Trust your eyes. - ?· Trust your eyes. Presbyopic treatment ... Independent from pupil size near intermediate…

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    07-Jul-2018

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    Trust your eyes.

    Presbyopic treatment methods on the cornea

    PresbyMAX The Principle

    PresbyMAX Expectations and Key Factors

    PresbyMAX Upcoming Software Features

    PresbyMAX Decision criteria and patients acceptance

    Directory

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    0%

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    120%

    0 1 2 3 4 5 6 7 8

    Object distance (m)

    Vis

    ual

    Acu

    ity

    (%)

    Emmetrope 25yo

    Emmetrope 45yo

    Emmetrope 55yo

    0%

    20%

    40%

    60%

    80%

    100%

    120%

    0,00 0,10 0,20 0,30 0,40 0,50 0,60 0,70 0,80 0,90 1,00

    Object distance (m)

    Vis

    ual

    Acu

    ity

    (%)

    Emmetrope 25yo

    Emmetrope 45yo

    Emmetrope 55yo

    Introduction and Basics:Visual Acuity and Object Distance related to Age

    The average distance (more than 1 m) visual acuity in emmetropes until 45 years of age is high, the senior population shows diminished performance.

    The average near (less than 1 m) visual acuity in emmetropes until 40 years of age is ok, the senior population shows diminished performance.

    Advantage/Comfort Disadvantage/Discomfort

    Introduction and Basics:Monovision

    Clear focus, i.e. sharp retinal image Anisometropia (more than 1 D)

    Highly accept in patients and physicians Loss in stereopsis

    Independent from pupil size

    near

    intermediate

    farDE

    NDE

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    Advantage/Comfort Disadvantage/Discomfort

    Introduction and Basics:Bi-Focality

    Clear foci; i.e. two sharp images on the retinaDisturbing vision because of steps between zones

    Does typically not cover the whole distance range, especially not the intermediate part

    Pupil size critically dependent

    near

    intermediate

    far

    OR

    DE

    NDE

    Advantage/Comfort Disadvantage/Discomfort

    Introduction and Basics:Q-value adjusted

    Extended depth-of-focusThe Q-value is no predictor for visual performance

    The Q-value describes the shape between the cornea centre and periphery

    Influenced by the change in radius of curvature (dioptric power); i.e. kind of unpredicted

    Unilateral (non-dominant eye)

    near

    intermediate

    far

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    Advantage/Comfort Disadvantage/Discomfort

    Introduction and Basics:Multifocality

    Covers the whole distance range due to different foci for distance, intermediate, near

    Pupil size dependent

    Typically bilateral which keeps stereopsis Time of (neural) adaptation

    Possibly reduced contrast sensitivity

    near

    intermediate

    far

    OR

    DE

    NDE

    micro-monovision (ZEiSS) Aspheric (Nidek) PresbyMAX PresbyMAX -monovision

    DominantEye

    Non-dominantEye

    near

    far

    near

    far

    near

    far

    near

    far

    SCHWIND PresbyMAX

    vs. Competing Multifocal Technologies

    near

    intermediate

    far

    near

    far

    near

    far

    far

    near

    far

    near

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    Near(40cm)

    Intermediate(70cm)Far (>5m)

    MonovisionDENDE

    AMO VISXCustomVue Presbyopia

    DENDE

    Technolas PVSupracor

    DENDE

    NidekPAC Aspheric

    DENDE

    ZEiSSLaser Blended Vision

    DENDE

    Alcon WavelightQ-value adjusted

    DENDE

    SCHWIND PresbyMAX

    DENDE

    SCHWIND PresbyMAX -

    monovision

    DENDE

    SCHWIND PresbyMAX

    vs. Competing Technologies

    Alternative Presbyopic Solutions:IntraCOR

    Advantage/Comfort Disadvantage/Discomfort

    No refractive correction procedure, i.e. for emmetropes only Fast visual recovery

    No reverse application or re-treatmentMinimally invasive

    Difficulties in post-LASIK patients exist

    Intrastromal presbyopia treatment using photodisruption with the Technolas femtosecond

    Five rings (1.8, 2.2, 2.6, 3.0 and 3.4 mm in diameter) are created

    Cutting design and stromal depth based on refractive error

    A shift towards myopia exists due to central corneal steepening (hyper-prolate shape)

    Difficulties for LASIK post-IntraCOR

    No tissue removal

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    Alternative Presbyopic Solutions:Corneal Inlay

    Advantage/Comfort Disadvantage/Discomfort

    Easily removed or replacedNo refractive correction procedure, i.e. for emmetropes only

    Increased depth-of-focus without tissue removal

    Really fast recovery

    Intracorneal inlays have been designed to create a small aperture effect or central steepening.The implant is intended to be placed intra-stromally either under a corneal flap or into a cornealpocket. Placement of the CI will be centered over the pupil, typically in the non-dominant eye.

