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Surgical Correction of Presbyopia Con N. Moshegov Sydney
Treatment Modalities ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Conductive Keratoplasty ,[object Object],[object Object],CK tmt points
Conductive Keratoplasty ,[object Object],[object Object]
CK: good points ,[object Object],[object Object],[object Object],[object Object]
CK: not so good points ,[object Object],[object Object],[object Object],[object Object],[object Object]
PRK and LASIK ,[object Object],[object Object],[object Object],[object Object]
Patterns of Multifocal Ablation Near Far Near Far Far Near
Aspheric Ablations for  Presbyopia Correction Canadian Clinical Trial
Monocular Simultaneous Uncorrected Distance and Near Vision 20/25 or better J3 or better 77% of  eyes  achieve both 20/25 distance  and  J3 near  or better
Aspheric Ablation: good points ,[object Object],[object Object]
Aspheric Ablation: not so good points ,[object Object],[object Object]
Intracorneal Inlays ,[object Object],[object Object]
CURRENT CORNEAL INLAYS Micro-porous hydrogel (Nutrepore) for permeability of nutrients within the cornea Kynar (opaque polymer) with a small central apperture 78% water-permeable biocompatible hydrogel 45% hydrogel (Hefilcon-A) Material 1.5 mm 3.8 mm 3.0 mm 1.8 mm to 2.2 mm Diameter 10  μ m 10  μ m 20  μ m 0.03 mm  to  0.006 mm  Thickness ReVision Optics PresbyLens ® AcuFocus ACI 7000 ® Biovision Invue ™  Intracorneal Microlens System AcuFocus Hydrogel Lens ®
AcuFocus ACI 7000 ®  (Bausch & Lomb) PresbyLens ® ReVision Optics
 
 
[object Object],[object Object],[object Object],[object Object]
Inlay: good points ,[object Object],[object Object],[object Object]
Inlay: not so good points ,[object Object],[object Object],[object Object]
Intracorneal Inlay ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Scleral Expansion Bands ,[object Object],[object Object],[object Object]
SEB: good points ,[object Object],[object Object]
SEB: not so good points ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Laser Assisted Presbyopia Reversal (LAPR) ,[object Object],[object Object]
LAPR ,[object Object],[object Object],[object Object]
LAPR cosmetic appearance 1 week 4 months 7 months
LAPR complications ,[object Object],[object Object],[object Object]
LAPR ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
[object Object],[object Object],[object Object],Intraocular implants
Accommodating IOLs
 
 
CrystaLens (Stasiuk) ,[object Object],[object Object],[object Object]
CrystaLens: does it really vault? ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
HumanOptics 1CU ,[object Object],[object Object],[object Object]
Human Optics 1CU ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
[object Object],[object Object]
[object Object],[object Object]
[object Object],[object Object],[object Object],Design Theory vs. Practice
[object Object],[object Object],[object Object],[object Object]
[object Object],[object Object],[object Object]
The ARRAY ® IOL Refractive  Multifocal IOL Design ,[object Object],[object Object],[object Object]
3 rd   (distance dominant) ring enlarged and moved  3.4mm-3.9mm to 3.45mm-4.3mm 4 th   (near dominant) ring  shifted from  3.9mm-4.6mm to 4.3mm-4.6mm (and thinned out)
AMO ReZoom ™ ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
[object Object],[object Object],[object Object]
AMO Tecnis ZM9000 and Alcon ReSTOR
AMO Tecnis: Full Optic Diffractive
Alcon ReSTOR: Partial Optic Diffractive Apodized ,[object Object],[object Object],[object Object]
[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Average Intermediate Acuity  (at 60cm) ReSTOR ReSTOR/Array ReSTOR/ReZOOM ReSTOR ReSTOR/Array ReSTOR/ReZOOM P=0.0144 Array better BCVA than ReSTOR P=0.0694 Array better UCVA than ReSTOR
Average Near Acuity  (at 30cm) ReSTOR ReSTOR/Array ReSTOR/ReZOOM ReSTOR ReSTOR/Array ReSTOR/ReZOOM
And…Spectacle Independence
AcrySof ®  ReSTOR ®  Aspheric IOL ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Physical Comparison ,[object Object],[object Object],[object Object],+4 D, 12 zones +3 D,  9 zones
Mean Distance Corrected Intermediate VA 20/25 20/32 VAs are approximately 1.5 lines better for ReSTOR® Aspheric +3 D  20/20 20/40 Data on File.  Alcon, Inc.
Mean Visual Disturbances Data on File.  Alcon, Inc. Mild Moderate Severe None
[object Object]
Future IOLs ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Presbyopia treatment today ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]

