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Transcript of Gosford talk
AcrySof® IQ ReSTOR® Multifocal Toric IOL
Con Moshegov
Sydney
AcrySof®
MultiPiece
1994 2000 2003 2004 2005 2006
AcrySof®
TORIC
AcrySof®
Single Piece
AcrySof® Product Portfolio / Timeline
“Refractive” Optics
AcrySof® IQ
ReSTOR® +3
2008
+3
Presbyopia Correcting -IOLs Presbyopia Correcting -IOLs Most Often Used 2009Most Often Used 2009
Source: 2009 Leaming Survey
ReSTORReSTOR®® & Crystalens & Crystalens®®
US Market Share Trends US Market Share Trends
Source: 3Q09 Market Scope Quarterly Cataract Update
+28.2pt
29.3%
57.5%
45.7%
44.5%
Q4-07 Q4-08 Q4-09
30
35
40
45
50
55
60
-1.2pt
Overall Spectacle Wear
Portion of Time Wearing Glasses
Binocular – 6 Months Post op
0
10
20
30
40
50
60
70
80
90
100
Pe
rce
nta
ge
of
Pa
tie
nts
Never Sometimes Always
ReSTOR (n=29)
ReSTOR/Array (n=17)
ReSTOR/ReZoom (n=8)
Overall Spectacle Wear
Binocular – 6 Months Post op
13.0 mm
Anterior Apodized Diffractive Optic
6.0 mm6.0 mm
Symmetric Biconvex
Anterior Aspheric Optic
Anatomy of the Apodized Diffractive Technology
AcrySofAcrySof®® IQ ReSTOR IQ ReSTOR®® IOL IOL
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: +10.0 D to +34.0 D A-Constant: 118.9
IQ ReSTOR® IOL +4.0 D [N=131]
IQ ReSTOR® IOL +3.0 D [N=138]
26
28
30
32
34
36
Uncorrected
Cen
tim
ete
rs (
cm)
~6-7 cm difference
Source: AcrySof® IQ ReSTOR® IOL Package Insert
38
Average Near Best Distance
10
MoshegovMoshegov
Best near focus with ReSTOR +4: 32cm (median 34cm)
Best near focus with ReSTOR +3: 37cm (median 40cm)
Night Vision Problems Halos Glare
AcrySof ReSTOR +4 6 months
AcrySof ReSTOR +33 months
42%
8%
50%
ModerateNone, Mild Severe
62%
3%
35%
Visual Disturbances
Toric IOL Preferred 2009 Toric IOL Preferred 2009
Source: 2009 Leaming Survey
IOL Design – Rotational StabilityIOL Design – Rotational Stability
Adhesive nature of AcrySof® Toric IOL material provides high level of rotational stability
STABLEFORCE® haptic design allows the IOL to conform to the capsular bag
Promotes optimal placement and centration in different sized capsular bags
Average rotation of less than 4° at six months post-op
Measuring axis post-opMeasuring axis post-op
IOL rotationIOL rotation
Follow-up: I month post op n = 38 92% < 5° (highest was 7.5°) Direction: equal clockwise and anticlockwise
Angle Error (Degrees)
0.0%
5.0%
10.0%
15.0%
20.0%
25.0%
30.0%
35.0%
0 1 2 3 4 5 6 7 8 9 10
Angle Error (Degrees)
Un
der
corr
ecti
on
in
Ast
igm
atis
m
• For every 1°of rotation, 3.3% of the lens cylinder power is lost• For 30°of rotation there is a complete loss of astigmatic correction• Additional astigmatism or visual problems with greater than 30° of rotation
Post op: Toric vs. LRIPost op: Toric vs. LRI
Acrysof Toric SN60AT + LRIs
>/= 6/6 56% 24%
>/= 6/12 93% 85%
Post-op refractive cyl
0.48 D 0.97 D
Mean SE -0.45 -0.575
The Latest Advance in AcrySof® Technology
Australian launch: November 2010
AcrySofAcrySof®® IQ ReSTOR® IQ ReSTOR® Multifocal Toric IOLMultifocal Toric IOL
• Single surgical procedure for presbyopia
correction and corneal astigmatism
management
• Reduce or eliminate need to refine
residual cylinder with LRI, LASIK, or PRK
0.0
10.0
20.0
30.0
40.0
50.0
<.5 <1 <1.5 <2 <2.5 <3 <3.5 >3.5
Cylinder DistributionCylinder Distribution
Moderate 1.0 –
2.0D 25%
Severe >2.0 D
10%
Cylinder D ( < )
% o
f P
atie
nts
N = 10,411
Corrective Cylinder PowerCorrective Cylinder Power
Anterior Apodized Diffractive Aspheric Surface
Same design as current AcrySof® IQ ReSTOR® +3.0D
• 9 apodized diffractive steps for +3.0D add power
• Negative spherical aberration factor corrects for the
positive spherical aberration of the cornea
AcrySof® IQ ReSTOR® AcrySof® IQ ReSTOR® Multifocal Toric IOL Multifocal Toric IOL Product EvolutionProduct Evolution
Posterior Toric Lens Surface
Same design as current AcrySof® Toric IOLs• Posterior toric axis marks
• Posterior toric surface
Cylinder Powers Detail Cylinder Powers Detail (Models SND1T2 – T5)(Models SND1T2 – T5)
IOL Model
Cylinder Power @ IOL Plane
Cylinder Power @ Corneal
Plane*
Diopter Power Available**
0.5D increments (Spherical Equivalent)
SND1T2 1.00 0.68 6.0 to 34.0D
SND1T3 1.50 1.03 6.0 to 34.0D
SND1T4 2.25 1.55 6.0 to 34.0D
SND1T5 3.00 2.06 6.0 to 34.0D
* Based on an average pseudophakic human eye
Model Numbers
Product Characteristic
SND1T2 * SND1T3 SND1T4 SND1T5
Optic Type Biconvex Apodized Diffractive Aspheric Toric
Material Ultraviolet and blue light filtering Acrylate / Methacrylate Copolymer
Optic Diameter (mm) 6.0
Overall Length (mm) 13.0
Haptic Angle 0°
IOL Powers(spherical equivalent diopters)
Current availability is 10.0 to 30.0 D (0.5D increments)
IOL Cylinder Powers (IOL Plane)
1.00 D 1.50 D 2.25 D 3.00 D
IOL Cylinder Powers (Corneal Plane)†
0.68 D 1.03 D 1.55 D 2.06 D
Add Power +3.0 D
Add Power at Spectacle Plane
+2.5 D
Suggested A-Constant 118.9
†Based on average pseudophakic human eye * Model number SND1T2 not currently available.
