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3000.0
2500.0
2000.0
1500.0
Millions
1000.0
500.0
0.0
Population trends in
Canada predict a
significant increase
in patients requiring
cataract surgery in
the next 15 years
Advanced
technologies are now
available to these
patients to enhance
Age Group
their visual function
2010
2021
2031
Projected population by age group and sex according to three projection scenarios for
2010, 2011, 2016, 2021, 2026,2031 and 2036, at July 1. Statistics Canada.
A brief review
Advanced
Technology Lenses
(Part 1) Toric implants
presented September 15th, 2011
% of Patients
Cylinder Distribution
Modera
te
1.0
2.0D
25%
Severe
>2.0 D
10%
Cylinder D ( < )
N = 10,411
AcrySof IQ TORIC
IOL:
Astigmatism
Correction
Rotational Stability
81.1% of patients
were 5 of
intended axis
97.1% of patients
were 10 of
intended axis
Cylinder Powers
Estimated Percent of Cataract
Patients with Astigmatism
0.5D
4D+
Toric Implants My
Practice
2010 805 Cataract Cases
94 1%
Aspheri
c
Toric
ReSTOR
700
ReSTOR
Toric
73
47
166
546
Aspheric
Toric
ReSTOR
ReSTOR
Toric
Toric Implant at
axis 90 degrees
Multifocal IOLs
Multifocal Implants
Diffractive
ReSTOR +3.0
Technis
AcriLisa (Europe)
Zonal
Refractive
ReZoom
Accommodating
Crystalens
Synchrony
a light
management
system
Microscopic
steps
sends light
where you need
it, when you
need it
Apodization
18
Cylinder Power
@ IOL Plane
Cylinder Power
@ Corneal Plane*
Recommended
Corneal Astigmatism
Correction Range
(Online Calculator Limits)
SND1T2
1.00
0.68
0.50 to 0.89 D
SND1T3
1.50
1.03
0.90 to 1.28 D
SND1T4
2.25
1.55
1.29 to 1.80 D
SND1T5
3.00
2.06
1.81 to 2.32 D
19
cm
cm 0 cm 3 cm
0
0
7
3
5
4
20/20
20/25
20/32
20/40
20/50
20/63
20/80
20/100
+1.00 +0.50 0.00 -0.50 -1.00 -1.50 -2.00 -2.50 -3.00 -3.50 -4.00
Refraction (D)
AcrySof IQ ReSTOR IOL +3.0 D [N=116]
Mean Defocus Curve for AcrySof IQ +3.0 D ReSTOR IOL
Binocular, Best Case, 6 Months Postoperative
Source: AcrySof IQ ReSTOR IOL Package Insert
20
Premium Implants My
Practice
55 bilateral ReSTOR
implantations so far
30 have completed 6
month Late Outcome
Assessments
measuring UCDVA,
UCNVA, BCDVA,
BCNVA, refraction
and survey of visual
activities and
function
73
Aspher
ic
47
Toric
166
546
ReSTO
R
ReSTO
R Toric
Surgivision/Datalink
40,000 premium
lens implants
60% (24,000) eyes left
Patient Education
What
Optometry
Change in Mindset
Acceptance
and Embracement of a
change in practice model
From medicare model treatment for
pathology
High volume, efficient, low cost care
Patients
Patient Education
Define
Symptoms
Blurred vision
Dull colors
Poor night vision
Sensitivity to light
Treatment
Lifestyle
Astigmatism
Preexisting ocular conditions, i.e. dry eye
Pathology rule out retinal pathology
Astigmatism
No Astigmatism
Basic IOL
Toric IOL
<2.5D of
cy pre-op
ReSTOR
Toric
Basic IOL
regular
astigmatism
healthy eye?
ReSTOR
Shared Decision
Making!
C0-Management Pre
and Post Operative
Care
C0-Management OD/MD
Expansion
Complications Day 1
visit
IOP
spike
Bullous
keratopathy
Tilted
IOL
Peaked
Pupil
Not an emergency, but contact surgeon, check IOP and wound leak
Retain
lens fragment
Retinal
detachment
Decreased Vision
Check for ocular surface disease dry eye, MGD,
EBMD
IOP
Fundus - CME
Lens tilted
Inferior lens out of
bag
May or may not
require adjustment
Persistent Bullous
Keratopathy
Control IOP
Muro 128 gtts/ung
capsular opacification
(PCO)
Treated with a Nd:YAG laser
Persistent
Residual
Cylinder and
Residual Refractive
Error
Cornea and OSN
Capsule
CME
Centered
Artificial tears
Restasis
Serum based tears
Punctal plugs
Nutritional
supplements
omega 3s
Eyelid Disease
Lid hyperthermia
Hot compresses or lid
scrubs
Nutritional
supplements
Topical azithromycin
bid 2 days then qd
for 1 month
Tobradex
Severe cases
Oral doxycycline 50
mg PO daily
Capsule Opacification
Consider Yag laser
Avoid Yag laser if
explantation still a
consideration!
Thank You