Outcomes after WIOL – CF accommodative Outcomes after WIOL – CF accommodative intraocular lens implantationintraocular lens implantation

IInstitute of nstitute of VVision and ision and OOpticspticsUniversity of Crete School of MedicineUniversity of Crete School of Medicine

Heraklion, Crete GreeceHeraklion, Crete Greece

Ioannis G. Pallikaris MD, PhD, Dimitra M. Portaliou MD, Sophia I. Panagopoulou PhD

None of the authors has financial interests or None of the authors has financial interests or relationships to discloserelationships to disclose.

Financial Disclosure

WIOL – CF: Polyfocal hyperbolic opticsWIOL – CF: Polyfocal hyperbolic optics

Refractive power is maximum in the centre and gradually decreases in the periphery

WIOL – CF Features and benefits

Continuous sharp edgeContinuous sharp edge

Smooth gradual transition between central and peripheral opticsSmooth gradual transition between central and peripheral optics

Aspheric hyperboloid opticsAspheric hyperboloid optics

Full disc configuration Full disc configuration

Less optical complications, optimum vision qualitLess optical complications, optimum vision qualityy

WIOL- CF change of focus via WIOL- CF change of focus via lens deformation due to the action of natural focusing lens deformation due to the action of natural focusing

apparatus (cilliary muscle and zonules): apparatus (cilliary muscle and zonules):

F2F1

Clinical experience so far

11 key scientific publications and presentations

Results for 476 WIOL-CF eyes recorded in clinical trials adding to more than 500 eye-years of clinical-trial reported experience

Predominantly investigator driven studies and publications

WIOL-CF consistently shows accommodation range of more than 2D, that corresponds to the accomodation range of natural crystalline lens in 42-50 years of age. The range is stable over the long-term (up to 9 years)

Study / Observation Number of Eyes Accommodation Range Time of Evaluation

Pasta J 2003 79 2 D3 years

(67 eyes, 9 years follow-up)

Pasta J et al 2006 262.2 D

(young active: 2-3 D)over 12 m

Nylander A et al 2006

51 ˃ 2.25 D Up to 24 months

Pallikaris IG 2011 50 2 D 24 months

Materials and MethodsMaterials and Methods25 patients (50 eyes)

Mean age: 65, 3 ± 8,4 years (range from 53to 83 years)

12 male, 13 female

All patients underwent routine cataract surgery and WIOL – CF accommodative intraocular lens implantation .

Exclusion CriteriaExclusion Criteria

Astigmatism higher than 1.25 dioptersAstigmatism higher than 1.25 diopters

Pre-existing ocular historyPre-existing ocular history corneal corneal endothelial disease, abnormal cornea, macular endothelial disease, abnormal cornea, macular degeneration, retinal degeneration, glaucoma, and chronic drug miosis.degeneration, retinal degeneration, glaucoma, and chronic drug miosis.

Previous refractive surgeryPrevious refractive surgery

Retinal conditions or predisposition to retinal conditions, previous history of/or Retinal conditions or predisposition to retinal conditions, previous history of/or predisposition to: retinal detachment or proliferative diabetic retinopathy.predisposition to: retinal detachment or proliferative diabetic retinopathy.

AmblyopiaAmblyopia

Clinically severe corneal dystrophy (e.g., Fuchs')Clinically severe corneal dystrophy (e.g., Fuchs')

Extremely shallow anterior chamberExtremely shallow anterior chamberRecurrent anterior or posterior segment inflammation of unknown etiology, or any Recurrent anterior or posterior segment inflammation of unknown etiology, or any disease producing an inflammatory reaction in the eye (e.g. iritis or uveitis).disease producing an inflammatory reaction in the eye (e.g. iritis or uveitis).

AniridiaAniridia

Optic nerve atrophyOptic nerve atrophy

TraumaTrauma

 

Implantation

LogMAR CDVA Mean±SD [Range]

LogMARUDVA Mean±SD [Range]

0.25 ± 0.16 0.84±0.62

[0.0 to 0.8] [CF to 0.24]

LogMARCDVA Mean±SD [Range]

LogMAR UDVA Mean±SD

[Range]

0.08±0.07 0.16±0.13

[0.0 to 0.22] [0.0 to 0.54]

PREOP

Last POSTOP

Last Postoperative Days/ Months

Mean±SD [Range]

649.32±378.18 [1404 to 98]21.64±12.61 [46.8 to 3.27]

Safety

No eye has lost lines of CDVA88% of patients gained ≥ 1 lines of CDVA

Stability

0.00 LogMar equals at 1.00 decimal Visual Acuity

Uncorrected Near Visual AcuityUncorrected Near Visual Acuity

72% 72% of our patients had of our patients had J2 or betterJ2 or better, at the last follow – up examination, measured with , at the last follow – up examination, measured with Birkhauser reading charts at a distance of 33cm under photopic conditions.Birkhauser reading charts at a distance of 33cm under photopic conditions.

Uncorrected Intermediate Visual AcuityUncorrected Intermediate Visual Acuity

72% 72% of our patients had of our patients had J2 or betterJ2 or better, at the last follow – up examination, measured with , at the last follow – up examination, measured with Birkhauser reading charts at a distance of 66cm under photopic conditions.Birkhauser reading charts at a distance of 66cm under photopic conditions.

Natural Accommodation

NEAR

FAR

DIF.MAP

FAR

NEAR

Mean diff.-1.18D

Max diff -7.20D

Max -3.53D

Range 9.35D

Pseudoaccommodation assessed with the iTrace

Pseudoaccommodation assessed with the iTracePseudoaccommodation assessed with the iTrace

NEAR

FAR

Mean diff.-1.00DMax diff

-3.66D

Max -4.84D

Range 6.55D

Slit Lamp photos of patients

AS – OCT image (Visante)

ConclusionsConclusions

WIOL – CF can be considered a very promising alternative solution for patients that lead an active life and require good vision near, intermediate and far. In our patient series In our patient series all all patients obtained some level of accommodation which patients obtained some level of accommodation which remained stable throughout the follow – up period.remained stable throughout the follow – up period.

No complications occurred intra or postoperativelyNo complications occurred intra or postoperatively.

Larger series of patients and longer follow-up is necessary in order to confirm the encouraging results