focus less steps – more vision on the patients vision...

MediconturMedical Engineering [email protected]

Head OfficeHerceghalmi Road 1.2072 ZsámbékHungary

International OfficeChemin des Aulx 181228 Plan-les-OuatesGeneva/Switzerland

LESS STEPS – MORE VISION

”Exceptionally good platform and an optic that generates more patient satisfaction in terms of defocus curves and perceived dysphotopsia symptoms. I would not change a thing about this IOL.“

J. Fernandez MD, PhD, Spain

FOCUSon the patients visionsince 1989

Medicontur stands for consistent high quality, proven by more than

6 millionintraocular lensesimplanted.

„Clinical evidence of prospective randomized study catapulted Liberty into high quality trifocal group of IOLs available on the market.“

E. Van Acker, MD, Belgium

TRIFOCAL Complete Spectacle Independence

7 RINGS TO PERFECTIONSuperior Contrast Sensitivity

THE MOST BALANCED TRIFOCAL IOL

liberty-lens.com

References A. AF, Dunai et al. (Hungary) Comparison of two multifocal IOL Types (50 Bi-Flex M &50 Acrysof IQ) – long term visual outcome. ESCRS 2016, 2017. B. E. Van Acker, MD, (Belgium) Comparison of clinical outcomes and patient satisfaction after implantation of two different types of diffractive apodized IOLs: 40 Bi-Flex M (based on PAD technology) 40 Finevision (Micro F) trifocal diffractive IOL. Prospective, randomized, observational study. ESCRS 2017. C. J. Györy (Hungary) Long term functional and morphological outcomes and patient satisfaction after cataract surgery with 100 BiFlex M implantation with/without posterior central circular capsulorhexis (PCCC). ESCRS 2016, 2017. D. J. Fernandez MD, PhD, (Spain) Visual performance of patients implanted with progressive PAD Bi-Flex M analyzed by the Qvision iPAD Multifocal LensAnalyzer. ESCRS 2017. E. E. Law et al. (UK) Randomised clinical trial of the Bi-Flex M multifocal intraocular lens. ESCRS 2017. F. A Dexl. (Austria) Visual Outcome, Patient Satisfaction and Spectacle Independency after Implantation of 50 eyes with Progressive Bi-Flex M. Final Result of a Multicentric Trial with 50 Conscecutive Patients. ESCRS 2015. G. C. Naval. (Philippines) Evolution of multifocal practice. ESCRS 2014. H. N. Meijide (Argentina) Visual Outcomes After Bilateral Implantation of a New Progressive Apodized Diffractive Trifocal IOL. Clinical outcome ASCRS 2018 ID 42517. I. J. García-Bella et al. (Spain) Visual outcomes after progressive apodized diffractive intraocular lens implantation. Eur J Ophthalmol. 2017 Sep. J. M. Assouline MD, PhD, (France) Comparative Outcome of Four Multifocal Intraocular Lens. ESCRS 2015.

ENHANCED QUALITYOF VISION

IOL manufacturers eagerly compete for superior intermediate performance or compress the addition towards the intermediate to create some „comfort“. While doing this they disregard the main key of success for multifocal IOLs – SPECTACLE INDEPENDENCE.

Medicontur chooses not to compromiseIOL performance.

Liberty equates to spectacle independence without the compromise of reduced image quality or visual acuity at near and far distances.

LIBERTYFOR YOUR PATIENTS

Liberty-brochure-15.indd 1Liberty-brochure-15.indd 1 08.11.18 14:1808.11.18 14:18

2


Less Diffractive Steps – More Vision

Light is scattered within an IOL by every diffractive step. Considerable additional light scattering is caused by the manufactured imperfections of these steps on multiple points.

Therefore not only the quality but also the quantity of the manufactured steps has a great impact on light scattering and loss of light energy.

The below symbolic fi gures demonstrate the difference in light scattering and energy loss on two separate diffractive IOL profi les.

Quantity of Scattered Light

What does LESS STEPS mean for your patients?

