Visual outcome & subjective visual Visual outcome & subjective visual symptoms of the symptoms of the

Tecnis ZM900 multifocal Tecnis ZM900 multifocal

intraocular lens in Asian eyesintraocular lens in Asian eyes

Dr Colin S.H. Tan

MBBS, MMed (Ophth), FRCSEd (Ophth)

Co-investigatorsCo-investigators• Dr Hung Ming LeeDr Hung Ming Lee

• Dr Han Bor FamDr Han Bor Fam

• Dr Alex K.H. LauDr Alex K.H. Lau

The authors have no financial or proprietary interests in the subject of this presentation

Outcomes of cataract Outcomes of cataract surgerysurgery• Patients expect:Patients expect:

– Good functional vision & contrast sensitivityGood functional vision & contrast sensitivity

– Increasingly, good Increasingly, good distancedistance, , intermediateintermediate & & nearnear vision vision

• There is a decrease in image quality with age, which There is a decrease in image quality with age, which has been attributed to increasing has been attributed to increasing optical optical aberrationaberration

• An IOL designed to produce An IOL designed to produce negative spherical negative spherical aberrationaberration may theoretically compensate for the may theoretically compensate for the positive spherical aberration of the cornea, much like positive spherical aberration of the cornea, much like the crystalline lens in a young person. the crystalline lens in a young person.

Tecnis multifocal intra-ocular lens (IOL)Tecnis multifocal intra-ocular lens (IOL)• Advanced Medical Optics, Santa Ana, CAAdvanced Medical Optics, Santa Ana, CA

• Based on Tecnis Z9000 IOLBased on Tecnis Z9000 IOL

• Wavefront designed, modified prolate anterior Wavefront designed, modified prolate anterior surface to produce negative spherical surface to produce negative spherical abberrationabberration

• Diffractive multifocal optic to the posterior Diffractive multifocal optic to the posterior surface of the lens surface of the lens

The IOLThe IOL

ObjectiveObjective

• To evaluate the To evaluate the visual outcomevisual outcome, , subjective subjective visual symptomsvisual symptoms and and patient satisfactionpatient satisfaction in patients who in patients who had implantation of the Tecnis had implantation of the Tecnis multifocal intraocular lens (IOL)multifocal intraocular lens (IOL)

MethodsMethods

• Retrospective clinical studyRetrospective clinical study

• Main outcome measures:Main outcome measures:• Distance and near visual acuities (VA) Distance and near visual acuities (VA) • patient satisfaction with visionpatient satisfaction with vision• visual symptomsvisual symptoms• spectacles dependence spectacles dependence

• Parameters were assessed 6 months Parameters were assessed 6 months post-operativelypost-operatively

ResultsResults

• 72 eyes72 eyes

• Mean age: 62.6 yrs (range, 40 – 78)Mean age: 62.6 yrs (range, 40 – 78)

• Mean postop SE 0.11D (range, -1.00 Mean postop SE 0.11D (range, -1.00 to +1.00)to +1.00)

Distance VADistance VA

87.5

100

65.3

95.8

0

20

40

60

80

100

Per

cen

tag

e

20/30 or better 20/20

Uncorrected

Best corrected

Distance & near VADistance & near VA

95.8

100

80

100

Per

cen

tag

e

20/20 & N5 20/25 & N5

Best corrected

* 100% had unaided near VA of N5

Patients’ satisfactionPatients’ satisfaction

0

10

20

30

40

50

60

70

Perc

en

tag

e

Far Intermediate Near

Very satisfied

Satisfied

Dissatisfied

Visual symptomsVisual symptoms

0

10

20

30

40

50

60

Perc

en

tag

e

Glare Halo

none

mild

moderate

severe

0

0.2

0.4

0.6

0.8

1

1.2

1.4

1.6

1.8

A B C D E

Contrast

Contrast sensitivityContrast sensitivity

DiscussionDiscussion

• Tecnis MF comparable to Array SA40Tecnis MF comparable to Array SA4011

• Tecnis Z9000 (monofocal) had better distance VA Tecnis Z9000 (monofocal) had better distance VA and contrast compared to SI40and contrast compared to SI4022

• Tecnis MF achieved better uncorrected and Tecnis MF achieved better uncorrected and distance-corrected near vision vs. Array SA40distance-corrected near vision vs. Array SA4011

• 82.6% reported total spectacle independence for 82.6% reported total spectacle independence for near, compared to 100% for our studynear, compared to 100% for our study

11 Mester et al. JCRS 2007 Mester et al. JCRS 2007

22 Mester et al. JCRS 2002 Mester et al. JCRS 2002

Contrast sensitivity & Contrast sensitivity & visual symptomsvisual symptoms• Tecnis MF had similar photopic contrast Tecnis MF had similar photopic contrast

sensitivity vs. Array SA40sensitivity vs. Array SA4011

• Contrast sensitivity at 12 & 18 cpd higher under Contrast sensitivity at 12 & 18 cpd higher under mesopic conditionsmesopic conditions

• 70% had mild to moderate glare; 43.3% had 70% had mild to moderate glare; 43.3% had haloshalos

• Halos reported in 39% of patients with Tecnis Halos reported in 39% of patients with Tecnis ZM900 and in 39.1% - 58.3% of patients with ZM900 and in 39.1% - 58.3% of patients with Array SA40Array SA4011

11 Mester et al. JCRS 2007 Mester et al. JCRS 2007

Conclusion Conclusion

• The Tecnis multifocal IOL achieves The Tecnis multifocal IOL achieves good distance and near vision with good distance and near vision with minimal visual symptoms in Asian minimal visual symptoms in Asian eyeseyes