Our Experience with Advances Technology Lenses- AcrySof ReSTOR IOL/ AcrySof Toric IOL

Dr. Suresh K Pandey,

MS (Ophthalmology, PGIMER, CHANDIGARH), Anterior Segment Fellowship (USA)

Dr. Vidushi Sharma, MBBS (AIIMS),

MD (Ophthalmology, AIIMS, New Delhi), FRCS (UK) SuVi Eye Hospital & Lasik Laser Centre C-13, TALWANDI, KOTA, RAJASTHAN, INDIA www.suvieye.com, Email:suvieye@gmail.com Phone +91 9351412449 The authors have no financial interest in the subject matter of this presentation

Patient Considerations for Multifocal IOL

Subjective Exclusion Criteria
Hypercritical patients Patients with unrealistic expectations Those who want to wear glasses Occupational night drivers Individuals with a monofocal lens

Medical Exclusion Criteria

>1.0 D of corneal astigmatism Pre-existing ocular pathology Previous refractive patients

Patient Considerations for Multifocal IOL

Subjective Exclusion Criteria
Hypercritical patients Patients with unrealistic expectations Those who want to wear glasses Occupational night drivers Individuals with a monofocal lens

Medical Exclusion Criteria

>1.0 D of corneal astigmatism Pre-existing ocular pathology Previous refractive patients

Keratometry First & then Counseling Screen the patient for Keratometry first and then counsel patient for cataract surgery Patients having 1D Cyl are candidate for toric IOL

DIFFERENT MULTIFOCALS IOLS USED IN OUR PRACTICE OVER 6 YEARS (n=352)

140 120 100 80 60 40 20 0 ReSTOR Acri.LISA AcriDiff 52 46 26 56 30 12 Acryfold ReSTOR Tecnis MF Acri.LISA Preziol AcriDiff iDIFF Acryfold 130

PERSONAL CONFIDENCE
Implanted AcrySof ReSTOR bilaterally in father and unilaterally in mother (other eye awaiting surgery) Post Op VA 6/6 and N5 Both are satisfied and spectacle free (Do not use computers)

FIRST CASE OF ACRYSOF ReSTOR, AUGUST 9, 2006

43 years, Soft Cataract AcrySof ReSTOR Multifocal IOL (ODPlus 4 add) Post Op. 6/6 and N5

ACRYSOF ReSTOR IOL

High Myopia Post Op VA 6/9 N6 (UA)

RLE Post Op VA 6/6 N6 (UA)

My Experience of AcySof ReSTOR IOL

No. of AcrySof ReSTOR IOLs used since 2006 52 eyes (32 patients) 12 cases were unilateral; 20 had bilateral AcrySof ReSTOR IOL Gender distribution

20

12

Bilateral Unilateral

14 18

Male Female

POST OP UNAIDED DISTANCE VA (N=52 eyes)

30 25 20 15 10 5 0 6/6 or better 6/9 or 6/9p 6/12 or less 3 6/6 or better 6/9 or 6/9p 28 21

POST OPERATIVE DISTANCE BCVA (N=52)

50 45 40 35 30 25 20 15 10 5 0 48

6/6 or better 6/9 6/12 2 6/6 or better 6/9 2 6/12

POST OP UNAIDED NEAR VA AT BEST DISTANCE (N=52 eyes)

45 40 35 30 25 20 15 10 5 0 N6 or better N9 or N9p N12 or less 6 2 N6 or better N9 or N9p N12 or less 44

POST OP BEST CORRECTED NEAR VA (N=52)

50 45 40 35 30 25 20 15 10 5 0 50

N6 or better N9 or N9p N12 or less 2 N6 or better N9 or N9p

0 N12 or less

POST OP UNAIDED DISTANCE VA (N=20)

18 16 14 12 10 8 6 4 2 0 N6 or better N9 or N9p N12 or less 2 0 N6 or better N9 or N9p N12 or less 18

POST OP UNAIDED NEAR VA AT BEST DISTANCE (N=20)

20 18 16 14 12 10 8 6 4 2 0 19

N6 or better N9 or N9p N12 or less 1 N6 or better N9 or N9p

0 N12 or less

POST OP VISUAL DISTURBANCES NS (N=32 Patients)

