Current Trends in Modern Cataract Surgery. Jose Ivan Quiceno, MD Division of Ophthalmology Scripps Clinic Medical Group

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1 Current Trends in Modern Cataract Surgery Jose Ivan Quiceno, MD Division of Ophthalmology Scripps Clinic Medical Group

2 Current Trends in Modern Cataract Surgery Modern cataract surgery is not only a rehabilitative procedure, but a refractive procedure as well, that requires attention to detail. Every aspect of the surgery will have an impact on the final postoperative refractive result.

as well, that requires attention to detail.

3 Cataract Procedures are Growing

4 Start of the Baby Boom 77 million people in the US born between

5 Rate of Baby Boomers Turning 65 Yrs. Old in the US 2.7 million per year 7,584 per day 316 per hour 5 per minute

6 Getting to Know Today s Cataract Patient Large, rapidly growing demographic (i.e., baby boomers) Educated, financially secure Increased life expectancy Longer working careers

7 Getting to Know Today s Cataract Patient Are unwilling to compromise active lifestyle Embrace demand-driven healthcare Demand high quality vision (e.g., reading, distance, night) Have new requirements for intermediate vision (e.g., computers)

8 Understanding Today s Cataract Patient Baby boomers Cataracts are starting to compromise their active life style They are concerned about their appearance This generation coined the phrase antiaging BOTOX (onabotulinumtoxina ) Rogaine (minoxidil topical) Viagra (sildenafil)

about their appearance This generation coined the phrase antiaging

9 Understanding Today s Cataract Patient post refractive surgery expectation of spectacle independence challenge meeting their high vision expectations

10 Not all 20/20 Visual Acuity is Equal

11 Why Is the Active Range of Vision So Important? 82% of seniors 65+ are on the road, driving More than 50% of boomers exercise regularly 72% of boomers plan to keep working after retirement 66% of boomers send text messages 90% of boomers are on the computer 65% of seniors (66+) have a cell phone

exercise regularly 72% of boomers plan to keep working after retirement

12 Why Is Intermediate Vision So Important? Active patients need to see well for driving at night using a computer or handheld device viewing a movie or concert watching or participating in sports reading a menu or newspaper

using a computer or handheld device viewing a movie or

13 Advance Technology IOL Reduction of astigmatism by Toric IOL provides spectacle independent distance vision

14 Advance Technology IOL Reduction of presbyopia can be accomplished by refractive, diffractive, accomodating IOLs

$refractive, diffractive,$

15 Advance Technology IOL (ATIOL) Market1

16 All AT IOLs Share the Same Barriers to Adoption With the Same Relative Importance Multifocal IOLs Accommodating IOLs Patient cost too high Managing patient dissatis Difficult achieving targeted refraction Requires post-op enhancement Benefits not worth cost Higher risk of complications 12 10

$21 21 Difficult achieving targeted refraction 11 12 Requires post-op enhancement$

17 Advanced Technology IOL Preference Share 1

18 An Aging Population Means Increasing Presbyopia Prevalence 2005: 1 Billion Presbyopia Patients Worldwide 50% without spectacles or with inadequate spectacles 40% unable to ideally perform near tasks Future Global Projection 1.4 billion presbyopia patients by billion presbyopia patients by 2050

spectacles 40% unable to ideally perform near tasks Future Global

19 Reduction of Presbyopia

20 Apodized Diffractive Structure The following traits are unique to the AcrySof IQ ReSTOR IOLs: 3.6 mm diameter apodized diffractive region Precise reduction in step heights from 1.3 microns to 0.2 microns Decreasing step heights direct more light energy to the distance focal point Gradual energy blend between powers Step heights control the light distribution Width between steps determines the add power

2 microns Decreasing step heights direct more light energy to the distance focal point Gradual energy

21 Acrysof IQ Multifocal IOL Excellent Biomechanics The unique haptic design provides the constant compression force and consistent axial lens position critical for IOL power calculations: Single-piece design for rotational stability IOL haptics for capsular bag stability

22 Crystalens AO Design Characteristics Uniform center-to-edge power1 Designed for increased contrast sensitivity2 Designed to accommodate by moving forward and backward Excellent vision across the Active Range3 Less neuroadaptation than multifocals 360o enhanced barrier to PCO Aberration free Aspheric Advanced Optics

23 Quality of vision is deteriorated considerably by astigmatism 1.00 diopter of astigmatism 2.00 diopters of astigmatism

24 Astigmatism Precise astigmatism correction offers cataract surgery patients with astigmatism reduction of residual refractive cylinder improved uncorrected distance visual acuity increased spectacle-independent distance vision

25 So What About Astigmatism? How do we treat it? Vision without astigmatism * Vision with astigmatism 1.5D 90 * Vision with astigmatism 3.0D 90 *

26 Acrysof TORIC IOL

27 Acrysof IQ Toric IOL Model Number SN6AT3 SN6AT4 SN6AT5 SN6AT6 SN6AT7 SN6AT8 SN6AT9 IOL Plane 1.5 D 2.25 D 3.00 D 3.75 D 4.50 D 5.25 D 6.00 D Optic Diameter 6.0 mm Overall Length 13.0 mm Optic Type Biconvex Toric Aspheric Optic IOL Powers +6.0 D to 30.0 D Haptic Angulation 0 degrees (planar) Haptic Configuration STABLEFORCE modified L haptic Suggest A-Constant Refractive Index 1.55 Light Filtration UV and Blue Light

28 Toric IOL Placement

29 Toric IOL Placement

30 Thank you for your attention!

Increasing cost of health care 2010 Prevalence of Cataract Patients: 24.4 M (NEI/NIH) of patients age 40+

Increasing cost of health care 2010 Prevalence of Cataract Patients: 24.4 M (NEI/NIH) of patients age 40+ 7/27/15 Comanaging Modern Cataract Surgery: Guiding patients through Advanced Technology and Optimizing Surgical Outcomes Disclosures: Robert S. Stutman, OD, MBA, FAAO Alcon Speaker s Alliance Select Eye