Premium IOL and Cataract

Co-ManagementJ. Alberto Martinez, M.D.

Visionary OphthalmologyOctober 3, 2010

Testimonial

OUTLINE

THE MARKET AND THE OPORTUNITY

ETHICAL CONCERNS

TECHNICAL ASPECTS

LEGAL

SURGICAL

POSTOPERATIVE CARE

The Graying of America

Another boomer turns 50 years of age every 7 seconds

They represent the majority of the US workforce

They are the US economic engine

13 trillion in assets ( 50% of US asset base)

Average life span of 78.5 men, 82.5 women

As they age: glaucoma, diabetic eye disease and cataracts

The graying of America

Are you prepared to meet boomers health care challenges?

Are you current with technological advances?

Are you embracing the newest ophthalmic technologies?

Their increased expectations regarding outcomes is unprecedented!

We can not afford to wait. This wave has come to shore!

Ethical Concerns

Ethical concerns are absolutely above any considerations

Needless to say, the patient’s welfare must remain the top priority of the MD-OD team

World class outcomes can not be compromised by transfer of care

Team approach must benefit the patient first and MD-OD team second.

Legal concerns

Co-management more common but still controversial

It is critical that any c0-management relationship be ethical and compliant with all legal requirements

Professional societies including AOA have guidelines

Fundamental: no agreement to refer back. Must be based on patient choice

Legal Concerns

Patients must understand clearly who can provide post-op care

Patients must choose to return to OD and sign a statement

Work with a knowledgeable attorney

Medicare rules are clear on the amounts paid for surgery and for post-op care

OD must receive fair market value for their services

Legal Concerns

Patient must be informed about the amounts paid to each provider

Visionary Ophthalmology will develop a mechanism to allocate appropriate amounts

Premium IOLs are most complex c0-management arrangement for it involves covered and non-covered services

VO is committed to develop an ethical, legal and fair co-management practice.

High Technology IOLs

Many IOLs available. Choosing is a complex decision.

Surgeons need to take into account:

Patient’s desires and epectations

Status of the non-operative eye

Presence of any comorbidities

Potential risks

Spherical aberration occurs when light rays are over-refracted at the periphery of a lens system,resulting in a region of defocused light which candecrease image quality.

The Problem: Spherical Optics

*Smith G, Atchinson D A. The Eye and Visual Optical Instruments. Cambridge University Press, Cambridge, United Kingdom. 1997;667.

Aspheric optics align the light rays to compensate for

positive corneal spherical aberration, resulting inenhanced image quality.

The Solution: Aspheric Optics

*Smith G, Atchinson D A. The Eye and Visual Optical Instruments. Cambridge University Press, Cambridge, United Kingdom. 1997;667.

Clinical improvements

demonstrated over spherical

control lens include:• Improved functional

vision • Increased contrast

sensitivity• Reduction of

spherical aberration and total high order aberrations (HOAs)

Benefits of Asphericity

Why Toric IOL?

The AcrySof® IQ Toric IOL offers cataract surgery patients

with astigmatism:

Reduction of residual refractive cylinder

Improved uncorrected distance visual acuity

Increased spectacle-independent distance vision

Selection criteria for Toric IOL

Preoperative regular astigmatism

CCC possible

Intact capsular bag

Precautions in patients with pre-existing ocular disease conditions

Careful consideration in the cases of those with prior corneal refractive surgery

AcrySof® IQ Toric IOL isdesigned to

accommodatea variety of cataractpatients with

astigmatism

A wide range of cylinder powers means more candidates can benefit from AcrySof® IQ Toric

IOL

Designed for a Wide Range of Astigmatic Patients

63% of patients achieved ≤0.50 diopters of residual refractive cylinder1

87% of patients achieved ≤1.00 diopters of residual refractive cylinder1

Dramatically Reduces Residual Refractive Cylinder

The AcrySof® IQ Toric IOL:

Builds on a long line of innovation from Alcon

Takes the trusted platform for precise astigmatism correction and adds the enhanced image quality of an aspheric lens

The Next Step in Toric Technology

Presbyopia-correcting IOLs

Crystalens: an accomodating IOL. Reversible and unpredictable

Rezoom: A refractive mutifocal IOL (AMO)

Restor: Difractive IOL (Alcon)

Tecnis: Difractive IOL (AMO)

1Q08 2Q08 3Q08 4Q08 1Q09 2Q09 3Q09 4Q09 1Q100%

10%

20%

30%

40%

50%

60%

70%

80%

90%

100%

49.5 46.5 45.4 45 47.453.1 54.5 57.5 54.7

18.517.5

13.27.4 7.4

4.7 2.72.3

2.4

3236

41.445.5 43.4

36.3 34.429.3 27.2

1.7

5.9 8.410.9 15.2

AcrySof® ReSTOR® ReZoom* Tecnis MF* Crystalens*

Survey Share by Quarter

Perc

en

t of

Su

rvey S

hare

US Presbyopia-Correcting IOL Survey Share

Source: Market Scope Quarterly Cataract Update* Trademarks are the property of their respective owners.

Two Different Add Power Options

SN6AD3Add Power: +4.0 DSpectacle Plane: +3.2 DRange: +10.0 D to +34.0 D A-Constant: 118.9

SN6AD1Add Power: +3.0 DSpectacle Plane: +2.5 DRange: +6.0 D to +34.0 D A-Constant: 118.9

Source: AcrySof® IQ ReSTOR® IOL Package Insert.

AcrySof® IQ ReSTOR® IOL +3.0 D was specifically designed to: Maintain existing

optical design characteristics and manufacturing processes

Move near vision distance out 6-7 cm

Improve intermediate vision without sacrificing distance and near1

True Performance at All Distances

Source: AcrySof® IQ ReSTOR® IOL Package Insert.1.Maxwell A, et al. Functional Outcomes After Bilateral Implantation of Apodized Diffractive Aspheric Acrylic Intraocular Lenses with a +3.0 or +4.0 Diopter Addition Power. J Cataract Refractive Surg. Vol. 35, December 2009.

Patient Education

Define• Clouding of the

natural lens that allows less light to pass through to the retina

Symptoms• Blurred vision• Dull colors• Poor night vision• Sensitivity to light

Treatment• ONLY treatment is to

have it surgically removed and replaced with an artificial lens

Begin with the Problem: Cataracts

Take into account: Pathology Lifestyle Astigmatism Preexisting ocular conditions, i.e. dry

eye

Consider Their Needs

Before they leave the office, patients should have:

Educational materials on cataracts and the procedures

Materials that explain their IOL options A follow-up appointment for their cataract

surgical evaluation

Keep Them Informed

Post Operative Care

• Measure visual acuity Test all distances if the patient has a

presbyopia-correcting IOL

• Look for a quiet anterior chamber

• Continue antibiotic, steroidal and NSAID therapy

• Treat dry eye aggressively

What to Expect After Surgery – Day One

VO is committed to educating co-management physicians to provide seamless care.

Mini-fellowships to include:Day one post-op care at VOThree week post-op visit at VOPre-op evaluation and choosing the apropriate

IOLOR visit at our ASC to learn the technical issues

associated with Toric and Multifocal IOLEducational process tailored to individual needs

Educational Process for Optometrists

Premium IOLs are not only great technology to offer patients but can have a significant financial impact in

your practice as well

Financial Rewards

“To be on the cutting edge of optometry, you need to

be on the cutting edge of ophthalmology.”

- Richard Van De Velde, O.D.

Imhoff Eye Center Brunswick, GA

Today’s optometrist provides…• Patient care at any age• Patient support • Patient education for all conditions

Today's Optometrist

Testimonial