Provisus Research Institute www.augenklinik.de Treating a high hyperopic with EDOF IOLs: A Case Report Dr. Florian T.A. Kretz, FEBO Augenärzte Gerl, Kretz & Kollegen Head Office Am Schloßgraben 13 Email: f.kretz@augenklinik.de 48683 Ahaus Tel.: +49-2561-9555675 Germany
Financial Disclosure Cooperations Acufocus 1 MST 4 Alimera 2,3,4 Oculentis 1,2,3,4 AMO 1,2,3 ODC 4 AVS 1 PhysIOL 1 Carl Zeiss Meditec 1,2,3,4 Polytech 1,2,3,4 Glaukos 1,2,3,4 Santen 1 Hoya 1 Teleon 1,2,3 LensAR 1 Vision Ophthalmology Mediphacos 1 Group 2,3,4 1 = Research; 2 = Travel Expenses 3 = Honorary; 4 = Consulting Univ.- Augenklinik Universität Heidelberg Provisus Research Institute
The patient Female, 51 years old • Bilateral presbyopia • Daily life activities require Intermediate (iPad and computer work) and Far • vision with low tolerance of dysphotopsia (Night driving) => Patient demands spectacle independence in those distances Presbyopic, hyperopic: • OD: +4.00, -0.25 (85°) OS: +4.25, -0.5 (106°) History of dry eyes, shallow anterior chamber with history of angle closure • glaucoma (YAG laser iridotomy in 2012) CDVA preoperatively= 0.1 logMAR (Binocular and Monocular) • Provisus Research Institute
PENTACAM: OS OD Flat Cornea Shallow anterior chamber Provisus Research Institute
IOL Power calculation Complicated Cases: IOL calculation team Carl Zeiss Meditech in Berlin Provisus Research Institute
The IOL: EDoF AT LARA 829MP • Surgery: Same surgeon One day time difference • Bilateral implantation of AT LARA 829MP • OD: IOL Power= 30D Targeted refraction= 0.06D • OS: IOL Power= 31D Targeted refraction=-0.38D Provisus Research Institute
RESULTS: Refraction Postoperative Subjective Refraction: OD: +0.25 OG: 0, -0.25 (2°) Spherical Equivalent: OD= +0.25 D (+3.875 Pre-op) OG=-0.125 D (+4.00 Pre-op) Provisus Research Institute
Binocular and Monocular VA -0,25 -0,2 -0,15 -0,1 VA in logMAR -0,05 0 MONOCULAR BINOCULAR 0,05 0,1 0,15 0,2 0,25 UDVA CDVA DCIVA 90cm DCIVA 80cm DCIVA 60cm DCNVA 40cm UDVA CDVA DCIVA 90cm DCIVA 80cm DCIVA 60cm DCNVA 40cm MONOCULAR -0.09 -0.09 -0.04 -0.03 -0.02 0.09 Provisus BINOCULAR -0.09 -0.09 -0.14 -0.2 -0.07 0.09 Research Institute
Binocular and Monocular Defocus Curves -0,2 -0,1 0 0,1 VA in logMAR 0,2 0.3 logMAR or better between 0,3 BINOCULAR +1.00 and -2.50 D (Binocular) 0,4 MONOCULAR 0,5 0,6 0,7 0,8 0,9 -3 -2,5 -2 -1,5 -1 -0,5 0 0,5 1 1,5 Provisus Research Institute
Halo & Glare Strength Halo & Glare simulator (Carl Zeiss Meditec, Germany). Halo: • Type: H2 Size: 58 Intensity: 69 Glare: • Type: G2 Strength= 63.26% Size: 70 (Moderate) Intensity: 44 Calculated using the Strength Formula (P.Hagen et al, Düsseldorg, Germany) Provisus Research Institute
HD Analyzer: Objective Scattering index OSI MTF cut off (c/deg) Strehl ratio OD 0.4 46.263 0.233 OS 0.5 49.239 0.222 OSI: Objective Scattering Index: Light • scattering MTF cutoff: Modulation transfer function • cutoff: Loss of contrast Strehl Ratio:Optical Quality • Theoretical best value = 1 • Max normal value in a young eye ~ 0.3 • Provisus Research Institute
McAlinden Questionnaire • Halo, Glare and Starbust: • How often do you experience..?: Quite Often. • How severe is..?: Moderate. • How bothersome is..?: A little (Halo), quite bothersome (Glare and starbust). • No focusing difficulties! • If you had to choose again, would you pick a multifocal intraocular lens again? YES Provisus Research Institute
McAlinden Questionnaire Spectacle independancy Did the Surgery offer you spectacle independency? In all Distances: Far, Intermediate and Near Provisus Research Institute
Conclusion The new EDOF AT LARA 829MP offers a new range of individualized care. It allowed in this hyperopic patient an excellent visual restoration in all distances due to the Extended range of focus with excellent VA in Far, Intermediate and Near distances. Spectacle independence and satisfaction from the surgery and the choice of the IOL. Persistence of photic phenomena without impact on daily life. Good optical quality. Provisus Research Institute
Provisus Research Institute Thank you very much for Your Attention! Augenärzte Gerl, Kretz & Kollegen Dr. med. Florian T. A. Kretz, FEBO CEO – Share Holder – Lead Surgeon Augentagesklinik Rheine - Greven Email: f.kretz@augenklinik.de Tel.: +49-2561-9555675 Head Office Follow us on Am Schloßgraben 13 48683 Ahaus Germany @drkretz @KretzDr
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