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How currently achieve an EDoF lens

Technical paramaters to achieve an EDoF lens. How consider an EDof lens ? What does EDoF mean for the patient?

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How currently achieve an EDoF lens

  1. 1. S.FRANSSENS How currently achieve an EDoF lens?
  2. 2. S.FRANSSENS ESCRS Survey 2016 2 http://www.eurotimes.org/escrs-clinical-survey-2016-results/
  3. 3. S.FRANSSENS ESCRS survey 2016 3Market scope 2016
  4. 4. S.FRANSSENS How do EDoF lenses work ? 4
  5. 5. S.FRANSSENS EDoF Statement ? 5
  6. 6. S.FRANSSENS Parameters to achieve an EDoF lens? 6 LCA (chromatic aberrations) SA (spherical aberrations) RI (refractive index) Abbe N (abbe Number) HOA (High order aberration)
  7. 7. S.FRANSSENS RI 7 RI (Refractive Index)
  8. 8. S.FRANSSENS Refractive index How much light slows down as it travels through a material Higher index material requires less convexity. Benefit from a thin profilewww.co-ophthalmology.com Volume 27 Number 4 July 2016 8
  9. 9. S.FRANSSENS Refractive Index How much light slows down as it travels through a material Higher index material demonstrates greater REFLECTANCE Unclear how sensitive patients are to such reflections… 1. Glistenings 2. Positive and negative dysphotopsias (?) www.co-ophthalmology.com Volume 27 Number 4 July 2016 9
  10. 10. S.FRANSSENS Parameters to achieve an EDoF lens? 10 LCA SA RI Abbe N HOA = NO Influence = Influence (could)
  11. 11. S.FRANSSENS LCA 11 LCA
  12. 12. S.FRANSSENS Chromatic aberration LCA & TCA Dispersion on the axial axis Off-axis dispersion Blurry or « waxy » images Rainbow edge blurring For most human eyes, the impact of LCA is thought to be greater than the impact of all higher-order aberrations Zhai Y, Wang Y, Wang Z, et al. Construction of special eye models for investigation of chromatic and higher-order aberrations of eyes. Biomet Mater Eng 2014; 24:3073–3081. 12
  13. 13. S.FRANSSENS LCA is Colors Refraction (FAR) Shift 1 D Myopic 0,25 Hyperopic 13
  14. 14. S.FRANSSENS Key factor for LCA: « ABBE » number Abbe number indicates how the refractive index (RI) material changes with wavelength of emitting light. • Change of RI with wavelength  chromatic aberration • Larger Abbe #  less chromatic aberration 14
  15. 15. S.FRANSSENS Positive and negative LCA REFRACTION : Power RED light < Power GREEN light < Power BLUE light DIFFRACTION : Power RED light > Power GREEN light > Power BLUE light Refraction (FAR): Diffraction (NEAR and INTER): Refractive LCA Diffractive LCA >0 <0
  16. 16. S.FRANSSENS Parameters to achieve an EDoF lens? LCA ? 16 LCA SA RI Abbe N HOA Diffractive steps
  17. 17. S.FRANSSENS LCA correction ? Symfony Zeiss At LARA 829 MP 17 LCA
  18. 18. S.FRANSSENS Zeiss EDoF AT Lara Journal of Refractive Surgery • Vol. 32, No. 11, 2016 18
  19. 19. S.FRANSSENS TECNIS ZMB00 BIFOCAL TECNIS SYMFONY « EDoF » FINEVISION TRIFOCAL 22 rings 9 rings 23 rings Purpose Less rings / Higher steps D Gatinel, C Pagnoulle, J Loicq 19
  20. 20. S.FRANSSENS Halos level on optic bench 20
  21. 21. S.FRANSSENS Near Vision… 21
  22. 22. S.FRANSSENS Parameters to achieve an EDoF lens? 22 LCA SA RI Abbe N HOA Diffractive steps
  23. 23. S.FRANSSENS High Orders Aberrations = Visual Quality 23 HOA
