Why I Have Decided to Implant Trifocal IOLs Technology in ... · Pinhole IOLs –IC8 Acufocus...
19
Why I Have Decided to Implant Trifocal IOLs Technology in My Own Eyes *Matteo Piovella, MD & **Barbara Kusa, MD *President of Italian Ophthalmological Society – SOI *Medical Director ** Centro di Microchirurgia Ambulatoriale - CMA Monza - Milan Italy Dr Piovella Has the Following Possible Financial Interests or Relationships to disclose. As Consultant: • Acufocus • Carl Zeiss Meditec • Johnson & Johnson • TearLab As Lectures Fees: • BVI Beaver Visitec International • Ocular Therapeutix • TearScience [email protected] Dr. Kusa Does Not Have Any Financial Interests or Relationships to Disclose.
Transcript of Why I Have Decided to Implant Trifocal IOLs Technology in ... · Pinhole IOLs –IC8 Acufocus...
Why I Have Decided to Implant Trifocal IOLs Technology in My Own Eyes
*Matteo Piovella, MD & **Barbara Kusa, MD
*President of Italian Ophthalmological Society – SOI
*Medical Director
** Centro di Microchirurgia Ambulatoriale - CMA
Monza - Milan
Italy
Dr Piovella Has the Following Possible Financial
Interests or Relationships to disclose.
As Consultant:
• Acufocus
• Carl Zeiss Meditec
• Johnson & Johnson
• TearLab
As Lectures Fees:
• BVI Beaver Visitec International
• Ocular Therapeutix
• TearScience
Dr. Kusa Does Not Have Any Financial Interests or
Relationships to Disclose.
The Marvellous Journey of Cataract Surgery Has Always Been Based on
Progress and Surgical EvolutionNobody Has the Opportunity to Block the Progress of Science
From The Very Beginning Cataract Surgery Has Provided for the Removal of Lens Which Progressively Loses Transparency
Today Refractive Cataract Surgery Is the Most Common and Efficient Way to Correct Refractive Defects,
Myopia, Hyperopia, Astigmatism and to Overcome Presbyopia Limitations
The Good News is That You Have the Opportunity to Adopt These Extraordinary Updates
Without Having to Overturn Your Surgical Skills
It Is However Necessary To Revolutionize the Organization of the Surgical Center by Taking Advantage
of the Possibility of Introducing the Use of the Most Advanced Technologies
The Most Challenging Thing is to Succeed in Moving from an Organizational System Based on High Numbers at Low Cost
Embracing High Tech Refractive Cataract Surgery : This is “The Change”
Cost Efficiency is a Non Medical Indication Acting Normally in Contries Members of The Third World Community
No Patient Has Ever Thanked Me for Spending Less and Not Giving Him the Best CareM Piovella 2010
Today It Is Necessary to Provide a Good Quality of Vision After Cataract Surgery
Loss of Contrast Sensitivity Penalizes All People After 60 Years of Age
How to Combine Different Image Dimensions and Corresponding Contrasts Into a Single Characteristic?
Modulation Transfer Function (MTF) = Modulations at the Image Plane as a Function of Spatial Frequency
MTF is Quantitative Measure of the Ability of Optical System (IOLs)
to Reproduce Contrast of Original Object by Its Image
In-focus Image Quality - Characterization
MTF Quality of Vision Drops Down From 100% to 0% with Only 8 Degree Axis Rotation Misalignment
with a Toric IOLs Implant to Correct 2 D AstigmatismMTF (50 lp/mm) Sensitivity vs Toric IOL Rotation Errors
The Importance of Callisto Markerless Digital System
2 D Cylinder Correction Toric IOL – Pupil Size 5 mm
“E” (20/40) sensitivity to IOL rotation errors of 0, 5, 10, 15, 20 degrees
5.0 mm
MTF WITH CORNEA CYLINDER CORRECTED
ACE, 550 nm, 5MM
0.00
0.10
0.20
0.30
0.40
0.50
0.60
0.70
0.80
0.90
1.00
0 2 4 6 8 10 12 14 16 18 20
ROTATION (DEGREES)
MTF
@50
lp/m
m
0.0D
0.5D
1.0D
2.0D
Multifocal Toric Optic is More Sensitive to Cylinder Misalignment then Monofocal Toric Optic
Residual Postop Astigmatism is Responsible for the Biggest Complains Concerning Low Quality of VisionLow-Order Aberrations Due to Post-operative Refraction Residues Significantly Penalize Quality of Vision
