis Tecnis nonsel P<.5 Stereo Optical VT16X Photopic Contrast Sensitivity ReZoom Tecnis P<.5 21

22 Contrast Sensitivity Contrast Sensitivity Tecnis Rezoom Tecnis Rezoom Mesopic Contrast Sensitivity Mesopic Contrast Sensitivity ReZoom SA.37/Tecnis Tecnis nonsel P<.5 P<.1 SA.37/Tecnis Tecnis nonsel P<.5 Mesopic Contrast Sensitivity Contrast Sensitivity ReZoom Tecnis P<.5 Tecnis Rezoom 22

23 Mesopic Contrast Sensitivity Photopic Contrast Sensitivity ReZoom SA.37/Tecnis Tecnis nonsel P<.5 Young Rezoom P<.5 P<.1 Mesopic Contrast Sensitivity Contrast Sensitivity Young Rezoom P<.5 P<.1 Young Rezoom Contrast Sensitivity Contrast Sensitivity Young Rezoom Young Rezoom 23

24 Contrast Sensitivity Contrast Sensitivity 2-3 yr olds Rezoom-DY Young Rezoom-DY Contrast Sensitivity Contrast Sensitivity Young Rezoom-DY Young Rezoom Conclusions Contraindications to IOLs Multifocal IOL s can provide excellent distance & intermediate vision and near vision Significant improvement in distance, intermediate and near vision with time post-op Dysphotopic phenomena are minimal with newer lenses and strategies, and improved by 6 months Selected patients are satisfied Younger patients more likely to be spectacle independent 24

25 Thank you 25