Customized IOLs- -Post Insertion Post Insertion Customized IOLs - PowerPoint PPT Presentation

Customized IOLs- -Post Insertion Post Insertion Customized IOLs Christian A. Sandstedt, Ph.D. Christian A. Sandstedt, Ph.D. Calhoun Vision, Inc Calhoun Vision, Inc Pasadena, CA Pasadena, CA th International Conference of 4 th International Conference of 4 Wavefront Sensing and Wavefront Sensing and Aberration- -Free Refractive Free Refractive Aberration Correction Correction San Francisco, CA San Francisco, CA February 15, 2003 February 15, 2003

The Light Adjustable Lens The Light Adjustable Lens The Light Adjustable Lens (LAL) (LAL) (LAL) � Clinical need and background Clinical need and background � Clinical need and background � � Description of technology Description of technology � Description of technology � � In In- -vitro vitro testing and results testing and results � In-vitro testing and results � � Examples and future work on higher Examples and future work on higher � Examples and future work on higher � order aberration correction order aberration correction order aberration correction

Clinical Need Clinical Need Clinical Need • Cataract surgery with IOL implantation is • Cataract surgery with IOL implantation is the most commonly performed surgery in the most commonly performed surgery in patients over 65 patients over 65 • 50% of these patients require spectacle • 50% of these patients require spectacle correction after insertion and refractive correction after insertion and refractive stabilization stabilization Defocus, Lateral Displacement, Post-Operative Defocus, Lateral Displacement, Post-Operative Astigmatism (Unpredictable Wound Healing), Astigmatism (Unpredictable Wound Healing), Rotation. Rotation. • 98% of these are within ± 2 D. • 98% of these are within ± 2 D.

Non- -Invasive Alteration of Invasive Alteration of Non Non-Invasive Alteration of IOL Power Post- -Operatively Operatively IOL Power Post IOL Power Post-Operatively � Foldable IOL made of photosensitive material Foldable IOL made of photosensitive material � Foldable IOL made of photosensitive material � � Adjust IOL power post Adjust IOL power post- -operatively by treating operatively by treating � Adjust IOL power post-operatively by treating � with safe levels of light to alter its refractive with safe levels of light to alter its refractive with safe levels of light to alter its refractive properties properties properties

Animation: Hyperopic Animation: Hyperopic Animation: Hyperopic Correction Correction Correction

Single Pass Interferometry Single Pass Interferometry

Myopic Correction Myopic Correction Myopic Correction � Measurements made in double pass Measurements made in double pass � Measurements made in double pass � � The number of interference fringes (OPD) proportional to The number of interference fringes (OPD) proportional to � The number of interference fringes (OPD) proportional to � the induced power change the induced power change the induced power change Pre-irradiation +20 D LAL –2 D Correction

Sample In Vitro Nomogram Sample In Vitro Nomogram Sample In Vitro Nomogram � The intensity is kept constant and the time is varied The intensity is kept constant and the time is varied � The intensity is kept constant and the time is varied � Dose # 0 1 2 3 4 5 6 7 8 9 0.0 -0.5 ∆ Diopters -1.0 -1.5 -2.0

Method of LAL Optical Method of LAL Optical Method of LAL Optical Characterization: MTF Characterization: MTF Characterization: MTF � MTF measurements made in a wet cell with the ISO MTF measurements made in a wet cell with the ISO � MTF measurements made in a wet cell with the ISO � prescribed model eye prescribed model eye prescribed model eye � MTF of LAL comparable to commercial IOL MTF of LAL comparable to commercial IOL � MTF of LAL comparable to commercial IOL � 1 MTF LAL Post Lock-In 0.8 MTF Allergan Si40 IOL Modulus 0.6 0.4 MTF LAL Pre-Adjustment MTF = 0.43 @100 lp/mm 0.2 0 0 50 100 150 lp/mm

Hyperopic Correction Hyperopic Correction Hyperopic Correction � Measurements made in double pass Measurements made in double pass � Measurements made in double pass � � The number of interference fringes (OPD) proportional to The number of interference fringes (OPD) proportional to � The number of interference fringes (OPD) proportional to � the induced power change the induced power change the induced power change Calhoun Vision Calhoun Vision LAL Preirradiation + 20.0 D LAL + 2.0 D Correction

Future Work Future Work In- -Vitro Astigmatism Vitro Astigmatism In Astigmatic Correction: Classic Astigmatic Wavefront 3.50 D ± 0.15 D of Toric Correction

Multifocality - Treatment of Presbyopia Without Need for Accommodation - Embodiments - Diffractive Optics - Refractive Optics - Central Add and Central Subtract - Repeating Zones (Allergan Array)

Calhoun Capabilities Calhoun Capabilities � Predictable Achievement of Emmetropia � Multifocal IOL Centered on Visual Axis � Customizable Zone Size � Center Add and/or Subtract � Potential Non Invasive Reversibility

Multifocality After Two Corrections + 2.0 D Add in Patient with +22.5 D LAL –2.0 D Post-Op Center 2 mm Myopic Error Zone Size Light In Situ Creation of MF Adjustment Removal of Removal of -0.5 D –1.5 D Of Power Of Power Light Adjustment

Digital Light Delivery Device Digital Light Delivery Device Digital Light Delivery Device � Breadboard System Developed in Collaboration with Carl Zeiss-Meditech AG � Allows Researcher/Physician Control of Applied Spatial Intensity Pattern

Digital Light Delivery Device Digital Light Delivery Device Digital Light Delivery Device Tetrafoil Bitmap Spatial Intensity Pattern for Input to the DMD ( ) 2 2 = − θ ρ ρ 4 3 cos 2 I Tetrafoil

Digital Light Delivery Device Digital Light Delivery Device Digital Light Delivery Device - Tetrafoil Imprint

Spherical Aberration Spherical Aberration Spherical Aberration Cause Cause Cause � OPD between the paraxial and marginal rays OPD between the paraxial and marginal rays � OPD between the paraxial and marginal rays � � Different annular zones of a lens focus at different Different annular zones of a lens focus at different � Different annular zones of a lens focus at different � points along the optical axis points along the optical axis points along the optical axis Marginal Focus Best Focus Paraxial Focus

Spherical Aberration Spherical Aberration Spherical Aberration Treatment Correction Treatment Correction Treatment Correction � Irradiation of an annular ring on the periphery of the Irradiation of an annular ring on the periphery of the � Irradiation of an annular ring on the periphery of the � LAL LAL LAL � Note the removal of ~2 fringes (1 Wave) of LSA Note the removal of ~2 fringes (1 Wave) of LSA � Note the removal of ~2 fringes (1 Wave) of LSA � Preirradiation 24 hours Post Irradiation

What The LAL Can Do What The LAL Can Do What The LAL Can Do � Correct spherical errors with high reproducibility and repeatibilty � Maintain optical quality through the entire treatment procedure � Astigmatic corrections � Customized Bifocality � Higher order aberrations All of these once it has been implanted in the eye!

Last Slide Last Slide Last Slide Special Thanks Special Thanks Special Thanks Calhoun Vision Team Calhoun Vision Team Calhoun Vision Team Dan Schwartz, MD Dan Schwartz, MD Dan Schwartz, MD Shiao Chang, PhD Chang, PhD Shiao Shiao Chang, PhD Jay Wilson, MS Jay Wilson, MS Jay Wilson, MS Veronica Jaramillo, PhD Veronica Jaramillo, PhD Veronica Jaramillo, PhD