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Jérôme C. VRYGHEM, M.D.
Steven HEIREMAN, M.D.
Comparison of the visual outcomes
of
a bifocal refractive versus
a trifocal diffractive IOL
Steven HEIREMAN, M.D.
Clinique St-Jean, Brussels
Brussels Eye Doctors, Brussels
Belgium
No financial interest !
� AMO Array 1997
� Ioltech MF4
� Crystalens AT-45
Humanoptics 1CU
My experience
Multifocal and accomodative IOL’s
� Humanoptics 1CU
� Acri.Twin
� Acri.Lisa
� Physiol FineVision
� Trifocal diffractive� Oculentis M Plus
� Bifocal Refractive
Two new multifocal IOL’s
N=100 eyes N=250 eyes
OCULENTIS Mplus
A new concept of multifocal IOL technology:
6 months results
OCULENTIS Mplus
A new concept of multifocal IOL technology:
6 months results
Jérôme C. VRYGHEM, M.D.Jérôme C. VRYGHEM, M.D.
Steven HEIREMAN, M.D.
Clinique St-Jean, Brussels
Brussels Eye Doctors, Brussels
Belgium
No financial interest !
Oculentis Mplus
� One-piece multifocal IOL with refractive design
� Aspheric, asymmetric distance-vision zone
� Sector-shaped near-vision zone of +3.00 D
� Seamless transition zone
Oculentis Mplus
� Acrylic material
� 360°continuous square optic and haptic edge
� Independent of pupil size
� Reflection of light hitting the transition area away
from the optical axisfrom the optical axis
◦ To prevent superposition of interference or diffraction
◦ Minor loss of light intensity
◦ Improved contrast sensitivity
◦ Reduced glare and halo effects
Oculentis Mplus
� IOL calculation
◦ IOL-Master in all eyes
◦ A-constant: 118.0
IOL-positioning� IOL-positioning
◦ Marks on the optic of the IOL
◦ IOL to be rotated in vertical position with reading segment
positioned inferiorly
� MICS
Clinical Study
Settings
� Retrospective study
(Clinique St-Jean Brussels and Brussels Eye Doctors)
Oculentis MPlus
� 25 patients (24 binocular and 1 monocular), 49 eyes
� Mean age: 72 years (39 - 87 years)
� Follow-up ≥ 6 months
� Cataract and RLE patients
� No other pathology
� Pre-op astigmatism ≤ 1 D
Clinical Study
Selection of patients
Oculentis MPlus
� Pre-op astigmatism ≤ 1 D
� Uneventful surgery
� No surgically induced astigmatism:
MICS with temporal incision of 1.9 mm
� UCDVA and BCDVA
� UCNVA
� Refraction
Clinical Study
Methods
Oculentis MPlus
� Refraction
� Defocus curve
� Questionnaire to evaluate:
◦ Independence towards reading glasses
◦ Patient satisfaction
� Mean UCNVA: Parinaud 3.75
(Parinaud 7 – Parinaud 1.4)
Clinical Study
Results: VA
Oculentis MPlus
N=49
� Average spherical equivalent: 0.02 ± 0.24 D
Clinical Study
Results: Refraction
Oculentis MPlus
N=49
� IOL repositioning: 4 % (1 patient)
� Secondary refractive retreatment: 4% (1 patient)
� Would you undergo implantation with this lens type again?
