Early Outcomes (9 months) with a Toric Accommodating IOL How do They Fit in My refractive Practice Douglas Katsev MD Sansum Clinic i Chairman Ophthalmology Santa Barbara CA 1
Disclosure Consulting Fee: Abbott Medical Optics; Bausch + Lomb Speakers Bureau: Alcon Laboratories, Inc.; Allergan Ownership Interest: TruVision 2
Model Specifications Model Recommended Starting A-constant Recommended Starting ACD Overall Diameter Available Now Diopter Power Accomodating Toric IOL BL1UT 119.1* 5.61 mm* 11.5 mm 17.0 to 25.0 D in 0.50 D steps Cylinder powers IOL plane Cylinder powers corneal plane 1.25, 2.00, 2.75 D 0.83, 1.33, 1.83 D Optic body diameter 5.0 mm Anterior surface Aspheric with axis marks Posterior surface Aspheric toric (cyl at 1.25, 2.00, 2.75 D) Material body and plates Silicone with enhanced UV protection; 10% UV cutoff at 400 nm Material loop (haptics) Polyimide Refractive index at 35 o C 1.43 Edge design 360º posterior square edge Delivery system Crystalsert IOL Delivery System 3
Accomadating Toric How do I position it? A broader range of vision with astigmatic correction May read but NO promise Does NOT produce all ranges of Vision all the time Telling the patient the real results will not hurt your conversion rate but will help with patients satisfaction It may take time and work to get the result Need to offer a good reading multifocal IOL too 4
Accomodating Lens with and without Toric Work with Previous Refractive These are harder patients, they need to know it! Works with Coma/Trefoil Previous RK, need to know they are harder Lasik especially hyperopic do well in my hands Informed consent is the most important Prepare for reops PRK/LASIK Prepare for IOL exchange Especially with RK but only after healing 5
Retina s View of Crystalens Less issue than multifocals Easier to work around view when operating Can use with SMD and ERM with proper consent Less chance they tell the patient later that lens makes thing difficult 6
Crystalens AO - Non Post Refractive Absolute Prediction Error <0.5D 100% TMF 84% 93% 94% Restor 84% 88% 85% 80% 73% 67% 60% 40% 40% 44% 20% 0% 0.25D 0.5D 0.75D 1D PreOp Est Prediction Error ORA N=864; Mean 0.47 0.94 N=869; Mean 0.29 0.31
Dr. Douglas Katsev Santa Barbara Surgery Center ORA Outcome Analysis
Accomodating Toric Global ORA Data (non VerifEye) Astigmatism Management Pre-Op Keratometric Astigmatism N=70; Mean 1.64 D 078 0.78 Range 0.25 D to 4.68D Prost-Op Refractive Astigmatism N=70; Mean 0.43 D 041 0.41 Range 0.00 D to 1.50 D
Accommodating Toric Personal Data Astigmatism Management (early data) PreOp Keratometry Post Op Manifest Ref N=5; Mean 2.12 0.7 N=5; Mean 0.5 045 0.45
Accommodating Toric Personal Data Astigmatism Management Pre-Op Keratometric Astigmatism Post-Op Refractive Astigmatism N=11; Mean 2.30 D 1.04 N=11; Mean 0.51 D 0.47 Range:103Dto468D 1.03 4.68 D Range:000Dto150D 0.00 1.50 D
Accommodating Toric Personal Data Post-op op Refractive Astigmatism N=11; Mean 0.51 D 0.47
Accommodating Toric Absolute Prediction i Error and Distribution ib i ORA N=11 Mean 0.31 D 0.19
Comparison with Standard Toric IOLs TRULIGN Toric IOL 1 AcrySof IQ Toric 2 Tecnis Toric IOL 3 Uncorrected Distance Visual Acuity: Eyes 20/40 97.8% 93.8% 97.0% Rotational Stability: Rotation 5 at 6 months vs prior 96.1% 81.1% 94.1% assessment Residual Cylinder: Eyes 1.0 10D 95.5% 87.0% 94.1% 14 1. Data on file, Bausch & Lomb Incorporated. Study 650. Results of a prospective, multicenter, randomized, single-masked, clinical study of 229 eyes of 229 subjects. 2. AcrySof IQ Toric Directions for Use. 3. Tecnis Toric IOL Directions for Use.