AcrySof® IQ ReSTOR® Multifocal AcrySof® IQ ReSTOR® Multifocal Toric IOL (Model SND1TT)Toric IOL (Model SND1TT)Product Characteristic Summary TableProduct Characteristic Summary Table
Inte
rnal
Use
On
ly –
For
Sal
es T
rain
ing
Pur
pose
s
Product CharacteristicsProduct CharacteristicsLight Transmission CurveLight Transmission Curve
AcrySof® IQ ReSTOR® IOL +3.0 D Theoretical Total Energy Balance
Source: Data on file. Alcon, Inc. R&D Technical Report
Product Performance AcrySof® IQ ReSTOR® IOL
Refraction (D)AcrySof® IQ ReSTOR® IOL +3.0 D [N=117]
Mean Defocus Curve for AcrySof® IQ +3.0 D ReSTOR® IOLBinocular, Best Case, 6 Months Postoperative
Source: AcrySof® IQ ReSTOR® IOL Package Insert
70 cm50 cm
40 cm33 cm
∞
20/25
20/32
20/40
20/50
20/63
20/80
20/100
20/20
+1.00 +0.50 0.00 -0.50 -1.00 -1.50 -2.00 -2.50 -3.00 -3.50 -4.00
Product Performance: IQ ReSTOR® Product Performance: IQ ReSTOR®
Double Peaked Defocus CurveDouble Peaked Defocus Curve
Updated Online CalculatorUpdated Online Calculator
www.acrysoftoriccalcular.com
ASICO instrumentsASICO instruments
PRE-OP TORIC REFERENCE MARKER
A. AE-2791 Marking Eye with Patient Sitting Up
B. Patient Lying Down
AE-2791
Marking of the Eye – Axis MarkingMarking of the Eye – Axis Marking
INTRA-OP MARKER
A. AE-2792 Aligned to Steepest Meridian
B. Marks on Steepest Meridian
AE-2792
62 yr old female +2.00/-2.00x5 +2.50/-0.50x180 42.50/44.0x90 42.75/44.0x87 +22.0 ReSTOR T4 BE 2.2mmx135 2.2mmx30 T4@84 T4@92 Assume +0.50D SIA At 1 week: 6/7.5 6/9 J4 at 43cm
42.50/44.25x83 and 42.25/43.75x85
52 yr old Indian male restauranteur +1.75/-0.75x80 +1.25/-0.25x100 42.88/43.90x165 43.32/44.5x15 +22.0 ReSTOR T3 BE 2.2mmx170 2.2mmx30 At 1 month: 6/6 6/6 J1 at 43cm
ReSTOR +3D ToricReSTOR +3D Toric
The majority work very well The majority work very well but..but..
Success with the ReSTOR requires:Careful patient and doctor/practice selectionGood patient counselingAccurate preoperative biometryCareful surgical techniqueAttention to astigmatism
ConcernsConcerns
Optometrists will stop referring patients if I use ReSTOR
ConcernsConcerns
Patients don’t mind wearing glasses
ConcernsConcerns
Glare and halos are a big problem with multifocals
ConcernsConcerns
Multifocals may need to be explanted
Ideal patients for the Ideal patients for the ReSTORReSTOR
Ideal patients for the Ideal patients for the ReSTORReSTOR
Patients with no other ocular pathologyPatients in line for bilateral surgeryPeople with easy going personalities, realistic
expectations and not too obsessiveCare with engineers, high school teachers,
pharmacists and accountants
Bad patients for the Bad patients for the ReSTORReSTOR
Intra-operative Exclusion Intra-operative Exclusion CriteriaCriteria
Exclusion during surgery• Significant vitreous loss• Damage to zonules• Pupil trauma
Preoperative counselingPreoperative counseling
Patient Information videoCan’t compete with young crystalline lensExplain inevitability of faint halo around letters
and lightsReSTOR will give excellent distance vision and
excellent near vision, the new +3 gives good intermediate vision
You may be more comfortable using magnifiers for computers or reading under poor light
Preoperative counselingPreoperative counseling
ButYou won’t have to struggle with your bifocal or
multifocal glassesYou’ll love being able to see your watch, mobile
phone, prices in stores, menu in restaurants and be able to put on makeup
These lenses will free you up!
IQ ReSTOR® Toric Conclusions
• AcrySof® IQ ReSTOR® Toric has been designed to perform at all distances for patients with and without astigmatism
• Gives surgeon the ability to reduce or eliminate the need to correct residual cylinder with LRI, LASIK, or PRK.
• Allows single surgical procedure for presbyopia correction and corneal astigmatism management
• It increases the number of patients who can be considered for multifocal IOL implantation.