abifocal refractive trifocal diffractive IOLh24-files.s3.amazonaws.com/50165/117579-dQGLU.pdf · Jérôme C. VRYGHEM, M.D. Steven HEIREMAN, M.D. Comparison of the visual outcomes

$Page 1: abifocal refractive trifocal diffractive IOLh24-files.s3.amazonaws.com/50165/117579-dQGLU.pdf · Jérôme C. VRYGHEM, M.D. Steven HEIREMAN, M.D. Comparison of the visual outcomes$
Jérôme C. VRYGHEM, M.D.

Steven HEIREMAN, M.D.

Comparison of the visual outcomes

of

a bifocal refractive versus

a trifocal diffractive IOL


Clinique St-Jean, Brussels

Brussels Eye Doctors, Brussels

Belgium

No financial interest !

� AMO Array 1997

� Ioltech MF4

� Crystalens AT-45

Humanoptics 1CU

My experience

Multifocal and accomodative IOL’s

� Humanoptics 1CU

� Acri.Twin

� Acri.Lisa

� Physiol FineVision

� Trifocal diffractive� Oculentis M Plus

� Bifocal Refractive

Two new multifocal IOL’s

N=100 eyes N=250 eyes

OCULENTIS Mplus

A new concept of multifocal IOL technology:

6 months results

OCULENTIS Mplus

A new concept of multifocal IOL technology:

6 months results

Jérôme C. VRYGHEM, M.D.Jérôme C. VRYGHEM, M.D.




Belgium


Oculentis Mplus

� One-piece multifocal IOL with refractive design

� Aspheric, asymmetric distance-vision zone

� Sector-shaped near-vision zone of +3.00 D

� Seamless transition zone

Oculentis Mplus

Oculentis Mplus

� Acrylic material

� 360°continuous square optic and haptic edge

� Independent of pupil size

� Reflection of light hitting the transition area away

from the optical axisfrom the optical axis

◦ To prevent superposition of interference or diffraction

◦ Minor loss of light intensity

◦ Improved contrast sensitivity

◦ Reduced glare and halo effects

Oculentis Mplus

� IOL calculation

◦ IOL-Master in all eyes

◦ A-constant: 118.0

IOL-positioning� IOL-positioning

◦ Marks on the optic of the IOL

◦ IOL to be rotated in vertical position with reading segment

positioned inferiorly

� MICS

Clinical Study

Settings

� Retrospective study

(Clinique St-Jean Brussels and Brussels Eye Doctors)

Oculentis MPlus

� 25 patients (24 binocular and 1 monocular), 49 eyes

� Mean age: 72 years (39 - 87 years)

� Follow-up ≥ 6 months

� Cataract and RLE patients

� No other pathology

� Pre-op astigmatism ≤ 1 D

Clinical Study

Selection of patients

Oculentis MPlus


� Uneventful surgery

� No surgically induced astigmatism:

MICS with temporal incision of 1.9 mm

� UCDVA and BCDVA

� UCNVA

� Refraction

Clinical Study

Methods

Oculentis MPlus

� Refraction

� Defocus curve

� Questionnaire to evaluate:

◦ Independence towards reading glasses

◦ Patient satisfaction

� Mean UCDVA: 0.88 ± 0.24 (0.4 -1.5)

Clinical Study

Results: VA

Oculentis MPlus

N=49

� Mean BCDVA: 1.02 ± 0.22 (0.6 -1.5)

Clinical Study

Results: VA

Oculentis MPlus

N=49

� Mean UCNVA: Parinaud 3.75

(Parinaud 7 – Parinaud 1.4)

Clinical Study

Results: VA

Oculentis MPlus

N=49

� Average spherical equivalent: 0.02 ± 0.24 D

Clinical Study

Results: Refraction

Oculentis MPlus

N=49

� IOL repositioning: 4 % (1 patient)

� Secondary refractive retreatment: 4% (1 patient)

Clinical Study

Results: Defocus Curve

Oculentis MPlus

0,4 at intermediate

distance

N=49

� Would you undergo implantation with this lens type again?