Outstanding Rotational Stability Absolute rotation results at 4 to 6 months 1 1.25 D 2.00 D 2.75 D All Toric 5.00,% 93.1 100 100 96.1 10.00,% 98.6 100 100 99.2 Mean IOL rotation < 2 96.1% exhibited IOL rotational stability of 5 1. Data on file, Bausch & Lomb Incorporated. Study 650. 650-CSR-PMA-20feb2012.doc T 54 p75
Premium IOL Complaints 2011-2012: 2164 cataract surgeries implanted premium lenses 570 times (25% conversion rate) I received 12 patient complaints related to the use of these lenses 2.1% of cases 16
Convertion Rates to Premium IOL 2012 Total 29% TMF 13% Toric 11.5% Crystalens 4.5% 17
Convertion Rates to Premium IOL 1 st half year 2013 Total 36% TMF 12% Toric 12.5% Crystalens 12% 18
Convertion Rates to Premium IOL 2 st half year 2013 Total 38% increased 2% over 1 st have 12% over previous 2 years TMF 5% decreased Toric 8.5% Decreased 4% Crystalens 16% Trulign 8% 19
Premium IOL Complaints 2013 to date ~800cases implanted premium lenses 332 times (38% conversion rate) I received 1 patient complaints related to the use of these lenses 0.3 % of cases *time could bring more *complaint was didn t use ORA 20
My Ideal Patient for Accommodating Toric Most appropriate for astigmatic cataract patients who perform a variety of activities that require a range of vision. My patients Computer, ipad, iphone and texting drive and flying participate in sports NOT for the person that wants to read at close in a dark room NOT for the person who has good accommodation and wants Refractive Lensectomy 21 1. Data on file, Bausch & Lomb Incorporated, Study 650. 2. TRULIGN Toric IOL Directions for Use.
The Ideal Patient (cont) Good ocular health hnot impacting best-corrected visual acuity Active lifestyle Realistic expectations 22
PRE-OP PEARLS Spherical Targeting First eye implant should be targeted between -0.25 and -0.50 D Second eye implant targeted for plano based on first eye results Ora can help tighten results but doesn t eliminate touch ups 23
Marking the Cornea Prior to surgery, the subject s operative eye should be marked to identify the axis of placement TruVision works well ORA works well if you fill with viscoelastic and then mark cornea, reposition to marks after viscoelastic removed NOTE: I use the TRULIGN Toric IOL Calculator software program 24
Symmetrical Capsulorhexis Create a symmetrical capsulorhexis of 5.0 to 6.0 mm Very small and very large should be avoided d Femto will make this none issue o o 25
Polishing the Capsule Very important t change for me Polish the anterior and posterior capsule Meticulous cortical cleanup is very important to minimize capsular contraction and posterior capsular opacification (PCO) Special attention should be given to keeping the zonular apparatus intact, because IOL placement is highly dependent on an intact capsular zonular system and capsular bag HELP PREVENT Zsyndrome 26
Accommodating Toric Toric IOL Insertion IOL Delivery System requires a 2.85-mm opening for injection I prefer the injector to be deep in eye for easier haptic in bag placement Verify that the IOL is right-side-up (refer to Directions for Use) The round knob leading haptic on the right (remember round to the right ) 27
INTRA/Post-OPERATIVE PEARLS I put a drop of atropine I put a suture in *new FDA approved sealant may stop I have them use reading glasses 2 weeks 28
My Summary of Accommodating Toric IOL A broader range of vision than standard toric IOLs 1 Excellent visual acuity at intermediate and distance 2 Outstanding rotational stability 2,3 Effective cylinder correction 2 Residual cylinder 1.0 D: 95.5% of eyes 2 99.2% of patients reported no visual disturbances 2 1. TRULIGN Toric IOL Directions for Use. 2. Data on file, Bausch & Lomb Incorporated. Study 650. 3. AcrySof IQ Toric Directions for Use. 29
The Biggest Reason it Fits in My Practice Increase Conversion rates Less Complaints Happy Patients 30