Patient Selection Refraction IOL Power Calculation...Biometry IOL-Power calculation using Vericalc...

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Patient SelectionIOL Power Calculation

Verisyse™ and VeriFlex™ Iris Claw

Technology for Correcting Refractive Errors in Phakic and Aphakic Eyes

ESCRS 2011 Intructional Course 61

Patient SelectionIOL Power Calculation

Verisyse™ and VeriFlex™ Iris Claw

Technology for Correcting Refractive Errors in Phakic and Aphakic Eyes

ESCRS 2011 Intructional Course 61

Josef RuckhoferJosef RuckhoferJosef RuckhoferJosef Ruckhofer

University Eye Clinic Salzburg, Austria Verisyse and Veriflex Iris Claw Technology ESCRS 2010

Verisyse™ and VeriFlex™Verisyse™ and VeriFlex™

� Patient Selection� Refraction

� History

� General

� Ocular

� Social

� Exclusion Criteria

� Preop Examination

� ACD

� Pupil Size

� Planning Surgery

� Biometry� IOL-Power calculation using

Vericalc 2.0

� Patient Selection� Refraction

� History

� General

� Ocular

� Social

� Exclusion Criteria

� Preop Examination

� ACD

� Pupil Size

� Planning Surgery

� Biometry� IOL-Power calculation using

Vericalc 2.0


Patient Selection for Verisyse/VeriflexPatient Selection for Verisyse/Veriflex

� Refraction� stable ± 0.5 D within 2 years

� Myopia

� - 1.0 up to - 23.5 D (5 mm optic)

� - 1.0 up to - 15.5 D (6 mm optic)

� - 2.0 up to - 14.5 D (Veriflex)

� Hyperopia

� + 1.0 to +12.0 D

� Astigmatism

� 1 to 7.5 D

� Refraction� stable ± 0.5 D within 2 years

� Myopia

� - 1.0 up to - 23.5 D (5 mm optic)

� - 1.0 up to - 15.5 D (6 mm optic)

� - 2.0 up to - 14.5 D (Veriflex)

� Hyperopia

� + 1.0 to +12.0 D

� Astigmatism

� 1 to 7.5 D


Patient Selection for Verisyse/VeriflexPatient Selection for Verisyse/Veriflex

� AC-Depth� > 3.0 mm (FDA 3.2 mm)

� Scotopic (Low Mesopic) Pupil Size � 5 to 6 mm

� Endothelial Cell Count� according to age

� >2.000

� No other major systemic or ocular disorders

� AC-Depth� > 3.0 mm (FDA 3.2 mm)

� Scotopic (Low Mesopic) Pupil Size � 5 to 6 mm

� Endothelial Cell Count� according to age

� >2.000

� No other major systemic or ocular disorders

Abib, JCRS 2001


General HistoryGeneral History

� pregnancy

� collagen-vascular dis. (rheumatism)

� diabetes mellitus

� thyroid dis.

� hyperplastic scars

� heart problems

� blood pressure

� pregnancy

� collagen-vascular dis. (rheumatism)

� diabetes mellitus

� thyroid dis.

� hyperplastic scars

� heart problems

� blood pressure

� asthma

� epilepsy

� kidney dis.

� liver dis.

� medication

� asthma

� epilepsy

� kidney dis.

� liver dis.

� medication


Ocular HistoryOcular History

� Known ocular disorders � (e.g.: Keratoconjunctivitis sicca or optic neuritis)

� Ocular trauma

� Squint

� Previous surgeries

� Family Hx of ocular disease

� Amblyopia

� Known ocular disorders � (e.g.: Keratoconjunctivitis sicca or optic neuritis)

� Ocular trauma

� Squint

� Previous surgeries

� Family Hx of ocular disease

� Amblyopia

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Social HistorySocial History

� Age

� Profession� far/near work, PC, taxi/bus driver ?

� Reading with or without spectacles ?

� CL – Wearer ? � type / tolerance / duration / last time wore

� Hobby � martial arts / golf / reading

� Age

� Profession� far/near work, PC, taxi/bus driver ?

� Reading with or without spectacles ?