10 9 8 7 6 5 4 3 2 1 0 10 8 5 3
Glare Haloes Night Driving (n=16) Reduced Contrast

Glare

Haloes

Night Driving (n=16)

Reduced Contrast

AcrySof TORIC IOLs (First 100 Cases)

Cases with pre-op astigmatism of >1.25 D Total eyes 100 in 87 patients (74 unilateral, 13 bilateral) 52of 100 eyes had 0.5D postop cylinder, 93 of 100 eyes had 0.75D 54 of 100 eyes had unaided VA 6/6 or better, 94 of 100 had 6/12 or better Postop IOL rotation < 5 in 97 eyes

PURPOSE
To evaluate visual outcome and astigmatic correction following implantation of the first 100 AcrySof Toric IOLs at our centre Patients with cataract and coexistent regular Corneal Astigmatism of >1.25D All cases (except one under GA) underwent topical phacoemulsification with AcrySof toric IOL or Acrysof Restor Toric (n=5) implantation

VISUAL OUTCOME
Visual acuity and Refraction checked at 1st postop day, 2 weeks and 6 weeks Final correction at 6 weeks IOL rotation also checked at 6 weeks correlating with incision placed at steep axis

RESULTS
No. of AcrySof toric IOLs used since 2008 100 (87 patients) 74 cases were unilateral; 13 had bilateral toric IOL Gender distribution
58 29

Male Female

AGE DISTRIBUTION (N=87)

45 40 35 30 25 20 15 10 5 0 <40 yrs 40-60 yrs >60 years 14 29 <40 yrs 40-60 yrs >60 years 44

PREOP CYLINDER (N=100)

POST OP CYLINDER (N=100)

60 50 41 40 30 20 10 0 0.5D 0.5-0.75D 7 0.5D 0.5-0.75D 075-1.0D 52

075-1.0D

POST OP UNAIDED VA (N=100)

60 50 40 30 20 10 0 6/6 or better 6/9 to 6/12 <6/12 6 6/6 or better 6/9 to 6/12 <6/12 43 51

POST OPERATIVE BCVA (N=100)

90 80 70 60 50 40 30 20 10 0 6/6 or better 6/9 6/12 8 3 6/6 or better 6/9 6/12 89

POST OP IOL ROTATION

100 90 80 70 60 50 40 30 20 10 0 97

<5 degree 5-10 degree

3 <5 degree 5-10 degree

DISCUSSION
In our series, 65% patients achieved 0.5D astigmatism and 95% patients achieved postoperative astigmatism within 0.75D 95% patients achieved an unaided visual acuity of 6/12 or better markedly decreasing their spectacle dependence for distance vision

DISCUSSION/CONCLUSION
One patient had CME (BCVA 6/12) One 8 year old child had surgery for developmental cataract and achieved postoperative BCVA of 6/12 (amblyopia) Only 1 patient had IOL rotation > 5 (postoperative cylinder - 0.75D) AcrySof Toric IOL shows excellent rotational stability, if placed accurately during surgery due to its sticky surface

AcrySof Toric IOL in White Cataract

AcrySof Toric IOL in Anterior Lenticonus

 45 years patient, high hypermetropia Refractive Error (+ 16.0 D with 1.50 D Cyl at 170 degree) K Reading : 44.00/45.50 (1.50 D Cyl at 170 degree) Early lenticular changes Post Op UAVA 6/9 (Near N5 with plus2.5 D Add)

AcrySof Toric IOL with implantation of Piggyback Monofocal IOL

PiggyBack IOL

Practice of Non-Toric IOL (Video)

Thanks for your attention ?Question/Comment

Our Experience with Advances Technology Lenses- Alcon AcrySof ReSTOR IOL/ Alcon AcrySof Toric IOL
Dr. Suresh K Pandey,
MS (Ophthalmology, PGIMER, CHANDIGARH), Anterior Segment Fellowship (USA)

Dr. Vidushi Sharma, MBBS (AIIMS),

MD (Ophthalmology, AIIMS, New Delhi), FRCS (UK)

SuVi Eye Institute & Lasik Laser Centre

C-13, TALWANDI, KOTA, RAJASTHAN, INDIA www.suvieye.com, Email:suvieye@gmail.com Phone +91 9351412449
The authors have no financial interest in the subject matter of this presentation