◦ Yes: 88 % (22 patients)
◦ No: 4 % (1 patient)
◦ Undecided: 8 % (2 patients)
Clinical Study
Results: Questionnaire
Oculentis MPlus
◦ Undecided: 8 % (2 patients)
� Use of near spectacles:
◦ No: 52 % (13 patients)
◦ Yes:
� Only for small characters: 12 % (3 patients)
� Always: 36 % (9 patients)
� Use of distance spectacles: none
� Ghost images: 4 % (1 patient)
Clinical Study
Results: Questionnaire
Oculentis MPlus
� Double images: none
� Halos
◦ Spontaneously: 8 % (2 patients)
◦ On inquiry: 20 % (5 patients)
� Glare
Clinical Study
Results: Questionnaire
Oculentis MPlus
� Glare
◦ Spontaneously: 4 % (1 patient)
◦ On inquiry: 12 % (3 patients)
� Discoloration
◦ Spontaneously: 4 % (1 patient)
◦ On inquiry: 12 % (3 patients)
� Subjective quality of vision
Clinical Study
Results: Questionnaire
Good Average Poor
Watching TV 92 % 8 % 0 %
Oculentis MPlus
Watching TV 92 %(23 patients)
8 %(2 patients)
0 %
Reading a book 76 %(19 patients)
16 %(4 patients)
8 %(2 patients)
Needlework 80 %(20 patients)
20 %(5 patients)
0 %
� Good distant and intermediate VA
� Average near VA
Conclusion
Oculentis MPlus
� Halos spontaneously reported in 8% of patients
� High patient satisfaction
J. C. Vryghem, S. Heireman
Jérôme C. VRYGHEM, M.D.
Early results with the
implantation of the
Physiol FineVision :
a new trifocal diffractive IOL
Jérôme C. VRYGHEM, M.D.
Steven HEIREMAN, M.D.
Clinique St-Jean, Brussels
Brussels Eye Doctors, Brussels
Belgium
No financial interest !
Same platform as Physiol Micro AY
Material :
• Hydrophilic Acrylate with 25 % water content
Yellow: UV and blue light blocker
Dimensions : Overall 10.75 mm
Physiol FineVision
Dimensions : Overall 10.75 mm
Optic body 6.15 mm
Angulation : 5°
A-constant : 118.9 (IOL-Master), 118.5 (US)
Optic is biconvex and aspheric
Power range: 10.00 to 30.00 D in 0.50 D steps
Trifocal diffractive (over the whole optic) IOL
achieved by the combination of 2 bifocal patterns
(+1.75 D add and +3.50 D add)
Physiol FineVision
F ar
I ntermediate Vision
NE ar
First diffractive grating Second diffractive grating
Order 0 Far vision Far vision
Order 1 3.5 D Near vision 1.75 D Intermediate vision
Combination of two diffractive patterns
Physiol FineVision
Order 1 3.5 D Near vision 1.75 D Intermediate vision
Order 2 Lost light (+ 7 D) + 3.5 D Near vision
The second order of the +1.75D add diffractive grating is reinforcing
the first order of the +3.5D add diffractive grating, providing an
improvement in intermediate vision in maintaining far and near
vision
This IOL is apodized: the step height decreases from the center
towards the periphery.
Physiol FineVision
This diffractive pattern is then pupil dependent allocating more
energy to far vision in dim conditions (large pupil).
30
40
50
60%
En
erg
y
Near
Far
Physiol FineVision
0
10
20
30
1,50 2,00 2,50 3,00 3,50 4,00 4,50 5,00
Pupil diameter (mm)
Near
Intermediate
� Prospective observational study (Clinique St-Jean
Brussels and Brussels Eye Doctors)
� 32 eyes, 16 patients (binocular)
Clinical Study
Settings
Physiol FineVision
� Mean age: 75 ± 10 years (65 - 84 years)
� Mean preoperative best corrected visual acuity
0.59 ± 0.15
� Cataract and RLE patients
� No other pathology
Settings: Patient selection
Physiol FineVision
� Pre-op astigmatism ≤ 1 D
� Uneventful surgery by the same surgeon (JCV)
� IOL calculation
◦ IOL-Master in all eyes
◦ A-constant : 118.5 !!!
