apodized model alcon
TRANSCRIPT
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Study of the Alcon Restor +3
Add lens and the I‐ Diff Dr Cyres K. Mehta
Director‐International EyeCentres,
Mumbai
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Diffrac:on
Movement
Imagine a wave of water striking a break in a dike.Asthe water passes throughthe dike, it spreads out onthe other side. That isDiffraction. Light acts in the
same way when it passesover a groove, or step, in alens.
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Thomas Young's Diffraction ExperimentThomas Young's Diffraction Experiment
zero-orderaxial light (brighter)
1st-orderlight (dimmer)
Point LightSource
at Infinity
BendingBending &
Interference Pattern
Barrierwith Slits ScreenWave Crest
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Diffrac:ve Interac:on
Light
entersthis side
Light is diffractedthrough apertures
As the waves spreadout and bump into
each other,constructive anddestructiveinterference occurs.
1.
2.
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MONOFOCAL LENS
PARALLEL RAYS ARE COMBINED BY A LENS INTO ONEFOCUS
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DIFFRACTION THROUGH A PLANE LENS
THE DIFFRACTION EFFECT IS CAUSED BY A MICRO STRUCTUREDSURFACE PROFILE OF THE LENS
THE SIZE OF THE STRUCTURES IS IN THE ORDER OF MICRONS.
A DIFFRACTIVE LENS COMBINES PARALLEL RAYS ALSO TO A FOCUS, BUTTHE OPTICAL PATH LENGTH OF EACH RAY DIFFERS FROM ZONE TO ZONEBY ONE WAVELENGTH.
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Diffractive bifocal lens
Refractive lens + diffractive microstructure
Beamsplitting by energy division (physical beamsplitter)
Advantages: The brightness distribution is independent of the pupil size.The visual acuity is not limited by diffraction effects at thezones.
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Diffractive bifocal lens
Because of a saw tooth shape of the surface profile with adepth smaller than one wavelength, diffraction causes a bifocaleffect.
The diffracted light contributes to the near focus and theundiffracted light to far focus.
The brightness ratio of far and near focus can be tuned by theprofile depth.
λ
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Physics ‐ Bifocal IOL
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Surface profile
Interferometric measurement of the surface profile
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iDIFF Presbyopic IOL
• Refractive-Diffractive
Technology
• Addresses Cataract
Patients with or withoutPresbyopia
* Allowed Patients a High
Level of Freedom From
Glasses in clinical trial
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iDIFF Features based on Benefits
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Smooth Transi:on Zones
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Full Optic Diffractive IOL
Advantages
Provides multifocal vision
Reduced pupil dependency
Balanced distribution of light
energy for all pupils
Less sensitive for decentration
* Creates Halos and scattering Light
Disadvantages
Potential for glare and halos at
night
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advantages
Provides multifocal vision
Reduced pupil dependency
Balanced distribution of light energyfor all pupils
Less sensitive for decentration
Reduces halos through perfect
distance distribution of light
Reduced straight through smooth steps
iDIFF IOL
iDIFF Design Advantages
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Perfect Light Distribu:on forDistance &Near( 60/40)
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Works Independent of Pupil Size
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Aspheric Op:c
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Spherical Aberra:on is s:ll
increased
Aer IOL Implanta:on?
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Aspheric Op6c
of the IOL
Spherical Aberra:on is
eliminated
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ASPHERIC PLATFORM IS BETTER FOR MULTIFOCALS-MTF of a spherical monofocal and an aspherical IOL
ideal monofocalvision (diffractionlimited)
MTF spherical PMMA IOL MTF aspherical Silicone IOL
Normalized spatial frequencyUniversität Karlsruhe, ITIV
Normalized spatial frequencyUniversität Karlsruhe, ITIV
loss of contrast vision dueto spherical aberration
ideal contrast vision, nospherical aberration
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• Edge thickness correspond to
standard designed IOLs
• Square edge design
• Extremely low incidence of PCO
• An: Z effect Hap:c design
iDIFF 360⁰square Edge
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+3.5 Addi:on for Near Vision
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AcrySof ® ReSTOR® Aspheric IOL
SN6AD3 Add Power: +4 DSpectacle Plane: 3.2 DRange: +10 D to +34 D
A‐Constant: 118.9
SN6AD1 Add Power: +3 DSpectacle Plane: 2.4 DRange: +10 D to +34 D
A‐Constant: 118.9
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Discussion Topics Aspheric (SN6AD3) vs. Spheric (SN60D3)
Introduction of SN6AD1
True performance at near, intermediate, and distance Comparison between SN6AD1 and SN6AD3
High resolution image quality
Minimal visual disturbances
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AcrySof® ReSTOR®
Aspheric IOL
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Anatomy of the Apodized Diffrac:ve
Technology
A +4 D at lens plane
equaling +3.2 atspectacle plane
Central 3.6 mmapodized diffractivestructure
Step heights decrease
peripherally from1.3 – 0.2 microns
Anterior asphericoptic
Outer refractivezone
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Anterior AsphericOptic
Anterior ApodizedDiffractiveOptic
Symmetric Biconvex
13.0 mm
6.0 mm 6.0 mm
Anatomy of the Apodized Diffrac:ve
Technology
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Apodiza6on
Gradual reduction or blending of the diffractive step heights.