Less light scattering improves vision by Higher Contrast Sensitivity Less Halos & Glare

N I F

N I F

Figure 1a:LIBERTY optic with 7 diff ractive steps Moderate light scattering

Figure 1b:Diff ractive optic with2× more diff ractive stepscreates minimum3× more light scattering


Out-Of-Focus Light IntensityDistribution by Visualization ofLight Propagation along the Optical Axis

Which Lens Would You Prefer For Driving At Night?* Simulated by Zemax extension for calculation of light propagation aft er custom defi ned diff ractive surfaces.

Light Energy Intensity at 4.5 mm Aperture* Halos in FAR focal plane

Log of relative intensity (-)



Defocus (D) Distance from optical axis (um)

Distance from optical axis (um)

Distance from optical axis (um)

5.0 4.5 4.0 3.5 3.0 2.5 2.0 1.5 1.0 0.5 0.0 +0.5 -1.0

Dist

ance

from

opt

ical

axi

s (um

)

150

100

50

0

-50

-100

-150

80

60

40

20

0

0-20 20-40 40-60 60-80 80

0-20 20-40 40-60 60-80 80

0-20 20-40 40-60 60-80 80

-20

-40

-60

-80

80

60

40

20

0

-20

-40

-60

-80

80

60

40

20

0

-20

-40

-60

-80

0

-1

-2

-3

-4

-5

-6

-7

-8

0

-1

-2

-3

-4

-5

-6

-7

-8

0

-1

-2

-3

-4

-5

-6

-7

-8

0

-1

-2

-3

-4

-5

-6

-7

-8

0

-1

-2

-3

-4

-5

-6

-7

-8

0

-1

-2

-3

-4

-5

-6

-7

-8

Medicontur Liberty 1.0

OUT-OF-FOCUS INTENSITY



NEAR

NEAR

NEAR

FAR

FAR

FAR

Defocus (D)5.0 4.5 4.0 3.5 3.0 2.5 2.0 1.5 1.0 0.5 0.0 +0.5 -1.0

Dist

ance

from

opt

ical

axi

s (um

)

150

100

50

0

-50

-100

-150

Competitor 1 - quadrofocal

Defocus (D)5.0 4.5 4.0 3.5 3.0 2.5 2.0 1.5 1.0 0.5 0.0 +0.5 -1.0

Dist

ance

from

opt

ical

axi

s (um

)

150

100

50

0

-50

-100

-150

Competitor 2 – trifocal apodized


4

Figure 2: MTF through focus curves with central diff ractive phase shift s at a destructive and a constructive interference level resulting in a 3rd focal point for intermediate vision.

Figure 1: Radial profi le with central diff ractive phase shift elevated from a destructive level to a constructive interference level.

Ph

ase

Shif

t (

)

Radial distance from the optical axis (mm)

Bifocal = Destructive interference phase levelTrifocal = Elevated Phase Shift* Constructive interference

* patent pending

0.7

0.6

0.5

0.4

0.3

0.2

0.1

0.00.0 0.4 0.6 0.8 1.0 1.2 1.40.2

-0.8 -0.5 -0.3 0.0 0.3 0.5 0.8 1.0 1.5 1.5 1.8 2.0 2.3 2.5 2.8 3.0 3.3 3.5 3.8 4.0

MTF

@ 5

0 lp

/mm

Defocus in ISO eye model (D)

Bifocal = Destructive interference levelTrifocal = EPS * Constructive interference

* patent pending

0.40

0.35

0.30

0.25

0.20

0.15

0.10

0.05

0.00

A TRIFOCAL DESIGN: Elevated Phase Shift * (EPS) technology

Medicontur‘s proprietary, patented approach to trifocality uses EPS in the central part of the optic to generate constructive interference between the 0th (far) and 1st (near) diffractive order. This revolutionary optical design generates the 3rd focal point for intermediate vision in a very unique way:


EPS* technology uses only 7 rings within a 3 mm diameter for complete spectacle independence, improved image quality and excellent performance at near and far.


7 steps to Trifocal perfection

LIBERTY IOLs achieve trifocal performance with

7 steps in a precise diffractive array within a 3 mm diameter leaving a 75% refractive lens surface.

LIBERTY IOLs are strongly pupil dependent using the NEAR TRIAD which implies miosis under accommodation. We believe that too much light distribution into the near focus above 3 mm aperture does not match normal ocular physiology.

