Post on 15-Feb-2017
transcript
Richard L. Lindstrom, MDFounder and Attending Surgeon:
Minnesota Eye ConsultantsAdjunct Clinical Professor Emeritus:
University of Minnesota: Department of OphthalmologyAssociate Director: Minnesota Lions Eye Bank
Board Member: University of Minnesota FoundationVisiting Professor: UC Irvine: Gavin Herbert Eye Institute
Acufocus, Inc. C,I,R
, Abbott Medical Optics, Inc. C,I,, Advanced Refractive Technologies CAlcon Laboratories, Inc.
C, AqueSys C,I Bausch +
Lomb, Inc. C,I,R,
Bio Syntrx C,I Calhoun Vision Inc, C,I Clarity Ophthalmics C,I,
Clear Sight C,I, Confluence Acquisition Partners I, Inc. I, Curveright, LLC I, CXL Ophthalmics, LLC I, EBV Partners C,I, EGG Basket Ventures C,I,
ELENZA, C, Encore C,I
Evision Photography, C,I, Evision Medical Laser , I, Eyemaginations, Inc. C,I
, ForSight, C,
Forsight Vision 6, Inc. C
Foresight Venture Fund #3, C,I, Fziomed I, Glaukos
Corporation C,I
, HEAVEN Fund I, Healthcare Transaction Services
I, High Performance Optics
C,I,
Hoya Surgical Optics C , ISTA, C, Lensar C,I
Lifeguard Health, C,I , Lumineyes, Inc. C , Minnesota Eye Consultants, P.A. C,I
,
NASA –Vision for Mars Program,C
Nicox, C
NuLensC,I
Ocular Surgery News/Slack,c
, Ocular Optics C,I
Ocular Therapeutix, C,I, Oculeve, Inc. C, ,
Omega Eye Health,C,I, Omeros Corp., C
OnPoint, I, Quest C,I.R, Rainwater Healthcare I, Refractec C,I, MD, Revision Optics,I,
Revital Vision C, I,, Schroder Life Science Venture Fund C,1, Sight Path, C, I
3D Vision Systems C,I
, Tearlabs, Inc. C,I, Tracey Technologies C,I
, Transcend
Medical, Inc,C,I
, True Vision, C,I, Versant C
ViradaxI, Vision Solutions Technologies C,I,
*C=Consultant *I= Investor * MD= Medical Director *R= Royalty
THIS PRESENTATION MAY CONTAIN DISCUSSION OF OFF LABEL USE OF FDA APPROVED DRUGS AND/OR DEVICES
“This presentation represents the speaker’s professional experience.”“Products/procedures not approved by the FDA and off label use of FDA approved products/procedures may be discussed.”
Financial Disclosures
Incidence and Prevalence of Presbyopia/Near Vision Dysfunction
• Universal after the age of 45
• 40% of USA population
• 110-120 million people
• 24% myopic (>-1.00)
• 26% hyperopic (>+1.00)
• 50% emmetropic (+0.875 to -0.875)
• 30% also have astigmatism over 1 diopter
A Few Important Concepts:
Accommodation: The eyes dynamic ability to focus under CNS control through a range in power of the eye as the distance to the object being observed varies. (Usually measured in diopters or an accommodative amplitude).
A Few Important Concepts:
Depth of Focus: The range in distance or diopters over which an individual eye or optical system can see specific target (usually 20/40 and J3)
Monovision Blended Vision:
A. Most popular approach to enhance near vision worldwide
B. Gives highest quality of vision.
C. Aspheric IOL’s or custom ablation stabilization preferred by me.
D. Visual target.
1. Distance eye: Plano to -0.50
2. Near eye: -1.25 to -1.75
Multifocal Optics
A. Second most popular approach to enhance near vision with corneal or lens based refractive surgery worldwide.
B. Multifocal Optics can be refractive, diffractive, or a hybrid.
C. Multifocal Optics can be distance dominant, near dominant, or symmetrical.
AcrySof® IQ Monofocal AcrySof® IQ ReSTOR +3 AcrySof® IQ Toric
TECNIS Multifocal Family of IOLsNEW NEW
AT LISA TRI / Toric
Add: 3.33 D / 1.66 D Optic: Aspheric trifocal/ bifocal
diffractive
Material: 25% hydrophilic acrylicwith hydrophobic surface
Filtration: UV blocker
Optic body diameter: 6 mm
Overall diameter: 11 mm
Angulation: -
from +0D to +32D (0.5D steps)
Toric from -10D to +24D (0.5D steps)
Quellen: Herstellerangaben
AT LISA TRI / Toric
Trial Physiol Trifocal IOL
N=40 eyes of 20 patients, 6 months follow-up
Cataract surgery
Alio et al, JRS 2013
TECNIS® Symfony IOL merges two complementary enabling technologies
1. Unique echelette design feature extends the range of continuous vision1
2. Proprietary achromatic technology reduces chromatic aberration for enhanced contrast sensitivity1
1. TECNIS Symfony DFU
TECNIS® Symfony IOL is not FDA approved for use in the US
Elongated Focus
Echelette design feature
Clinically Significant Increased Range of Vision( Depth of Focus)With Reduced Halo and Glare
TECNIS® Symfony IOL delivers:
- Sustained mean visual acuity of 20/20 or better through 1.5 D of defocus
- Full range of functional (20/40 or better) vision through 2.5 D of defocus
- Halo and glare levels comparable to that of a monofocal IOL due to the lack of a distinct second focus, coupled with achromat technology
1. 166 Data on File_Extended Range of Vision IOL 3-Month Study Results (NZ)
1.5 D
Mean VA of 20/20 or better though 1.5 D of defocus
2.5 D
VA of 20/40 or better through 2.5 D of defocus
TECNIS® Symfony IOL is not FDA approved for use in the US
Multifocal LASIK
• Currently there are three general methods for Multifocal LASIK
(No method is FDA approved in the U.S.)