Optimally manages light energy delivered to the retina as itdistributes the appropriateamount of light to near anddistant focal points, regardless of the lighting situation.
Designed to improve imagequality while minimizing visualdisturbances.
1.3 micronstep
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Technology of the AcrySof ® ReSTOR® IOL in
“human” terms
Thickness of a Human Hair = 60microns
Thickness of a Red Blood Cell = 7microns
Step Height at periphery of thediffractive portion of the AcrySof®ReSTOR® Aspheric IOL = 0.2 microns
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Design Objec:ve
Design considerations for the AcrySof® ReSTOR® Aspheric IOL:
Induce negative Spherical Aberrations with the lens to
compensate for positive corneal Spherical Aberrations
Source: SN6AD3 Package Insert
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Assessing IOL performance
Modula:on Transfer Func:on (MTF)
The MTF describes the loss in contrast in the image of asinusoidal pattern. The MTF depends upon spatial frequency.
Lens
0
0.25
0.50
0.75
1.00
0 100 200 300 400
M T F C o n t r a s t
Spatial Frequency (lp/mm)
The MTFPointobject
Pointimageis spreadout
Image contrast, and MTF,decrease as the “spatialfrequency” increases,even for a perfect lens
A i IOL f
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Assessing IOL performance
Light Spreading at Circular Apertures
Clear aperture(Airy Pattern)
0.5 radiusobstruction(or redirectionto other focus)
0.8 radiusobstruction(or redirectionto other focus)
MTF (Image Contrast)
0
0.25
0.50
0.75
1.00
0 100 200 300 400
M T F C o n t r a s t
Spatial Frequency (lp/mm)
0
0.25
0.50
0.75
1.00
0 100 200 300 400
M T F C o n t r a s t
Spatial Frequency (lp/mm)
0
0.3
0.5
0.8
1.0
0 100 200 300 400
M T F C o n t r a s t
Spatial Frequency (lp/mm)
focusing regionof lens aperture
Point image
6/6 or 20/20
vision
6/6 or 20/20vision
6/6 or 20/20vision
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Summary Op:cal Quality Comparison
Alcon ReStor®
Precision MTF
AMO ReZoom
Full Optic Blur
AMO Tecnis
Central Optic Blur
Dr Ligabue
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Summary Night Vision Comparison
ReSTOR
Best Image
Tecnis MF
Poor Resolution
ReZoom
Worst Resolution
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SN6AD1 Design Characteris:cs Utilizes existing ReSTOR® Aspheric +4 D platform
with identical asphericity, energy distribution profile,and shape factor
Modified add power from +4 D to +3 D 9 diffractive rings vs. 12 diffractive rings
Slightly wider ring spacing to modify the add power
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Both +4 D and +3 D have 3.6 mm Apodized Diffractiveregion
+4 D central zone diameter = 0.742 mm
+3 D central zone diameter = 0.856 mm
+4 D, 12 zones
+3 D, 9 zones
Physical Comparison
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Study Objec:ve To confirm that the increase in the distance of near vision for the ReSTOR ® Aspheric +3 D IOL does notnegatively impact:
visual acuity at near, distance, or intermediate contrast sensitivity
halo visual disturbance scores
as compared to the ReSTOR ® Aspheric +4 D IOL
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Study Design
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True VA Performance
Near Intermediate Distance
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Mean Distance VA
-0.10
0.30
Uncorrected VA Best Corrected VA
L o g M A
R
ReSTOR® Aspheric +3 D N=138 ReSTOR® Aspheric +4 D N=1313 Year (N=7)
20/20
20/25
Both VAs are less than one letter different
20/32
20/40
Data on File. Alcon, Inc.