The 4 charts below show the Useful Light Distribution in % of LIBERTY and 3 competitors depending on the aperture [mm] *. LIBERTY provides the highest light distribution in the near focus under accommodation and the highest for far vision under scotopic conditions.

100 %

50 %

0 %

2.0 2.5 3.0 3.5 4.0 4.5 5.0

Liberty 1.0

Aperture (mm)

100 %

50 %

0 %2.0 2.5 3.0 3.5 4.0 4.5 5.0

Competitor 1 quadrofocal

Aperture (mm)

100 %

50 %

0 %2.0 2.5 3.0 3.5 4.0 4.5 5.0

Competitor 2 trifocal apodized

Aperture (mm)

100 %

50 %

0 %2.0 2.5 3.0 3.5 4.0 4.5 5.0

Competitor 3 trifocal non-apodized

Aperture (mm)

* Based on Zemax simulation results, PMTF calculation method and on Strehl ratio calculated from Zemax simulated MTF values.

Far Near Inter


6

1. TRIFOCAL PERFORMANCE *2. COMPLETE SPECTACLE INDEPENDENCE *3. EXCELLENT FAR – NEAR & GOOD INTERMEDIATE VISION *4. REFRACTIVE PREDICTABILITY & LONG TERM STABILITY *5. OUTSTANDING CONTRAST SENSITIVITY *6. EXCELLENT READING SPEED *7. MINIMAL REPORTS OF DYSPHOTOPSIA *

” The most balancedtrifocal IOL on the market.“

M. Assouline, MD, PhDFrance

APAO 2018,Hong Kong

10CLINICALSTUDIES

IN

12 COUNTRIES

MORE THAN

900 EYES

100

80

60

40

20

0

Per

cen

tag

e of

pat

ien

ts (%

)

9692

49644

4

Very Satisfied Satisfied Rather satisfied

95%of patients

HIGHLYSATISFIED

at all distances (study C)

* Confi rmed by studies; see references.



TRIFOCAL performanceand Spectacle Independence

Clinical evidence shows excellent far & near, good intermediate vision.

Outstanding Visual Performance for Liberty 677MY (Study C)

Equivalent Clinical Visual Acuity compared to FineVision (PhysIOL) (Study B)

1.6

1.4

1.2

1.0

0.8

0.6

0.4

0.2

0 1.00

0.70

0.40

0.20

0.10

0.00

-0.10

-0.15

-0.20

2.0 1.5 1.0 0.5 0.0 -0.5 -1.0 -1.5 -2.0 -2.5 -3.0 -3.5 -4.0

Vis

ual

Acu

ity

(dec

imal

) Visu

al Acu

ity (logM

AR

)

Diopters

Binocular Defocus curve (24-month follow-up)

1.2

1.0

0.8

0.6

0.4

0.2

0.0

67 cm

+4.0 +3.5 +3.0 +2.5 +2.0 +1.5 +1.0 0.0 -0.5 -1.0 -1.5 -2.0 -2.5 -3.0 -3.5

Vis

ual

Acu

ity

(dec

imal

)

Liberty 677MYDiopters Micro F (PhysIOL)

1.00

0.70

0.40

0.20

0.10

0.00

-0.10 Visu

al Acu

ity (logM

AR

)


8


High Image QUALITY

Superior Contrast Sensitivity compared to FineVision (PhysIOL) in different light conditions. (Study B, C)

0.0

0.5

1.0

1.5

2.0

2.5

Spatial frequencySpatial frequency

3 6 12 18

PHOTOPIC

CYC/DEG CYC/DEG CYC/DEG

MESOPIC SCOTOPIC

Log

Con

tras

t Se

nsi

tivi

ty

Liberty 677MY (Medicontur) PhysIOL

3 6 12 18

Spatial frequency

3 6 12 18

Equivalent Contrast Sensitivityto Bi-Flex

Monofocal IOL (Study E)

Equivalent Reading Speedto Bi-Flex

Monofocal IOL (Study E)

„After over 100 implantations trifocal performance is evident. Less halos & glare, better contrast sensitivity. All my patients implanted with Liberty are spectacle independent.“ J. Győry, MD, Hungary ESCRS 2017, Lisbon