and They Multiply Exponentially the Effects of High-Order Aberrations Such as Coma and Trefoil
Corneal Astigmatism Management :
Toric IOLs When 0.75 Diopters of Astigmatism is Detected with Most Advanced Technology
This Means Implanting Multifocal Toric Intraocular Lenses in 50% of Patients Undergoing Cataract Surgery
The Use of IOL Master 700 and the Callisto System is Mandatory
The Postop Refractive “Gold Range” to Achieve Good Quality of Vision is 0.50 Diopters
The Use of Latest-Generation Autorefractometer Allows a Perfect Identification of the Residual Refractive Defects
The Most Widely Used EDOF IOLs Do not Allow Precise Identification of the Postoperative Residual Refractive Defect by the Latest Generation Autorefratometers. Moreover, Postoperative Refractive Stability is Normally not Determined Before 30 days Postoperatively
Zeiss Trifocal Lenses Allow Precise Identification of Postoperative Residual Refractive Defect in Real Time. Normally Maintain a Stable Refraction Two Days After Surgery
• AT LISA® tri toric implanted in 142 eyes of 86 patients
• Mean Age 66.83 ± 11.64
• Mean Preoperative UCVA 20/68 ± 39.24
• Mean Time Follow Up 4 years ± 3.6 Months
• Mean Preoperative Sphere Equivalent -1.16 ± 3.78
• Mean Preoperative Corneal astigmatism 1.45 ± 0.53
• Mean Preoperative Refractive Astigmatism 0.95 ± 0.84
AT LISA® Tri Toric Materials and Methods40.85% of Toric IOLs Implanted Provides Only One Diopter of Astigmatism Correction
to Match the Postoperative Refractive Result Within 0.50 D
Normally 50% of Cataract Patients Need Toric IOLs Implants
40,8548,59
10,56
0
20
40
60
1 ,00 D 1,5 D - 2,00 D > 2,00 D
Toric IOLs Diopters Correction Range :89.44% within 2 Diopters of Corneal Astigmatism
The History of Modern Multifocal IOLs15 Years Developments
• Restor + 4 Sferical Bifocal IOL Alcon 2004
• Restore + 4 Asferic Bifocal IOL Alcon 2005
• ReZoom™ Refractive MIOL AMO ABBOTT 2004
• TECNIS® Bifocal IOL AMO ABBOTT 2006
• Restor +3 Bifocal IOL Alcon 2007
• Acri Lisa Bifocal IOL Zeiss 2009
• Acri Lisa Toric Bifocal IOL Zeiss 2010
• Oculentis 2011
• AT Lisa Trifocal IOL Zeiss 2012
• Restor 2.5 Bifocal IOL Alcon 2013
• AT Lisa Trifocal Toric IOL Zeiss 2013 CMA – European Victori Study Coordinator Centre
(Centre 01)
• Mini Well SIFI 2014
• Synfony Extended Depth of Focus IOL AMO ABBOTT 2014
• Panoptix IOL Alcon 2015
• IC8 Pinhole IOL Acufocus 2015
• Panoptix Toric IOL 2016
• AT Lara Extended Depth of Focus IOL Zeiss 2017
• AT Lara Toric Extended Depth of Focus IOL Zeiss 2018
Trifocal , Extended Depth Of Focus (EDOF)and Pinhole IOLs Have Replaced Bifocal Multifocal Technology in Countries Where Are Available
Depending the Different IOLs Technologies
Trifocal IOLs
IOLs Technology Submitted and Approved for Distance, Intermediate and Near Vision
Less Sensitive to Small Post Operative Refractive Errors Then Bifocal IOLs
Best Technology for Clear Near Vision
M. Piovella MD, S. Colonval MD A. Kapp MD , J. Reiter MD , F. Van Cauwenberge MD J. Alfonso MD
Patient outcomes following implantation with a trifocal toric IOL: twelve-month prospective multicentre study
Nature, Eye, May 2018
Extended Depth Of Focus IOLs
IOLs Technology Submitted and Approved Only for Distance and Intermediate Vision
Less Sensitive to Small Post Operative Refractive Errors
Due to Far Extended Depth of Focus
Normally Need Glasses (+ 1 Diopter) for Comfortable Near Vision
Pinhole IOLs – IC8 Acufocus
Pinhole Effect : No Need of Toric Correction Up to 2 Diopters
Far Quality of Vision Based on Dominant Eye and Best Monofocal IOL
No Far Monovision : Distance Vision at Least 20/25 with IC8 Implants
Best IOLs After RK or in Presence of Aberrating Corneas
H.Burkhard Dick, MD,PhD, Matteo Piovella, MD, John Vukich, MD, Srividhya Vilupuru, OD,PhD, Ling Lin, PhD
Prospective multicenter trial of a small-aperture intraocular lens in cataract surgery.