� CL – Wearer ? � type / tolerance / duration / last time wore

� Hobby � martial arts / golf / reading


ScreeningScreening

Important:

Get patient‘s expectations down to a realistic level !

Important:

Get patient‘s expectations down to a realistic level !

What are your expectations ? What are your present problems ?


Exclusion CriteriaExclusion Criteria

� Cataract

� RD or Hx of RD

� Pupil abnormalities

� Abnormal iris anatomy

� Corneal affections

� Glaucoma incl. Hx of ocular hypertension

� Uveitis

� Rubeosis

� (Maculo-/ retinopathy)

� Cataract

� RD or Hx of RD

� Pupil abnormalities

� Abnormal iris anatomy

� Corneal affections

� Glaucoma incl. Hx of ocular hypertension

� Uveitis

� Rubeosis

� (Maculo-/ retinopathy)

� Age < 18 J. (21)

� Scotop. pupil > optic diameter

� EC-Count < 2.000 /mm2

� AC depth < 3.0 mm

� Violent / dangerous life style -sports

� Age < 18 J. (21)

� Scotop. pupil > optic diameter

� EC-Count < 2.000 /mm2

� AC depth < 3.0 mm

� Violent / dangerous life style -sports


Preop ExaminationPreop Examination

� Manifest refraction (BVD=12, CL-break !)

� Cycloplegic refraction

� Slitlamp

� IOP

� K-readings, (corneal topography)

� Endothelial cell count

� Retina in mydriasis

� Orthoptics (optional)

� Scotopic (low mesopic) pupil size

� Biometry, AC-Depth (IOL-Master)

� Manifest refraction (BVD=12, CL-break !)

� Cycloplegic refraction

� Slitlamp

� IOP

� K-readings, (corneal topography)

� Endothelial cell count

� Retina in mydriasis

� Orthoptics (optional)

� Scotopic (low mesopic) pupil size

� Biometry, AC-Depth (IOL-Master)


ACD: Distance to EndotheliumACD: Distance to Endothelium

antero-posterior

and peripheral

space at

various IOL power

section at -10 D section at -20 D

Budo C et al.: J Cataract Refract Surg 2000 Aug 26(8):1163-71

2.05

2.23

2.14

2.04

1.95

1.86

3.2 mm

3.3 mm

3.4 mm

ACDmin 1.5 mm


Verisyse™ Phakic IOLVerisyse™ Phakic IOL

� Mean distance Verisyse™ - Endothelium

� Myopia: 2.05 mm ± 1.67 SD (min 1.75 – max 2.3)

� Hyperopia: 1.78 mm ± 0.2 SD (min 1.5 – max 2.0)

� Mean distance Verisyse™ - Endothelium



Scheimpflug Evaluations

(3 months postop)

myopia: 19 eyes

hyperopia: 6 eyes

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Verisyse™ Phakic IOLVerisyse™ Phakic IOL

� Mean distance Verisyse™ - Crystalline lens:



� Mean distance Verisyse™ - Crystalline lens:



Scheimpflug Evaluations

(3 months postop)

myopia: 19 eyes

hyperopia: 6 eyes


� Rosenbaum Card � not exact !

� Colvard Pupillometer � user-friendly, popular, ($ 1.500)

� Rosenbaum Card � not exact !

� Colvard Pupillometer � user-friendly, popular, ($ 1.500)

Pupil - Measurement DevicesPupil - Measurement Devices


� Computerized Systems:� Procyon 3000

� Wavefront-analyzer (eg. WASCA)

� Computerized Systems:� Procyon 3000

� Wavefront-analyzer (eg. WASCA)

Pupil - Measurement DevicesPupil - Measurement Devices


Pupil SizePupil Size

� Large pupil diameter can be a contraindication forVerisyse™or VeriFlex™ phakic IOL, especially for patientswith relevant professions like Taxi drivers!

� Horizontal pupil diameter may be reduced by ~1 mm postop� Bootsma SJ et al. Evaluation of pupil dynamics after implantation of artisan phakic intraocular

lenses. J Refract Surg. 2006 Apr;22(4):367-71

� Dick HB et al. Change in pupil size after implantation of an iris-fixated toric phakic intraocular lens. J Cataract Refract Surg. 2005 Feb;31(2):302-7.