1.7

1.6

1.5

1.4

1.3Log

Con

tras

t Se

nsi

tivi

ty

Liberty 677MY

Pelli-Robson Contrast Sensitivity

Bi-Flex 677AB

Log

Con

tras

t Se

nsi

tivi

ty

Liberty 677MYBi-Flex 677AB

CSV-1000

0.4

0.6

0.20 3 6 9 12 15 18

0.8

1.0

1.2

1.4

1.6

1.8

2.0

CYC/DEG

Liberty 677MYBi-Flex 677AB

100

120

140

160

180

200

220

Wor

ds

per

min

ute


ACCURACY & PREDICTABILITY

Accuracy of refractive outcome of Liberty overshadow distinctivelyliterature average = ±0.5 D: 75.1%.

Excellent Long Term Refractive Stability and Visual Outcomes. (Study C)

Mean spherical equivalent residual error of -0.15D (± 0.33D) (Based on studies A, C, D)

Cooke DL, Cooke TL. J Cataract Refract Surg. 2016;42(8):1157-1164

UCVA vs BCVA

Uncorrected Corrected

Cumulative Snell Visual Acuity (20/40 or better)

DISTANCE

TIM

E

INTERMEDIATE NEAR

2 3 1 4

0 0

0 0

2 3

1 2

1 2

1629

67

19

4456

85 8997 93

99 100

100 100 100 100 100 100 100 100

100 1001001009397

7359

37

90 95 100

10096

20

44

63

37

57

80

98 9593 9095

77

47

2600

100 100 100 100

100 100 100 100

20/12.5 20/16 20/20 20/25 20/32 20/40

20/12.5 20/16 20/20 20/25 20/32 20/40

20/12.5 20/16 20/20 20/25 20/32 20/40

20/12.5 20/16 20/20 20/25 20/32 20/40

20/12.5 20/16 20/20 20/25 20/32 20/40

20/12.5 20/16 20/20 20/25 20/32 20/40

100

80

60

40

20

0

100

80

60

40

20

0

3 M

onth

s P

osto

pCu

mula

tive p

ercen

t of e

yes (

%)12

Mon

ths

Pos

top

Cum

ulativ

e perc

ent o

f eye

s (%)

88%of Eyes

≤ ± 0.50D

Refractive Stability and Predictability

Liberty-card-3-Graph-02.indd 1Liberty-card-3-Graph-02.indd 1 08.11.18 14:1908.11.18 14:19

A LEADINGHAPTIC DESIGNFOR ROTATIONALSTABILITYPCO PROTECTION 360° posterior optic edge (≤ 10 um edge radius)

ROTATIONAL STABILITY Ergonomic-adaptive fi t with optimal balancein haptic force – DOUBLE LOOP HAPTIC

180° contact angle between hapticand the capsular bag equator at 9 mm Ø

PREMIUM MATERIAL &ADVANCED

MANUFACTURING TECHNOLOGY

SAFETY RECORDS 20 years on the market

(since 2010 for trifocal IOLs)

IMAGE QUALITY Highest ABBE no. (58) for the lowest chromatic aberration

PCO protection Low ionicity surface for less cell adhesion

RETINA PROTECTION UV blocker

Violet light fi ltering

TRIFOCAL PERFORMANCE – SPECTACLE INDEPENDENCEHIGH QUALITY OF VISION

7 steps in a precise diffractive array with a 3 mm diameter leaving a

75% refractive lens surface Minimal dysphotopic phenomena

Superior contrast sensitivity Uncompromised near vision

PUPIL DEPENDENT using physiological NEAR TRIAD

Material. Design. Optics.

Liberty-card-1-MDO-03.indd 1Liberty-card-1-MDO-03.indd 1 08.11.18 14:1808.11.18 14:18

Single use injection system for Liberty 677PMY preloaded IOLs

* Other powers upon request** Patent pending*** It is recommended that surgeons personalize the constants they use.