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Advances in presbyopia treatment

  • 1. Surgical Correction of Presbyopia Con N. Moshegov Sydney
  • 2.
  • 3.
  • 4.
  • 5.
  • 6.
  • 7.
  • 8. Patterns of Multifocal Ablation Near Far Near Far Far Near
  • 9. Aspheric Ablations for Presbyopia Correction Canadian Clinical Trial
  • 10. Monocular Simultaneous Uncorrected Distance and Near Vision 20/25 or better J3 or better 77% of eyes achieve both 20/25 distance and J3 near or better
  • 11.
  • 12.
  • 13.
  • 14. CURRENT CORNEAL INLAYS Micro-porous hydrogel (Nutrepore) for permeability of nutrients within the cornea Kynar (opaque polymer) with a small central apperture 78% water-permeable biocompatible hydrogel 45% hydrogel (Hefilcon-A) Material 1.5 mm 3.8 mm 3.0 mm 1.8 mm to 2.2 mm Diameter 10 μ m 10 μ m 20 μ m 0.03 mm to 0.006 mm Thickness ReVision Optics PresbyLens ® AcuFocus ACI 7000 ® Biovision Invue ™ Intracorneal Microlens System AcuFocus Hydrogel Lens ®
  • 15. AcuFocus ACI 7000 ® (Bausch & Lomb) PresbyLens ® ReVision Optics
  • 16.  
  • 17.  
  • 18.
  • 19.
  • 20.
  • 21.
  • 22.
  • 23.
  • 24.
  • 25.
  • 26.
  • 27. LAPR cosmetic appearance 1 week 4 months 7 months
  • 28.
  • 29.
  • 30.
  • 32.  
  • 33.  
  • 34.
  • 35.
  • 36.
  • 37.
  • 38.
  • 39.
  • 40.
  • 41.
  • 42.
  • 43.
  • 44. 3 rd (distance dominant) ring enlarged and moved 3.4mm-3.9mm to 3.45mm-4.3mm 4 th (near dominant) ring shifted from 3.9mm-4.6mm to 4.3mm-4.6mm (and thinned out)
  • 45.
  • 46.
  • 47. AMO Tecnis ZM9000 and Alcon ReSTOR
  • 48. AMO Tecnis: Full Optic Diffractive
  • 49.
  • 50.
  • 51. Average Intermediate Acuity (at 60cm) ReSTOR ReSTOR/Array ReSTOR/ReZOOM ReSTOR ReSTOR/Array ReSTOR/ReZOOM P=0.0144 Array better BCVA than ReSTOR P=0.0694 Array better UCVA than ReSTOR
  • 52. Average Near Acuity (at 30cm) ReSTOR ReSTOR/Array ReSTOR/ReZOOM ReSTOR ReSTOR/Array ReSTOR/ReZOOM
  • 54.
  • 55.
  • 56. Mean Distance Corrected Intermediate VA 20/25 20/32 VAs are approximately 1.5 lines better for ReSTOR® Aspheric +3 D 20/20 20/40 Data on File. Alcon, Inc.
  • 57. Mean Visual Disturbances Data on File. Alcon, Inc. Mild Moderate Severe None
  • 58.
  • 59.
  • 60.

Editor's Notes

  1. The Array is a refractive IOL with five zones all offering near, intermediate and distance vision utilising 100% of available light. Zones 1,3 and 5 are weighted for distance and 2 and 4 are weighted for near.
  2. OUR LABEL MA60D3 None=81.0% SA60D3 None=75.7% MA60BM None=7.7%