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Surgical Presbyopia Therapy Today

Omid Kermani, Köln

09.05.2019 O. Kermani, MD1

EOS - Egyptian Society Of Ophthalmlogy | Cairo | March 26./27. 2019

Refractive Surgery

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RLE

LVC

pIOL

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Dominant Eye

Emmetropia

Target Q: -0,6

Non-Dominant Eye

Target Myopia -1,0D

Target Q: -0,6

„Blended“

Monovision

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Acufocus Kamra

° Polyvinyl: 5µm thickness (form stable)

° Permeable: 8400 Holes

° Ligh transparency of anulus = 5%

° 3,8mm outer ø //1,6mm inner ø

° Depth of Focus

° Monovision „non-dominant“

Presbia FlexiVue° Hydrophilic: water content 27% (form flexible)

° Refractive Index 1,37

° 3,2 mm outer ø (15 µm thickness)

° 0,50 mm ø central nutrition hole

° Refraction

° Monovison „non-dominant“

Pockets und Corneal Inlays

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Implantation Presbia Corneal Inlay

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Presbia Inlay in Situ

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° Signifikanter Anstieg des Nahvisus (operiertes Auge)

°Diskreter Verlust des Fernvisus (operiertes Auge)

° Binokular guter Fern und Nahvisus

Presbia bei Emmetropen

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0,13

0,350,32

0,32

-0,30

-0,20

-0,10

0,00

0,10

0,20

0,30

0,40

0,50

0,60

0,70

0,80

0,90

1,00

Preop 1M 3M 6M

UCDVAOP-Augen(logMAR)

0,76

0,230,20

0,18

-0,30

-0,20

-0,10

0,00

0,10

0,20

0,30

0,40

0,50

0,60

0,70

0,80

0,90

1,00

Preop 1M 3M 6M

UCNVAOP-Augen(logMAR)

0.070.01 0.00

-0.02

-0.30

-0.20

-0.10

0.00

0.10

0.20

0.30

0.40

0.50

0.60

0.70

0.80

0.90

1.00

Preop 1M 3M 6M

Binocular UCDVA (logMAR)

Refractive Surgery

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pIOL

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IPCL Phakic Multifocale IOL

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Age at ICL Implantation ./. Cataract Surgery

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Mean age is 42 years at ICL implantation vs. 34 years of total ICL population

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Refractive Surgery

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RLE

The Ideal Presbyopia Correcting IOL

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° Defocuscurve: The patient's best-corrected distance visual acuity, graphed on the Y-axis at zero, which

represents infinity. Minus lenses are added to the best-corrected distance visual acuity. Plotting the acuity

while viewing through a series of progressively more minus lenses creates the defocus curve for near objects.

1,0

0,5

Vis

us

(dezim

al)

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°Oculentis Plus

Rotationally Asymetric OpticsLow Addition Well Tolerated High Addition Not !

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° Shaping additional foci

Diffractive Multifocal Optics

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o Stepwidth determines the power of near add

o Stephight deternines distribution of light (distance/intermediat/near)

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MTF

Bifocal / Trifocal

IOL

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Trifocal IOL

• Intermediate VA is reduced under mesopic conditions

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Monokular 20/22 20/40 20/32

Binokular 20/22 20/32 20/25

Binokular vs Monokular

Binokular: Photopic vs Mesopic

Photopic 20/25 20/32 20/32

Mesopic 20/25 20/40 20/321. Alió JL, Montalbán R, Peña-García P, Soria FA, Vega-Estrada A. Visual outcomes of a trifocal aspheric diffractive intraocular lens with microincision cataract surgery. J Refract Surg. 2013

Nov;29(11):756-61.

2. Sheppard AL, Shah S, Bhatt U, Bhogal G, Wolffsohn JS. Visual outcomes and subjective experience after bilateral implantation of a new diffractive trifocal intraocularlens. J Cataract Refract

Surg. 2013 Mar;39(3):343-9. doi: 10.1016/j.jcrs.2012.09.017.

FineVision. AcriLisaTri PanOptix

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° Pinhole IOL

• Pseudoaccommodation

• Elimination:

• Astigmatism

• Aberrations

• Disadvantage: Loss of light

• Monovison

Improving Depth of Focus

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EDOF - Extended Depth Of Focus

° IOL generates

Focuselongation

Daten: Dr. Hoffmann (Castrop-Rauxel)

AMO Tecnis Symfony

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Bifocal and Trifocal IOL

show little tolerance with

regard to residual

astigmatism

EDOF:

High tolerance

with regard to

residual

astigmatism

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More comfort

• good vision at all

distances

Less quality:

o Very light

dependend

o At night halo, glare

and starburst

o At daylight waxy

vision

Dysphotopsia Diffractive MF-IOL

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IOL

Baukasten

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Dr. Schmidt MS714 PB diff

Hydrophilc Sulcus AddOn-IOL Models

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Cristalens Reverso 1stQ AddOnRayner Sulcoflex

Optik 6,5mm

Haptik 13,8m

Vorderseite konvex | Rückseite konkav

Haptik 100 angewinkelt

Bifokal

Add-dpt +1,5; +2,0; +2,5 oder +3,0

Basis bis ±3,0dpt

Keine torische Variante

Optik 6,0mm konkav

Haptik 13,0mm

Vorderseite konvex | Rückseite konkav

Haptik 100 angewinkelt

Bifokal

Add-dpt ????

F ? I ? N ?

Basis bis ±5,0dpt

Torische Variante

Optik 6,5mm

Haptik 14,0mm

Vorderseite konvex | Rückseite konkav

Haptik 100 angewinkelt

Trifokal

Add-dpt +1,75 und +3,5

Basis bis ±3(±7)dpt

Torische Variante +1,0cyl bis + 6,0cyl

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Adding MF Suclus IOL over PCL

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Construction Kit

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• Toric PCL & MF AddOn IOL

• MF PCL & Torical AddOn IOL

• PCL & Torical MF AddOn IOL

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Removing Additional MF Sulcus IOL

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Consider The Visual Demands

°Trifocal PCL °EDOF PCL

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AddOnRotationally AsymetricPinhole

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Consider The Risk Of Surgery

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Refractive Surgery

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RLE

LVC

pIOL

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Thank You

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