focus less steps – more vision on the patients vision ...€¦ · the most balanced trifocal iol...

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 WOC 2018, Barcelona

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 the high quality trifocal group of IOLs available on the market.“

E. Van Acker, MD, Belgium ESCRS 2017, Lisabon

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 funcional 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 ith 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 QUALITY OF 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 compromise IOL performance.

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

LIBERTY FOR YOUR PATIENTS

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 figures demonstrate the difference in light scattering and energy loss on two separate diffractive IOL profiles.

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 diffractive steps Moderate light scattering

Figure 1b:Diffractive optic with2× more diffractive steps creates 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 after custom defined diffractive surfaces.

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

Log of relative intensity (-)



Defocus (D) Distance from optical axis (μm)

Distance from optical axis (μm)

Distance from optical axis (μm)

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 (μm

)

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

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 (μm

)

150

100

50

0

-50

-100

-150

Competitor 1 - quadrifocal

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 (μm

)

150

100

50

0

-50

-100

-150

Competitor 2 – trifocal apodized

4

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

Figure 1: Radial profile with central diffractive phase shift elevated from a destructive level to a constructive interference level.

λP

hase

Shi

ft (

)

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

Aperture (mm)

100 %

50 %

0 %2.0 2.5 3.0 3.5 4.0 4.5 5.0

Competitor 1 quadrifocal

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 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 balanced trifocal IOL on the market.“

M. Assouline, MD, PhD France

APAO 2018, Hong Kong

10CLINICALSTUDIES

IN

12 COUNTRIES

MORE THAN

900 EYES

100

80

60

40

20

0

Per

cent

age

of p

atie

nts

(%)

9692

49644

4

Very Satisfied Satisfied Rather satisfied

95%of patients

HIGHLY SATISFIED

at all distances (study C)

* Confirmed by studies; see references.


TRIFOCAL performance and 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 A

cuit

y (d

ecim

al) V

isual Acuity (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 A

cuit

y (d

ecim

al)

Liberty 677MYDiopters FineVision (PhysIOL)

1.00

0.70

0.40

0.20

0.10

0.00

-0.10 Visual A

cuity (logMA

R)

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

nsit

ivit

y

Liberty 677MY (Medicontur) FineVision (PhysIOL)

3 6 12 18

Spatial frequency

3 6 12 18

Equivalent Contrast Sensitivity to Bi-Flex

Monofocal IOL (Study E)

Equivalent Reading Speed to 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, Lisabon

1.7

1.6

1.5

1.4

1.3Log

Cont

rast

Sen

siti

vity

Liberty 677MY

Pelli-Robson Contrast Sensitivity

Bi-Flex 677AB

Log

Cont

rast

Sen

siti

vity

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 p

er m

inut

e

ACCURACY & PREDICTABILITY

Accuracy of refractive outcome of Liberty overshadow distinctively literature 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

4020

0

100

80

60

4020

0

3 M

onth

s P

osto

pCu

mulat

ive pe

rcent

of ey

es (%

)12

Mon

ths

Pos

top

Cumu

lative

perce

nt of

eyes

(%)

88%of Eyes≤ ± 0.50D

Refractive Stability and Predictability

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 filter; Refractive Index 1.46; ABBE number 58

Optic design Biconvex, aspheric, diffractive-refractive, apodized

Powers available* +8.00 D +35.00 D (increment: 0.50 D)

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

Addition +3.50 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)

Liberty 677MY / 677PMY Technical Specification

1st CLICK LOADING1. Put a drop of visco in the lens holder2. Insert the injector into the wet container

3rd CLICK READY5. Push the red stopper forward to the end position6. Fill visco

2nd CLICK CLOSING3. Inject viscoelastic material into the cartridge nozzle

4. Fold up the cartridge nozzle

INJECTION7. Push the plunger midway then pull back to the end and continue pushing

A LEADING HAPTIC DESIGN FOR ROTATIONAL STABILITYPCO PROTECTION 360° posterior optic edge (≤ 10 um edge radius)

ROTATIONAL STABILITY Ergonomic-adaptive fit with optimal balance in haptic force – DOUBLE LOOP HAPTIC

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

PREMIUM MATERIAL & ADVANCED

MANUFACTURING TECHNOLOGY

SAFETY RECORDS 30 years experience in IOL design

and manufacturingIMAGE QUALITY

Highest ABBE no. (58) for the lowest chromatic aberrationPCO protection

Low ionicity surface for less cell adhesionRETINA PROTECTION

UV blocker Violet light filtering

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.

* Other powers upon request** Please note that at SEQ.: +8.0 D to +9.5 D, only cyl. +1.0 D to +4.5 D applies.*** Patent pending**** It is recommended that surgeons personalize the constants they use.

TypeSingle-piece hydrophilic trifocal toric intraocular lens for implantation into the capsular bag

Material25% water content with UV absorber + blue light filter; Refractive Index 1.46; ABBE number 58

Optic design Biconvex, aspheric, diffractive-refractive, apodized, toric

Powers available* +8.00 D +35.00 D (increment: 0.50 D)

Cylinders available**

+1.00 D +4.50 D (increment: 0.50 D)+5.25 D; +6.00 D

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

Addition +3.50 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)

Liberty 677MTY Technical Specification


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 funcional 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 ith 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 WOC 2018, Barcelona

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 the high quality trifocal group of IOLs available on the market.“

E. Van Acker, MD, Belgium ESCRS 2017, Lisabon

TRIFOCAL Complete Spectacle Independence

7 RINGS TO PERFECTIONSuperior Contrast Sensitivity

focus less steps – more vision on the patients vision ...€¦ · the most balanced trifocal iol...

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