J Cataract Refract Surg. 2017 04 ;43:956-968. doi: 10.1016/j.jcrs.2017.04.038 [email protected]
After Bilateral Trifocal IOLs Implantation On July,3/4, 2014,The Quality of My Vision Has Improved ConsiderablyI Have not Experienced Difficulties in Using a Surgical Microscope
I Have not Experienced Penalization in Dealing with Complex Surgical Maneuvers or Driving at Night
My Near Vision Is Excellent
124° Cataract Live Surgery Demonstration
Nov, 2017 - SOI National MeetingUncorrected Far
Intermediate and Near Vision Results
My Personal Bilateral Cataract Surgery Management : Cataract Surgical Plan :Surgeon : Burkhard Dick – Bochum - Germany J&J Catalys Femto Assisted Cataract SurgeryRight Eye BCFV 20/25 - 8 sph Right Eye AT LISA tri + 10.00 D
Left Eye BCFV 20/25 - 8 sph - 1.50 cyl axis 165° Left Eye AT LISA tri toric + 9.50 D +1.50 Toric D axis 71
Refractive Results
Right Eye BCFVA 20/12.5 - 0,50 Cyl 40°
Left Eye BCFVA 20/16 - 0,25 Sph - 1,00 Cyl 75°
I started to Implant Modern Multifocal IOLs Routinely in 2006
I Started Adopting Zeiss Bifocal IOLs Despite my Resistances in Adopting Plate Instead of Traditional C Haptic Because in 2010 It Was the Only IOL to Provide Toric Correction
Zeiss AT LISA® tri Was My First and Standard Choice for Presbyopia Correction Since Its Introduction in 2012
My Center Was the Monitor Centre for Multicenter Victory Study on Zeiss AT LISA® tri Toric
I Personally Measured Postoperative Refraction of All Patients Using the Most Advanced Technology
to Detect The Gold Range ± 0.50 Diopters
Why I Decided to Implant Zeiss AT LISA® tri and Toric IOLs in My Own Eyes
Advanced Biometry is a Real Key Point
“Right Range” : Sphere Equivalent Within - ±0.50 Sph
IOL Master 700 – Callisto System Advanced Technologies Adoption
130 Eyes (65 BILATERAL IMPLANT) WITH TRIFOCAL IOL
IOL MASTER 700
116 Eyes (58 BILATERAL IMPLANT) WITH TORIC TRIFOCAL IOL
86,2
10,8
3,1
2 Eye In
1 Eye Out
Both Eyes Out
86,2
8,6
5,2
2 Eye In
1 Eye Out
Both Eyes Out
CALLISTO EYE
Advanced Biometry Outcome is a Key Point
“Right Range” : Sphere Equivalent Within - ±0.50 Sph
Avoid the Eye Cyclotorsion Effect Adopting IOL Master 700 and Callisto System
246 Eyes (123 BILATERAL IMPLANT) WITH TRIFOCAL TECHNOLOGY
IOL MASTER 700
CALLISTO EYE
96% OF PATIENTS IN THE RIGHT RANGE (Almost One Eye in the Right Range)1.98 % OF ALL PATIENTS ADOPT GLASSES SOMETIMES FOR NEAR VISION
86,2
9,8
4,1
2 Eye In 1 Eye Out Both Eyes Out
1. Dry Eye and Meibomian Glands Disfunction(MGD) Management to Provide Healthy Cornea Surface
2. With Blocked Meibomian Glands Apply Treatments to Unblock the Excretory Ducts of Glands
3. Advanced Biometry: IOL Master 700 or Equivalent Technologies
4. Advanced Biometry Exam Performed Two Times Before and After MGD Management
5. Adopting Different Formulas and New IOLs Calculators Depending Axial Lenght or Previous Laser Vision Correction
6. Continuous Update of Costants
7. Callisto Markerless System or Equivalent Tecnologies to Overcome Eye Cyclotorsion : Avoid Toric IOLs Manual Alignment
8. Corneal Astigmatism Management : Apply Toric IOLs When 0.75 Diopter of Astigmatism is Detected
9. Target Postoperative Refraction : ±0.50 D or Emmetropia
10. Automated Mechanical Capsulotomy More Precise Then Capsulorhexis : It Reduces the Complications Rate of Refractive Cataracts