� In any case discuss the risks of glare and halos with the patient

� Large pupil diameter can be a contraindication forVerisyse™or VeriFlex™ phakic IOL, especially for patientswith relevant professions like Taxi drivers!

� Horizontal pupil diameter may be reduced by ~1 mm postop� Bootsma SJ et al. Evaluation of pupil dynamics after implantation of artisan phakic intraocular

lenses. J Refract Surg. 2006 Apr;22(4):367-71

� Dick HB et al. Change in pupil size after implantation of an iris-fixated toric phakic intraocular lens. J Cataract Refract Surg. 2005 Feb;31(2):302-7.

� In any case discuss the risks of glare and halos with the patient


Planning SurgeryPlanning Surgery

� Pentacam (Oculus)� Pentacam (Oculus)


Planning SurgeryPlanning Surgery

� Visante (Carl Zeiss Meditec)� Visante (Carl Zeiss Meditec)

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VeriCalc™ 2.0VeriCalc™ 2.0

Planning Refractive Success

for Verisyse™ and VeriFlex™

Planning Refractive Success

for Verisyse™ and VeriFlex™



� Assistant for determining the correct power of Verisyse™ and VeriFlex™ phakic IOL

� Developed in collaboration with Wolfgang Haigis,PhD, University Eye Clinic Würzburg

� Based on the “Refractive Vergence Formula”

� Valid for phakic and pseudophakic eyes with no or slight astigmatism (< 2D)

� Offers an inter-active choice of target refractions forvarious IOL power

� Assistant for determining the correct power of Verisyse™ and VeriFlex™ phakic IOL

� Developed in collaboration with Wolfgang Haigis,PhD, University Eye Clinic Würzburg

� Based on the “Refractive Vergence Formula”

� Valid for phakic and pseudophakic eyes with no or slight astigmatism (< 2D)

� Offers an inter-active choice of target refractions forvarious IOL power



� Displays safety distances to the endothelium based on empiric evaluations

� Data Import from IOL - Master possible

� No patient data bank

� Printout of calculation for patient file possible

� Displays safety distances to the endothelium based on empiric evaluations

� Data Import from IOL - Master possible

� No patient data bank

� Printout of calculation for patient file possible


VeriCalc™ 2.0 - Data Required For CalculationVeriCalc™ 2.0 - Data Required For Calculation

� Subjective Refraction � contact lens break!

� Calculation refers to spherical equivalent

� Astigmatism ≤ 2 D

� Anterior Chamber Depth� preferred: IOL Master or US in Immersion Mode

� ACD from endothelium? Add pachymetry for calculation!

� Keratometer Readings � K-Index correct ?

� Low Mesopic Pupil diameter � Choice of the Optical Diameter of the lens

� Subjective Refraction � contact lens break!

� Calculation refers to spherical equivalent

� Astigmatism ≤ 2 D

� Anterior Chamber Depth� preferred: IOL Master or US in Immersion Mode

� ACD from endothelium? Add pachymetry for calculation!

� Keratometer Readings � K-Index correct ?

� Low Mesopic Pupil diameter � Choice of the Optical Diameter of the lens


Confirm Settings!

VeriCalc™ 2.0 - StartVeriCalc™ 2.0 - Start


VeriCalc™ 2.0 - Import Patient DataVeriCalc™ 2.0 - Import Patient Data

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Patient Data


Patient Data


Patient Data


Patient Data


Calculation


Calculation

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Calculation


Calculation


Calculation


PrintoutPrintout

� The final choice of the power for Verisyse™ and VeriFlex™ Phakic IOL depends on various factors and is the responsibility of the physician implanting the lens

� The final choice of the power for Verisyse™ and VeriFlex™ Phakic IOL depends on various factors and is the responsibility of the physician implanting the lens


Thank you for your attention !Thank you for your attention !

Patient Selection Refraction IOL Power Calculation...Biometry IOL-Power calculation using Vericalc...

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