  24. 24. S.FRANSSENS HOA values In a Population average , most HOA terms average is 0 The optical quality of the eye is limited by optical aberrations, diffraction and scatter. Aberration order 24 Sine/ Cosine
  25. 25. S.FRANSSENS HOA’s RMS HOA are those equal to or above n=3 Cannot be corrected by spectacles RMS@6mm = 0,38µm ≥0,56µm Good candidates for MIOL’s ? 25
  26. 26. S.FRANSSENS HOA Correction Actually Not possible to correct with Intraocular lens ! 26
  27. 27. S.FRANSSENS Parameters to achieve an EDoF lens? HOA ? 27 L/(T)CA SA RI Abbe N HOA Diffractive optics
  28. 28. S.FRANSSENS Spherical aberration 28 SA
  29. 29. S.FRANSSENS Spherical aberration = +0,27 µm (6,0 mm pupil) 29
  30. 30. S.FRANSSENS Patient Benefits with Aspheric Lenses BCVA not improved with aspheric IOL Better contrast sensitivity , particularly under dim lighting conditions. Spherical aberration can vary significantly from patient to patient = Lasik patient (negative ) 30
  31. 31. S.FRANSSENS Increase in depth of field Consequences of (+)SA Bad depth of field Good depth of field 31
  32. 32. S.FRANSSENS Decrease in contrast sensitivity Consequences of (+)SA Bad contrast sensitivity Good contrast sensitivity 32
  33. 33. S.FRANSSENS Summary : Effect of (Positive) SA Depth of field Contrast sensitivity 33
  34. 34. S.FRANSSENS Parameters to achieve an EDoF lens? SA ? 34 L/(T)CA SA RI Abbe N HOA Diffractive optics
  35. 35. S.FRANSSENS MINI WELL (SIFI) 35 http://www.eurotimes.org/wp-content/uploads/2016/11/SIFI-SUPPLEMENT_EuroTimes_November16_WEB.pdf https://theophthalmologist.com/fileadmin/top/issues/0917/imag es/0917-901_Sifi_SF_3.pdf
  36. 36. S.FRANSSENS Parameters to achieve an EDoF lens? 36 L/(T)CA SA RI Abbe N HOA Low add ? Pinhole Effect Diffractive optics
  37. 37. S.FRANSSENS Low add addition ? 37 Low add
  38. 38. S.FRANSSENS « Oculentis Comfort » = BIFOCAL LOW ADD linical Results Prof. Dr. Jorge Alió, University Ophthalmology Clinic, Miguel Hernandez, Alicante, Spain In a comparative study by the Vissum Ophthalmology Institute (Alicante, Spain) under the management of Professor Alió, the visual results and the optical quality of the LENTIS Comfort and of a so-called accommodating lens were observed, and evaluated post-operatively in just under 40 patients and 66 implanted eyes. The LENTIS Comfort produced, for all distances, in particular in the wide intermediate range, considerably better visual acuity results than the accommodating IOL. 38
  39. 39. S.FRANSSENS TECHNOLOGY 39
  40. 40. S.FRANSSENS In Vitro optical performance 40
  41. 41. S.FRANSSENS Parameters to achieve an EDoF lens? 41 LCA SA RI Abbe N HOA Low add addition ? Pinhole Effect Diffractive
  42. 42. S.FRANSSENS Pinhole Effect 42 Pinhole Effect
  43. 43. S.FRANSSENS Pinhole effect 43
  44. 44. S.FRANSSENS Pinhole effect Journal of Refractive Surgery • Vol. 32, No. 4, 2016 44
  45. 45. S.FRANSSENS IC-8 IOL 45
  46. 46. S.FRANSSENS Summary : Parameters to achieve an EDoF lens? 46 LCA SA RI Abbe N HOA Low add addition ? Pinhole Effect Diffractive
  47. 47. S.FRANSSENS EDoF : global outcomes… global satisfaction ? 47 Forgiving? Spectacle independance? Quid near vision ?Refractive or Cataract lens?
  48. 48. S.FRANSSENS 48
  49. 49. S.FRANSSENS

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