AcrySof® IQ ReSTOR® Multifocal Toric IOL

Con Moshegov

Sydney

AcrySof®

MultiPiece

1994 2000 2003 2004 2005 2006

AcrySof®

TORIC

AcrySof®

Single Piece

AcrySof® Product Portfolio / Timeline

“Refractive” Optics

AcrySof® IQ

ReSTOR® +3

2008

+3

Presbyopia Correcting -IOLs Presbyopia Correcting -IOLs Most Often Used 2009Most Often Used 2009

Source: 2009 Leaming Survey

ReSTORReSTOR®® & Crystalens & Crystalens®®

US Market Share Trends US Market Share Trends

Source: 3Q09 Market Scope Quarterly Cataract Update

+28.2pt

29.3%

57.5%

45.7%

44.5%

Q4-07 Q4-08 Q4-09

30

35

40

45

50

55

60

-1.2pt

Overall Spectacle Wear

Portion of Time Wearing Glasses

Binocular – 6 Months Post op

0

10

20

30

40

50

60

70

80

90

100

Pe

rce

nta

ge

of

Pa

tie

nts

Never Sometimes Always

ReSTOR (n=29)

ReSTOR/Array (n=17)

ReSTOR/ReZoom (n=8)

Overall Spectacle Wear

Binocular – 6 Months Post op

13.0 mm

Anterior Apodized Diffractive Optic

6.0 mm6.0 mm

Symmetric Biconvex

Anterior Aspheric Optic

Anatomy of the Apodized Diffractive Technology

AcrySofAcrySof®® IQ ReSTOR IQ ReSTOR®® IOL IOL

SN6AD3Add Power: +4.0 DSpectacle Plane: +3.2 DRange: +10.0 D to +34.0 D A-Constant: 118.9

SN6AD1Add Power: +3.0 DSpectacle Plane: +2.5 DRange: +10.0 D to +34.0 D A-Constant: 118.9

IQ ReSTOR® IOL +4.0 D [N=131]

IQ ReSTOR® IOL +3.0 D [N=138]

26

28

30

32

34

36

Uncorrected

Cen

tim

ete

rs (

cm)

~6-7 cm difference

Source: AcrySof® IQ ReSTOR® IOL Package Insert

38

Average Near Best Distance

10

MoshegovMoshegov

Best near focus with ReSTOR +4: 32cm (median 34cm)

Best near focus with ReSTOR +3: 37cm (median 40cm)

Night Vision Problems Halos Glare

AcrySof ReSTOR +4 6 months

AcrySof ReSTOR +33 months

42%

8%

50%

ModerateNone, Mild Severe

62%

3%

35%

Visual Disturbances

Toric IOL Preferred 2009 Toric IOL Preferred 2009

Source: 2009 Leaming Survey

IOL Design – Rotational StabilityIOL Design – Rotational Stability

Adhesive nature of AcrySof® Toric IOL material provides high level of rotational stability

STABLEFORCE® haptic design allows the IOL to conform to the capsular bag

Promotes optimal placement and centration in different sized capsular bags

Average rotation of less than 4° at six months post-op

Measuring axis post-opMeasuring axis post-op

IOL rotationIOL rotation

Follow-up: I month post op n = 38 92% < 5° (highest was 7.5°) Direction: equal clockwise and anticlockwise

Angle Error (Degrees)

0.0%

5.0%

10.0%

15.0%

20.0%

25.0%

30.0%

35.0%

0 1 2 3 4 5 6 7 8 9 10

Angle Error (Degrees)

Un

der

corr

ecti

on

in

Ast

igm

atis

m

• For every 1°of rotation, 3.3% of the lens cylinder power is lost• For 30°of rotation there is a complete loss of astigmatic correction• Additional astigmatism or visual problems with greater than 30° of rotation

Post op: Toric vs. LRIPost op: Toric vs. LRI

Acrysof Toric SN60AT + LRIs

>/= 6/6 56% 24%

>/= 6/12 93% 85%

Post-op refractive cyl

0.48 D 0.97 D

Mean SE -0.45 -0.575

The Latest Advance in AcrySof® Technology

Australian launch: November 2010

AcrySofAcrySof®® IQ ReSTOR® IQ ReSTOR® Multifocal Toric IOLMultifocal Toric IOL

• Single surgical procedure for presbyopia

correction and corneal astigmatism

management

• Reduce or eliminate need to refine

residual cylinder with LRI, LASIK, or PRK

0.0

10.0

20.0

30.0

40.0

50.0

<.5 <1 <1.5 <2 <2.5 <3 <3.5 >3.5

Cylinder DistributionCylinder Distribution

Moderate 1.0 –

2.0D 25%

Severe >2.0 D

10%

Cylinder D ( < )

% o

f P

atie

nts

N = 10,411

Corrective Cylinder PowerCorrective Cylinder Power

Anterior Apodized Diffractive Aspheric Surface

Same design as current AcrySof® IQ ReSTOR® +3.0D

• 9 apodized diffractive steps for +3.0D add power

• Negative spherical aberration factor corrects for the

positive spherical aberration of the cornea

AcrySof® IQ ReSTOR® AcrySof® IQ ReSTOR® Multifocal Toric IOL Multifocal Toric IOL Product EvolutionProduct Evolution

Posterior Toric Lens Surface

Same design as current AcrySof® Toric IOLs• Posterior toric axis marks

• Posterior toric surface

Cylinder Powers Detail Cylinder Powers Detail (Models SND1T2 – T5)(Models SND1T2 – T5)

IOL Model

Cylinder Power @ IOL Plane

Cylinder Power @ Corneal

Plane*

Diopter Power Available**

0.5D increments (Spherical Equivalent)