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Mean Near VA at Best Distance
-0.10
0.30
Uncorrected VA Distance Corrected VA
L o g M A
R
ReSTOR® Aspheric +3 D N=138 ReSTOR® Aspheric +4 D N=1313 Year (N=7)
20/20
20/25
Both VAs are less than 2 letters and both 20/25
20/40
20/32
Data on File. Alcon, Inc.
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Mean Distance of Best Near VA
28.00
30.75
33.50
36.25
39.00
Uncorrected in cm Distance corrected in cm
ReSTOR® Aspheric +3 D N=138
ReSTOR® Aspheric +4 D N=131North
ReSTOR® Aspheric +3 D has approximately 6.5 cm (2.6 in)increase in distance compared to ReSTOR® Aspheric +4 D
D i s t a n
c e i n c m
Data on File. Alcon, Inc.
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Mean Uncorrected Intermediate VA
VAs are approximately 1-1.5 line(s) better for ReSTOR®
Aspheric +3 D
0
0.40
50 cm 60 cm 70 cm
L o g M
A R
ReSTOR® Aspheric +3 D N=138 ReSTOR® Aspheric +4 D N=1313 Year (N=7)
20/20
20/25
20/32
20/40
Data on File. Alcon, Inc.
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Mean Distance Corrected Intermediate VA
0
0.40
50 cm 60 cm 70 cm
L o g
M A R
ReSTOR® Aspheric +3 D N=138 ReSTOR® Aspheric +4 D N=1313 Year (N=7)
20/25
20/32
VAs are approximately 1.5 lines better for ReSTOR®
Aspheric +3 D
20/20
20/40
Data on File. Alcon, Inc.
bi d ’
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Combined VA’s
Distance, Intermediate, Near
0
20.0000
40.0000
60.0000
80.0000
100.0000
20/20 or better 20/25 or better 20/32 or better 20/40 or better worse than 20/40
P
e r c e n t o f S u b j e c t s
ReSTOR® Aspheric +3 D N=138 ReSTOR® Aspheric +4 D N=1313 Year (N=7)
Data on File. Alcon, Inc.
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Bilateral Defocus Curve
20/20
20/40
-0.15
0
0.15
0.30
0.45
0.60
2 1.5 1 0.5 0 0.5 -1 -1.5 -2 -2.5 -3 -3.5 -4 -4.5 -5
ReSTOR® Aspheric +3 D ReSTOR® Aspheric +4 D
l o g M A R
Refraction (D)
Data on File. Alcon, Inc.
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Mean Visual DisturbancesProblems with Night Vision
Problems with Color Perception
Halos
Glare/Flare
Double Vision
Distorted Near Vision
Distorted Far Vision
Blurred Near Vision
Blurred Far Vision
0 1.8 3.5 5.3 7.0
Bar 3 ReSTOR® Aspheric +4 D N=131 ReSTOR® Aspheric +3 D N=138
Mild Moderate SevereNone
Data on File. Alcon, Inc.
Frequency of Spectacle Wear (Distance
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Frequency of Spectacle Wear (Distance
Vision)
0 %
25 %
50 %
75 %
100 %
Never Sometimes Always
ReSTOR® Aspheric +3 D N=138ReSTOR® Aspheric +4 D N=131North
How often do you wear glasses?Data on File. Alcon, Inc.
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Frequency of Spectacle Wear
0 %
25 %
50 %
75 %
100 %
Never Sometimes Always
ReSTOR® Aspheric +3 D N=138
ReSTOR® Aspheric +4 D N=131
North
How often do you wear glasses?Data on File. Alcon, Inc.
96% f R STOR 3 P : t W ld H th
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96% of ReSTOR +3 Pa:ents Would Have the
Same Implant Again
0 %
25 %
50 %
75 %
100 %
No Yes
ReSTOR® Aspheric +3 D N=149ReSTOR® Aspheric +4 D N=139North
Would you have the same implant again?
P e r
c e n t o f S u b j e c t s
Data on File. Alcon, Inc.
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AcrySof® ReSTOR® Aspheric IOL
Conclusions• True performance at near, intermediate, and distance
• ReSTOR® Aspheric +3 D IOL provides a range of near vision• Best distance approximately 7cm out for ReSTOR® Aspheric +3 D IOL
• 1 – 1.5 line(s) improvement in intermediate VA
• Aspheric optic provides improved image quality
• No significant differences in visual disturbances
• High rate of patient satisfaction and spectacle independence
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So,to summarise Today we can offer refractive cataract surgery to our
clients at different price points with diffractive lenses
New technologies ensure good near vision,minimalglare and haloes and even decent intermediate vision.
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SEE YOU AT PRESBYMANIA 2010