◦ Yes: 88 % (22 patients)

◦ No: 4 % (1 patient)

◦ Undecided: 8 % (2 patients)

Clinical Study

Results: Questionnaire

Oculentis MPlus

◦ Undecided: 8 % (2 patients)

� Use of near spectacles:

◦ No: 52 % (13 patients)

◦ Yes:

� Only for small characters: 12 % (3 patients)

� Always: 36 % (9 patients)

� Use of distance spectacles: none

� Ghost images: 4 % (1 patient)

Clinical Study


Oculentis MPlus

� Double images: none

� Halos

◦ Spontaneously: 8 % (2 patients)

◦ On inquiry: 20 % (5 patients)

� Glare

Clinical Study


Oculentis MPlus

� Glare

◦ Spontaneously: 4 % (1 patient)


� Discoloration

◦ Spontaneously: 4 % (1 patient)


� Subjective quality of vision

Clinical Study


Good Average Poor

Watching TV 92 % 8 % 0 %

Oculentis MPlus

Watching TV 92 %(23 patients)

8 %(2 patients)

0 %

Reading a book 76 %(19 patients)

16 %(4 patients)

8 %(2 patients)

Needlework 80 %(20 patients)

20 %(5 patients)

0 %

� Good distant and intermediate VA

� Average near VA

Conclusion

Oculentis MPlus

� Halos spontaneously reported in 8% of patients

� High patient satisfaction

J. C. Vryghem, S. Heireman


Early results with the

implantation of the

Physiol FineVision :

a new trifocal diffractive IOL





Belgium


Same platform as Physiol Micro AY

Material :

• Hydrophilic Acrylate with 25 % water content

Yellow: UV and blue light blocker

Dimensions : Overall 10.75 mm

Physiol FineVision

Dimensions : Overall 10.75 mm

Optic body 6.15 mm

Angulation : 5°

A-constant : 118.9 (IOL-Master), 118.5 (US)

Optic is biconvex and aspheric

Power range: 10.00 to 30.00 D in 0.50 D steps

Trifocal diffractive (over the whole optic) IOL

achieved by the combination of 2 bifocal patterns

(+1.75 D add and +3.50 D add)

Physiol FineVision

F ar

I ntermediate Vision

NE ar

Bifocal diffractive lens

Physiol FineVision

Trifocal diffractive lens

First diffractive grating Second diffractive grating

Order 0 Far vision Far vision

Order 1 3.5 D Near vision 1.75 D Intermediate vision

Combination of two diffractive patterns

Physiol FineVision

Order 1 3.5 D Near vision 1.75 D Intermediate vision

Order 2 Lost light (+ 7 D) + 3.5 D Near vision

The second order of the +1.75D add diffractive grating is reinforcing

the first order of the +3.5D add diffractive grating, providing an

improvement in intermediate vision in maintaining far and near

vision

This IOL is apodized: the step height decreases from the center

towards the periphery.

Physiol FineVision

This diffractive pattern is then pupil dependent allocating more

energy to far vision in dim conditions (large pupil).

30

40

50

60%

En

erg

y

Near

Far

Physiol FineVision

0

10

20

30

1,50 2,00 2,50 3,00 3,50 4,00 4,50 5,00

Pupil diameter (mm)

Near

Intermediate

� Prospective observational study (Clinique St-Jean

Brussels and Brussels Eye Doctors)

� 32 eyes, 16 patients (binocular)

Clinical Study

Settings

Physiol FineVision

� Mean age: 75 ± 10 years (65 - 84 years)

� Mean preoperative best corrected visual acuity

0.59 ± 0.15

� Cataract and RLE patients

� No other pathology

Settings: Patient selection

Physiol FineVision


� Uneventful surgery by the same surgeon (JCV)

� IOL calculation

◦ IOL-Master in all eyes

◦ A-constant : 118.5 !!!