SND1T2 1.00 0.68 6.0 to 34.0D

SND1T3 1.50 1.03 6.0 to 34.0D

SND1T4 2.25 1.55 6.0 to 34.0D

SND1T5 3.00 2.06 6.0 to 34.0D

* Based on an average pseudophakic human eye

Model Numbers

Product Characteristic

SND1T2 * SND1T3 SND1T4 SND1T5

Optic Type Biconvex Apodized Diffractive Aspheric Toric

Material Ultraviolet and blue light filtering Acrylate / Methacrylate Copolymer

Optic Diameter (mm) 6.0

Overall Length (mm) 13.0

Haptic Angle 0°

IOL Powers(spherical equivalent diopters)

Current availability is 10.0 to 30.0 D (0.5D increments)

IOL Cylinder Powers (IOL Plane)

1.00 D 1.50 D 2.25 D 3.00 D

IOL Cylinder Powers (Corneal Plane)†

0.68 D 1.03 D 1.55 D 2.06 D

Add Power +3.0 D

Add Power at Spectacle Plane

+2.5 D

Suggested A-Constant 118.9

†Based on average pseudophakic human eye * Model number SND1T2 not currently available.

AcrySof® IQ ReSTOR® Multifocal AcrySof® IQ ReSTOR® Multifocal Toric IOL (Model SND1TT)Toric IOL (Model SND1TT)Product Characteristic Summary TableProduct Characteristic Summary Table

Inte

rnal

Use

On

ly –

For

Sal

es T

rain

ing

Pur

pose

s

Product CharacteristicsProduct CharacteristicsLight Transmission CurveLight Transmission Curve

AcrySof® IQ ReSTOR® IOL +3.0 D Theoretical Total Energy Balance

Source: Data on file. Alcon, Inc. R&D Technical Report

Product Performance AcrySof® IQ ReSTOR® IOL

Refraction (D)AcrySof® IQ ReSTOR® IOL +3.0 D [N=117]

Mean Defocus Curve for AcrySof® IQ +3.0 D ReSTOR® IOLBinocular, Best Case, 6 Months Postoperative

Source: AcrySof® IQ ReSTOR® IOL Package Insert

70 cm50 cm

40 cm33 cm

∞

20/25

20/32

20/40

20/50

20/63

20/80

20/100

20/20

+1.00 +0.50 0.00 -0.50 -1.00 -1.50 -2.00 -2.50 -3.00 -3.50 -4.00

Product Performance: IQ ReSTOR® Product Performance: IQ ReSTOR®

Double Peaked Defocus CurveDouble Peaked Defocus Curve

Updated Online CalculatorUpdated Online Calculator

www.acrysoftoriccalcular.com

ASICO instrumentsASICO instruments

PRE-OP TORIC REFERENCE MARKER

A. AE-2791 Marking Eye with Patient Sitting Up

B. Patient Lying Down

AE-2791

Marking of the Eye – Axis MarkingMarking of the Eye – Axis Marking

INTRA-OP MARKER

A. AE-2792 Aligned to Steepest Meridian

B. Marks on Steepest Meridian

AE-2792

62 yr old female +2.00/-2.00x5 +2.50/-0.50x180 42.50/44.0x90 42.75/44.0x87 +22.0 ReSTOR T4 BE 2.2mmx135 2.2mmx30 T4@84 T4@92 Assume +0.50D SIA At 1 week: 6/7.5 6/9 J4 at 43cm

42.50/44.25x83 and 42.25/43.75x85

52 yr old Indian male restauranteur +1.75/-0.75x80 +1.25/-0.25x100 42.88/43.90x165 43.32/44.5x15 +22.0 ReSTOR T3 BE 2.2mmx170 2.2mmx30 At 1 month: 6/6 6/6 J1 at 43cm

ReSTOR +3D ToricReSTOR +3D Toric

The majority work very well The majority work very well but..but..

Success with the ReSTOR requires:Careful patient and doctor/practice selectionGood patient counselingAccurate preoperative biometryCareful surgical techniqueAttention to astigmatism

ConcernsConcerns

Optometrists will stop referring patients if I use ReSTOR

ConcernsConcerns

Patients don’t mind wearing glasses

ConcernsConcerns

Glare and halos are a big problem with multifocals

ConcernsConcerns

Multifocals may need to be explanted

Ideal patients for the Ideal patients for the ReSTORReSTOR

Ideal patients for the Ideal patients for the ReSTORReSTOR

Patients with no other ocular pathologyPatients in line for bilateral surgeryPeople with easy going personalities, realistic

expectations and not too obsessiveCare with engineers, high school teachers,

pharmacists and accountants

Bad patients for the Bad patients for the ReSTORReSTOR

Intra-operative Exclusion Intra-operative Exclusion CriteriaCriteria

Exclusion during surgery• Significant vitreous loss• Damage to zonules• Pupil trauma

Preoperative counselingPreoperative counseling

Patient Information videoCan’t compete with young crystalline lensExplain inevitability of faint halo around letters

and lightsReSTOR will give excellent distance vision and

excellent near vision, the new +3 gives good intermediate vision

You may be more comfortable using magnifiers for computers or reading under poor light

Preoperative counselingPreoperative counseling

ButYou won’t have to struggle with your bifocal or

multifocal glassesYou’ll love being able to see your watch, mobile

phone, prices in stores, menu in restaurants and be able to put on makeup

These lenses will free you up!

IQ ReSTOR® Toric Conclusions

• AcrySof® IQ ReSTOR® Toric has been designed to perform at all distances for patients with and without astigmatism

• Gives surgeon the ability to reduce or eliminate the need to correct residual cylinder with LRI, LASIK, or PRK.

• Allows single surgical procedure for presbyopia correction and corneal astigmatism management

• It increases the number of patients who can be considered for multifocal IOL implantation.