Physiol FineVision
Settings: Surgical parameters
� IOL-positioning: autocentering
� MICS with temporal incision of 1.9 mm:
No surgically induced astigmatism
Methods
2 months post-op:
� Distance VA
� Near and intermediate VA
� Mesopic VA
� Refraction
Physiol FineVision
� Refraction
� Defocus curve
� Questionnaire to evaluate:
◦ Independence towards reading glasses
◦ Patient satisfaction
40
50
60
70
80
Pe
rce
nta
ge
of
ey
es
Mean spherical equivalent = 0.03 ± 0.3 D100% ≤ -0.5 and +0.5 D
Results Postoperative refraction
Physiol FineVision
0
10
20
30
40
-1 -0,5 0 0,5 1
Pe
rce
nta
ge
of
ey
es
Achieved postoperative spherical equivalent (D)
Mean monocular UCVA
0.90 ±±±± 0.20
100% ≥ 0.5 78% ≥ 0.8 (dryness)
Results:
Distance Uncorrected VA
Physiol FineVision
100% ≥ 0.5 78% ≥ 0.8 (dryness)
Mean binocular UCVA
1.13 ±±±± 0.24
100% ≥ 0.5 100% ≥ 0.8
Mean monocular BDCVA
0.96 ±±±± 0.17
100% ≥ 0.5 90.6% ≥ 0.8
Results:
Best Distance Corrected VA
Physiol FineVision
100% ≥ 0.5 90.6% ≥ 0.8
Mean binocular BDCVA
1.14 ±±±± 0.23
100% ≥ 0.5 100% ≥ 0.8
Mean monocular UCIVA:
Parinaud 2.46 ±±±± 1.09
96,9% ≤ P4 84,3% ≤ P3
Physiol FineVision
Results:
Uncorrected Intermediate VA
Parinaud 2 = Jaeger 1
96,9% ≤ P4 84,3% ≤ P3
Mean binocular UCIVA:
Parinaud 1. 69 ±±±± 0.53
100% ≤ P4 100% % ≤ P3
Mean monocular UCNVA
Parinaud 1. 34 ±±±± 0.50
100% ≤ P3 93.75% ≤ P2
Physiol FineVision
Results:
Uncorrected Near VA
100% ≤ P3 93.75% ≤ P2
Mean binocular UCNVA
Parinaud 1. 08 ±±±± 0.16
100% ≤ P3 100% % ≤ P2
Results: Defocus curve
Physiol FineVision
0,6
0,8
1
1,2
1,4Visual
acuity
(Decimal)Defocus add (D)
0
0,2
0,4
0,6
-4-3-2-1012
Binocular defocus curve (16 patients)
Apodization outcomes: near and intermediate visual acuities drop in mesopic conditions for far vision enhancement.
4
5
6
Vis
ua
l a
cuit
y (
Pa
rin
au
d) Intermediate
Neart-test small sample
Results: Mesopic VA
Physiol FineVision
0
1
2
3
4
Vis
ua
l a
cuit
y (
Pa
rin
au
d)
MesopicPhotopic
t-test small sample
p<0.05
60%
80%
100%
Good
quality of
vision94 %� Would you undergo
implantation with this lens type
again?
◦ Yes: 76 %
Results: Questionnaire
Physiol FineVision
0%
20%
40%
Use of
distance
spectacles
Use of
near
spectacles
◦ Yes: 76 %
◦ 24 % cannot answer because
they cannot compare.
60%
80%
100%
Good
quality of
vision
� Use of near
spectacles:
◦ No: 82 %
◦ Yes:
� Only for small
Results: Questionnaire
Physiol FineVision
0%
20%
40%
Use of
distance
spectacles
Use of
near
spectacles
� Only for small
characters: 18 %
� Always: none
� Use of distance
spectacles: 6 %18 %
6 %
20%
40%
60%
80%
100%No ghost image
No double imageNo difficulties for
light transition
Results: Questionnaire
Physiol FineVision
0%
20%
No halos
No glare
No discoloration
Halos:◦ Spontaneously: 9 % ◦ On inquiry: 9 %
Glare: 6 %
Good Average Poor
� Subjective quality of vision
Results: Questionnaire
Physiol FineVision
Watching TV 100 % none none
Reading a book 94 % 6 % none
Needlework 94 % 6 % none
� Good distance, intermediate and near VA
� Apodization to favor night vision is effective
Conclusions
Physiol FineVision
� High(er) patient (and surgeon)
satisfaction
The design of the Physiol FineVision trifocal diffractive IOL
adds intermediate vision
with no significant decrease in near and distance vision
as compared to currently available bifocal IOL’s
Conclusions
Physiol FineVision