Physiol FineVision

Settings: Surgical parameters

� IOL-positioning: autocentering

� MICS with temporal incision of 1.9 mm:

No surgically induced astigmatism

Methods

2 months post-op:

� Distance VA

� Near and intermediate VA

� Mesopic VA

� Refraction

Physiol FineVision

� Refraction

� Defocus curve

� Questionnaire to evaluate:

◦ Independence towards reading glasses

◦ Patient satisfaction

40

50

60

70

80

Pe

rce

nta

ge

of

ey

es

Mean spherical equivalent = 0.03 ± 0.3 D100% ≤ -0.5 and +0.5 D

Results Postoperative refraction

Physiol FineVision

0

10

20

30

40

-1 -0,5 0 0,5 1

Pe

rce

nta

ge

of

ey

es

Achieved postoperative spherical equivalent (D)

Mean monocular UCVA

0.90 ±±±± 0.20

100% ≥ 0.5 78% ≥ 0.8 (dryness)

Results:

Distance Uncorrected VA

Physiol FineVision

100% ≥ 0.5 78% ≥ 0.8 (dryness)

Mean binocular UCVA

1.13 ±±±± 0.24

100% ≥ 0.5 100% ≥ 0.8

Mean monocular BDCVA

0.96 ±±±± 0.17

100% ≥ 0.5 90.6% ≥ 0.8

Results:

Best Distance Corrected VA

Physiol FineVision

100% ≥ 0.5 90.6% ≥ 0.8

Mean binocular BDCVA

1.14 ±±±± 0.23

100% ≥ 0.5 100% ≥ 0.8

Mean monocular UCIVA:

Parinaud 2.46 ±±±± 1.09

96,9% ≤ P4 84,3% ≤ P3

Physiol FineVision

Results:

Uncorrected Intermediate VA

Parinaud 2 = Jaeger 1

96,9% ≤ P4 84,3% ≤ P3

Mean binocular UCIVA:

Parinaud 1. 69 ±±±± 0.53

100% ≤ P4 100% % ≤ P3

Mean monocular UCNVA

Parinaud 1. 34 ±±±± 0.50

100% ≤ P3 93.75% ≤ P2

Physiol FineVision

Results:

Uncorrected Near VA

100% ≤ P3 93.75% ≤ P2

Mean binocular UCNVA

Parinaud 1. 08 ±±±± 0.16

100% ≤ P3 100% % ≤ P2

Results: Defocus curve

Physiol FineVision

0,6

0,8

1

1,2

1,4Visual

acuity

(Decimal)Defocus add (D)

0

0,2

0,4

0,6

-4-3-2-1012

Binocular defocus curve (16 patients)

Apodization outcomes: near and intermediate visual acuities drop in mesopic conditions for far vision enhancement.

4

5

6

Vis

ua

l a

cuit

y (

Pa

rin

au

d) Intermediate

Neart-test small sample

Results: Mesopic VA

Physiol FineVision

0

1

2

3

4

Vis

ua

l a

cuit

y (

Pa

rin

au

d)

MesopicPhotopic

t-test small sample

p<0.05

60%

80%

100%

Good

quality of

vision94 %� Would you undergo

implantation with this lens type

again?

◦ Yes: 76 %


Physiol FineVision

0%

20%

40%

Use of

distance

spectacles

Use of

near

spectacles

◦ Yes: 76 %

◦ 24 % cannot answer because

they cannot compare.

60%

80%

100%

Good

quality of

vision

� Use of near

spectacles:

◦ No: 82 %

◦ Yes:

� Only for small


Physiol FineVision

0%

20%

40%

Use of

distance

spectacles

Use of

near

spectacles

� Only for small

characters: 18 %

� Always: none

� Use of distance

spectacles: 6 %18 %

6 %

20%

40%

60%

80%

100%No ghost image

No double imageNo difficulties for

light transition


Physiol FineVision

0%

20%

No halos

No glare

No discoloration

Halos:◦ Spontaneously: 9 % ◦ On inquiry: 9 %

Glare: 6 %

Good Average Poor

� Subjective quality of vision


Physiol FineVision

Watching TV 100 % none none

Reading a book 94 % 6 % none

Needlework 94 % 6 % none

� Good distance, intermediate and near VA

� Apodization to favor night vision is effective

Conclusions

Physiol FineVision

� High(er) patient (and surgeon)

satisfaction

The design of the Physiol FineVision trifocal diffractive IOL

adds intermediate vision

with no significant decrease in near and distance vision

as compared to currently available bifocal IOL’s

Conclusions

Physiol FineVision

Thank you

for

your attention!

www.vryghem.be

Documents

abifocal refractive trifocal diffractive IOLh24-files.s3.amazonaws.com/50165/117579-dQGLU.pdf · Jérôme C. VRYGHEM, M.D. Steven HEIREMAN, M.D. Comparison of the visual outcomes