VISX Aspherical Treatment Design(Center-Near)
CustomVue
Multifocal Ablation
CustomVue + Multifocal
+2.00+0.50x125
INTRACOR Post-Op Photos (same eye)
a) 30 min
b) 1 day
Intracorneal Inlays for Enhanced Near
Vision
AcuFocus KAMRA inlay reduces aperture size and increases depth of field. The inlay harnesses useful light and allows only focused rays to reach the retina through an uninterrupted pathway.
Presbia Flexivue Microlens and Neoptics Icolens are multifocal optics. The outer zone on both inlays provides near vision and the central zone has a neutral power to provide distance vision. Both inlays come in a range of powers to address the progression of near vision dysfunction over time.
ReVision Optics (RVO) Raindrop Near Vision Inlay increases the steepness of the cornea centrally to provide near vision.
Current Corneal Inlays
Small Aperture Inlay
1.6mm Aperture
5 μm thick
Made from Polyvinylidene
Fluoride (PVDF)
8,400 holes (5-11 μm)
Inlay matches corneal curvature
3.8mm Diam
Inlay DesignPresbyo
pia
With Inlay
Inlay
Lens cannot
accommodate
Depth of Focus
Inlay in vivoImage courtesy of Dr. Minoru TomitaShinagawa LASIK Center
RVO: Raindrop Near Vision Inlay
Stromal Cushion100 µm
• Design:– A 2mm hydrogel inlay– Create a multifocal cornea– Proprietary hydrogel is
permeable allowing for nutrient flow through the inlay
• Surgical Procedure:– Implanted ~150 microns deep– Under a corneal flap
• Method of Action:– Central 2mm provides near
vision – Results in a 2-3mm central
corneal steepening– Peripheral cornea provides
distance– Transition zone provides
intermediate vision• Patient Candidates:
– Emmetropes
Presbia: Flexivue Microlens
Design: Disc shape bifocal inlay with
refractive power Central 0.15mm hole for
nutrient flow
Surgical Procedure: Implanted 280-300 microns
deep Inserted into a pocket
Method of Action: Central zone provides
distance vision Peripheral zone provides
near Peripheral corneal also
provides distance vision
Patient Candidates: Ametropes between -1.00D
to +1.50D
Thickness*: 15 µm Diameter: 3.2 mm
Peripheral zone with refractive
power: +1.5 D to +3.5 D
Central zone
without refractive
power*Thickness varies based on power
Neoptics: Icolens Design:
Disc shape bifocal inlay with refractive power
Central 0.15mm hole for nutrient flow
Surgical Procedure:
Inserted into a pocket
Inlay preloaded into an inserter
Method of Action:
Central zone provides distance vision
Peripheral zone provides near
Peripheral corneal also provides distance vision
Patient Candidates:
Ametropes between -1.00D to +1.50D
Inlay
Accommodating IOL’s
A. Third most common approach to lens based refractive surgery to enhance intermediate and near vision.
B. The mechanism of action of accommodating IOL’s, like normal accommodation, is multifactorial and includes increased depth of focus benefits of pseudo-accommodation and accommodation.
C. Quality of vision issues are significantly less than in a multifocal IOL, but slightly greater than with an aspheric monofocal IOL.
(ARMD, glaucoma, previous refractive surgery, etc are therefore less of an issue.)
Built on an Innovative Platform
Crystalens® AOOct 2009
AT-45/AT-45SENov 2003
AT-Five-0Nov 2006
AT-HDJuly 2008
TRULIGN™
Toric IOLMay 2013 o
o
FluidVision Lens Design
6.0 mm optic diameter
10.0 mm overall diameter
Haptic height 3.0 mm
RI = 1.48
The optic is suspended between the haptics
Thought on the Future
A. Monovision/blended vision will remain an attractive option.
B. Multifocal development is maturing and growth in use will continue for several years and then plateau. (2020)
C. Accommodating IOL development is less mature than multifocal, but advancing steadily and may eventually dominate. ( 2020)
D. By 2020 Accommodating IOL’s or those that increase depth of focus will become more popular, but not completely replace monovision and multifocal optics.
Thank you for your attention