    I. The AcuFocus Kamra corneal inlay (US): 3.8 mm, 10 m thick, central opening of 1.6 mm, thousands of small laser openings for good corneal nutrition transport

    II. Flexivue Micro-Lens (NL): clear circular implant of 1.5 mm, 10 m thick in the periphery, increase of 24 to 40 m to the centre, out of hydrogel (hydrophilic polymer)

    III. PresbyLens (US): clear circular implant of 2 mm like a tiny contact lens out of hydrogel

    Before PresbyMAX With PresbyMAX

    Presbyopia software that offersa broad treatment spectrum for different indications:

    Treatment of emmetropic, myopic,hyperopic, and astigmatic eyes

    Correction of these visual defects can beperformed as Aberration-Free orCustomized treatments

    Any treatment method possible:PRK, TransPRK, LASEK, LASIK and FemtoLASIK

    Limited treatment range

    e.g. only hyperopic patients

    e.g. only patients with minor astigmatism

    e.g. no presbyopia treatment ofemmetropic or myopic patients

    e.g. only in combination with standardtreatments

    e.g. only in combination with wavefrontguided treatments

    PresbyMAX - Unique Treatment Range

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    extendeddepth-of-focus

    PresbyMAX

    pseudo-far-point

    PresbyMAX

    pseudo-near-point

    foveola

    PresbyMAX

    multiaspheric cornea

    PresbyMAX - The Principle

    Introduction and Basics:Visual Acuity Scales

    Near Visual Acuity Scales

    logRAD(40 cm)

    Revised Jaeger(35 cm)

    Nieden(40 cm)

    -0.2 - -

    -0.1 - N1

    0.0 J1: = 1.00 N2

    0.1 J2: = 0.80 N3

    0.2 J4: = 0.63 N4

    0.3 J5: = 0.50 N5

    0.4 J6: = 0.40 N6

    0.5 J8: = 0.32 N7

    0.6 J9: = 0.25 N8

    0.7 J10: = 0.20 N9

    0.8 J12: = 0.16 N10

    0.9 J13: = 0.13 N11

    1.0 J14: = 0.10 N12

    Distance Visual Acuity Scales

    logMAR feet20/

    decimal

    -0.2 10 1.60

    -0.1 12.5 1.25

    0.0 20 1.00

    0.1 25 0.80

    0.2 32 0.63

    0.3 40 0.50

    0.4 50 0.40

    0.5 63 0.32

    0.6 80 0.25

    0.7 100 0.20

    0.8 125 0.16

    0.9 160 0.13

    1.0 200 0.10

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    PresbyMAX - ExpectationsReading Acuity vs. Print Size

    0.4 logRAD (J6; 20/50) 10 Pt @ 40 cm

    0.5 logRAD (J8; 20/63) 12 Pt @ 40 cm

    0.7 logRAD (J10; 20/100) 18 Pt @ 40 cm

    0.8 logRAD (J12; 20/125) 20 Pt @ 40 cm

    0.2 logRAD (J4; 20/30) 6 Pt @ 40 cm

    normally suffices to clearly recognize newspaper print in well lit conditions

    Pupil 3.0 mm 3.8 mm 4.5 mm 5.5 mm

    Far

    (6 m)

    Far Intermediate

    (1.5 m)

    Intermediate

    (70 cm)

    Near

    (40 cm)

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    Visual Acuity as a function of the object distance

    0%

    10%

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    30%

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    50%

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    70%

    80%

    90%

    100%

    0 1 2 3 4 5 6 7 8

    Object distance (m)

    Vis

    ual

    Acu

    ity

    (%)

    PresbyMAX V2 +3D (6 mm)

    PresbyMAX V2 +3D (3,8 mm)

    PresbyMAX V2 +3D (2 mm)

    Visual Acuity as a function of the object distance

    0%

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    0,00 0,10 0,20 0,30 0,40 0,50 0,60 0,70 0,80 0,90 1,00

    Object distance (m)

    Vis

    ual

    Acu

    ity

    (%)

    PresbyMAX V2 +3D (6 mm)

    PresbyMAX V2 +3D (3,8 mm)

    PresbyMAX V2 +3D (2 mm)

    Visual Acuity after PresbyMAX

    related to different Pupil Sizes

    Visual Acuity as a function of the object distance

    0%

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    120%

    0 1 2 3 4 5 6 7 8

    Object distance (m)

    Vis

    ual

    Acu

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    (%)

    Emmetrope (55 yo)

    PresbyMAX V2 +2D (50 yo)

    PresbyMAX V2 +3D (60 yo)

    Visual Acuity as a function of the object distance

    0%

    20%

    40%

    60%

    80%

    100%

    120%

    0,00 0,10 0,20 0,30 0,40 0,50 0,60 0,70 0,80 0,90 1,00

    Object distance (m)

    Vis

    ual

    Acu

    ity

    (%)

    Emmetrope (55 yo)

    PresbyMAX V2 +2D (50 yo)

    PresbyMAX V2 +3D (60 yo)

    As a compromise between multifocality, distance and near UCVAs, consider planning additions between 1.25 D to 2.50 D

    Visual Acuity after PresbyMAX

    related to different Additions

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    PresbyMAX - ExpectationsUncorrected Visual Acuity over time

    10

    15

    20

    25

    30

    35

    400 1 2 3 4 5 6 7 8 9 10 11 12

    Follow-up time (months)

    DU

    CV

    A (20

    /n)

    1

    2

    3

    NU

    CV

    A (Jm

    )

    DUCVA (20/n)NUCVA (Jm)

    The postoperative progress behaves in all refraction types similar but the acceptance patient by patient may differ.

    PresbyMAX - Key Factors for Success

    Patients with positive thinking preoperatively knowing that reduced distance vision postoperatively (DBCVA pre-op vs. UCVA post-op) may occur.

    Trial with multifocal conta