Type Single-piece hydrophilic intraocular lensfor implantation into the capsular bag

Material 25% water content with UV absorber + blue light fi lter; Refractive Index 1.46; ABBE number 58

Optic design Biconvex, aspheric, diffractive-refractive, apodized

Powers available* 8.0 D +35.0 D · (increment: 0.5 D)*

Diffractive zone EPS technology**, anterior surface, Ø 3.0 mm

Addition +3.5 D (near); +1.75 D (intermediate)

A-constant*** 118.9 (SRK/T)***

Dimensions Overall length 13.0 mm; optic Ø 6.0 mm

PCO protection 360° Special Square Edge (patented)

Haptic angulation 0° – asymmetrical design with posterior vaulting

Sterilization Steam (shelf life 5 years after sterilization)

Storage conditions at +15 °C – +35 °C (15% – 50% humidity)

1st CLICK LOADING

Put a drop of visco in the lens holder and insert the injector to the wet container.

3rd CLICK READY

Push the redstopper forwardto the endposition andfi ll visco

2nd CLICK CLOSING

Fold up the cartridgenozzle

INJECTION

Push the plunger midwaythen pull back 1–2 mm and continuepushing

SING

ge

nger midwayk 1–2 mm

DY

Liberty 677PMY Technical Specifi cation

Liberty-card-2-Data-Sheet-04.indd 1Liberty-card-2-Data-Sheet-04.indd 1 08.11.18 14:1908.11.18 14:19


liberty-lens.com

References A. AF, Dunai et al. (Hungary) Comparison of two multifocal IOL Types (50 Bi-Flex M &50 Acrysof IQ) – long term visual outcome. ESCRS 2016, 2017. B. E. Van Acker, MD, (Belgium) Comparison of clinical outcomes and patient satisfaction after implantation of two different types of diffractive apodized IOLs: 40 Bi-Flex M (based on PAD technology) 40 Finevision (Micro F) trifocal diffractive IOL. Prospective, randomized, observational study. ESCRS 2017. C. J. Györy (Hungary) Long term functional and morphological outcomes and patient satisfaction after cataract surgery with 100 BiFlex M implantation with/without posterior central circular capsulorhexis (PCCC). ESCRS 2016, 2017. D. J. Fernandez MD, PhD, (Spain) Visual performance of patients implanted with progressive PAD Bi-Flex M analyzed by the Qvision iPAD Multifocal LensAnalyzer. ESCRS 2017. E. E. Law et al. (UK) Randomised clinical trial of the Bi-Flex M multifocal intraocular lens. ESCRS 2017. F. A Dexl. (Austria) Visual Outcome, Patient Satisfaction and Spectacle Independency after Implantation of 50 eyes with Progressive Bi-Flex M. Final Result of a Multicentric Trial with 50 Conscecutive Patients. ESCRS 2015. G. C. Naval. (Philippines) Evolution of multifocal practice. ESCRS 2014. H. N. Meijide (Argentina) Visual Outcomes After Bilateral Implantation of a New Progressive Apodized Diffractive Trifocal IOL. Clinical outcome ASCRS 2018 ID 42517. I. J. García-Bella et al. (Spain) Visual outcomes after progressive apodized diffractive intraocular lens implantation. Eur J Ophthalmol. 2017 Sep. J. M. Assouline MD, PhD, (France) Comparative Outcome of Four Multifocal Intraocular Lens. ESCRS 2015.

MediconturMedical Engineering [email protected]

Head OfficeHerceghalmi Road 1.2072 ZsámbékHungary

International OfficeChemin des Aulx 181228 Plan-les-OuatesGeneva/Switzerland

LESS STEPS – MORE VISION

”Exceptionally good platform and an optic that generates more patient satisfaction in terms of defocus curves and perceived dysphotopsia symptoms. I would not change a thing about this IOL.“

J. Fernandez MD, PhD, Spain

FOCUSon the patients visionsince 1989

Medicontur stands for consistent high quality, proven by more than

6 millionintraocular lensesimplanted.

„Clinical evidence of prospective randomized study catapulted Liberty into high quality trifocal group of IOLs available on the market.“

E. Van Acker, MD, Belgium

TRIFOCAL Complete Spectacle Independence

7 RINGS TO PERFECTIONSuperior Contrast Sensitivity

focus less steps – more vision on the patients vision...

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