11. The Importance of an Indication Based Mainly on the Selection of the Eye and not on the Evaluation of the Habits or Requests of Patients
12. Preoperative Normal Convergence ,Stereopsis and Near Vision
13. A New Surgical Center Organization
14. Professional Refraction Management
Clinical Indications, Patient and Eye Selection and Surgical Center Organization
to Adopt Safely and Successfully Advanced Technology IOLs in Refractive Cataract Surgery :
The Italian Ophthalmological Society (SOI) Report
AT LISA® TRIFOCAL 839 MP IOL
AT LISA® Tri and Tri Toric
Materials and Methods
• AT LISA® trifocal technology implanted in 294 eyes
• Mean Age 67.35 ± 10.28
• Mean Preoperative BCVA 20/43 ± 38.51
• Mean Time Follow Up 44.0 months ± 3 months
• Mean Preoperative Sphere Equivalent -0.59 ± 1.98
AT LISA® TORIC TRIFOCAL 939 MP IOL
0,00
20,00
40,00
60,00
80,00
100,00
120,00
140,00
160,00
180,00
200,00
Preop 1 Month PO
3 Months PO
6 Months PO
1 Year PO 2 Years PO 3 Years PO 4 Years PO 5 Years PO
67,00
20,4821,03 20,10
20,0520,00 19,99
20,80 20,10
UCDVA
AT LISA® Trifocal Technology
Uncorrected Binocular VA Results : Distance Intermediate and Near Vision142 patients (284 eyes)
0,00
20,00
40,00
60,00
80,00
100,00
120,00
140,00
160,00
180,00
200,00
Preop 1 Month PO
3 Months PO
6 Months PO
1 Year PO 2 Years PO 3 Years PO 4 Years PO 5 Years PO
41,30
21,2021,83 20,05
21,0020,60 22,00
21,90 20,00
0,00
20,00
40,00
60,00
80,00
100,00
120,00
140,00
160,00
180,00
200,00
Preop 1 Month PO
3 Months PO
6 Months PO
1 Year PO 2 Years PO 3 Years PO 4 Years PO 5 Years PO
58,00
25,0023,90 25,10
25,0024,10 25,00
26,00 24,00
UCIVA UCNVA
Uncorrected Binocular Distance Vision 20/20
Uncorrected Binocular Intermediate Vision 20/20
Uncorrected Binocular Near Vision 20/24
0,0020,0040,0060,0080,00
100,00120,00140,00160,00180,00200,00
Preop 1 MonthPO
3 MonthsPO
6 MonthsPO
1 Year PO 2 Years PO 3 Years PO 4 Years PO 5 Years PO
72,10
21,2021,99 20,46
20,0520,00 19,80
20,10 20,00
UCDVA
AT LISA® Toric Trifocal Technology
Uncorrected Binocular VA Results : Distance Intermediate and Near Vision
58 patients (116 eyes)
0,00
20,00
40,00
60,00
80,00
100,00
120,00
140,00
160,00
180,00
200,00
Preop 1 MonthPO
3 MonthsPO
6 MonthsPO
1 Year PO 2 Years PO 3 Years PO 4 Years PO 5 Years PO
41,30
21,2021,83 21,20
21,0020,80 22,00
22,00 20,41
0,0020,0040,0060,0080,00
100,00120,00140,00160,00180,00200,00
Preop 1 MonthPO
3 MonthsPO
6 MonthsPO
1 Year PO 2 Years PO 3 Years PO 4 Years PO 5 Years PO
45,00
25,0024,99 24,00
24,1023,82 25,00
24,70 24,00
UCIVA UCNVA
Uncorrected Binocular Distance Vision 20/20
Uncorrected Binocular Intermediate Vision 20/20
Uncorrected Binocular Near Vision 20/24
74% of Our Patients Were Implanted with Trifocal IOLs in Year 2015
73% of Our Patients Were Implanted with Trifocal IOLs in Year 2016
69 % of Our Patients Were Implanted with Presbyopic IOLs in Year 2017
53%(2015) - 44%(2016) - 51%(2017) of These Groups Were Implanted with Trifocal Toric IOLs
“Personalized Advanced Biometry” Was Applied in All Patients
70 % of Our Cataract Patients
Were Implanted with Trifocal IOLs Since 2015
1
2
3
4
FIRST CONTACT
Phone
Person
Website
SECRETARY
Check in
Demographic
General informations
TECHNICAL STAFF
Diagnostic
Information (dilation)
EYE DOCTOR
Medical Examination
Raccomendations
FOLLOW UP
Maintenance contact with
The Patient
5
Communication and Path of The Patient
Thank you for your attention
