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

Customized IOLs Customized IOLs-

• Post Insertion

Post Insertion

Christian A. Sandstedt, Ph.D. Christian A. Sandstedt, Ph.D. Calhoun Vision, Inc Calhoun Vision, Inc Pasadena, CA Pasadena, CA

4 4th

th International Conference of

International Conference of Wavefront Sensing and Wavefront Sensing and Aberration Aberration-

• Free Refractive

Free Refractive Correction Correction San Francisco, CA San Francisco, CA February 15, 2003 February 15, 2003

The Light Adjustable Lens (LAL) The Light Adjustable Lens The Light Adjustable Lens (LAL) (LAL)

Clinical need and background Description of technology In-vitro testing and results Examples and future work on higher

• rder aberration correction
• Clinical need and background

Clinical need and background

• Description of technology

Description of technology

• In

In-

• vitro

vitro testing and results testing and results

• Examples and future work on higher

Examples and future work on higher

• rder aberration correction
• rder aberration correction

• Cataract surgery with IOL implantation is

the most commonly performed surgery in patients over 65

• 50% of these patients require spectacle

correction after insertion and refractive stabilization

Defocus, Lateral Displacement, Post-Operative Astigmatism (Unpredictable Wound Healing), Rotation.

• 98% of these are within ± 2 D.
• Cataract surgery with IOL implantation is

the most commonly performed surgery in patients over 65

• 50% of these patients require spectacle

correction after insertion and refractive stabilization

Defocus, Lateral Displacement, Post-Operative Astigmatism (Unpredictable Wound Healing), Rotation.

• 98% of these are within ± 2 D.

Clinical Need Clinical Need Clinical Need

Non-Invasive Alteration of IOL Power Post-Operatively Non Non-

• Invasive Alteration of

Invasive Alteration of IOL Power Post IOL Power Post-

• Operatively

Operatively

Foldable IOL made of photosensitive material Adjust IOL power post-operatively by treating

with safe levels of light to alter its refractive properties

• Foldable IOL made of photosensitive material

Foldable IOL made of photosensitive material

• Adjust IOL power post

Adjust IOL power post-

• operatively by treating
• peratively by treating

with safe levels of light to alter its refractive with safe levels of light to alter its refractive properties properties

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

Single Pass Interferometry Single Pass Interferometry

Myopic Correction Myopic Correction Myopic Correction

Measurements made in double pass The number of interference fringes (OPD) proportional to

the induced power change

• 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 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

• 2.0
• 1.5
• 1.0
• 0.5

0.0 1 2 3 4 5 6 7 8 9 Dose # ∆Diopters

Method of LAL Optical Characterization: MTF Method of LAL Optical Method of LAL Optical Characterization: MTF Characterization: MTF

MTF measurements made in a wet cell with the ISO

prescribed model eye

MTF of LAL comparable to commercial IOL

• 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

• MTF of LAL comparable to commercial IOL

MTF of LAL comparable to commercial IOL

0.2 0.4 0.6 0.8 1 50 100 150

lp/mm Modulus MTF LAL Post Lock-In MTF Allergan Si40 IOL MTF LAL Pre-Adjustment

MTF = 0.43 @100 lp/mm

Hyperopic Correction Hyperopic Correction Hyperopic Correction

Measurements made in double pass The number of interference fringes (OPD) proportional to

the induced power change

• 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 induced power change the induced power change Calhoun Vision LAL Preirradiation + 20.0 D Calhoun Vision LAL + 2.0 D Correction

Future Work Future Work

In In-

• Vitro Astigmatism

Vitro Astigmatism

Astigmatic Correction: 3.50 D ± 0.15 D

• f Toric Correction

Classic Astigmatic Wavefront

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

Center 2 mm Zone Size Patient with +22.5 D LAL –2.0 D Post-Op Myopic Error

Light Adjustment In Situ Creation of MF

Removal of

• 0.5 D

Of Power Removal of –1.5 D 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

( )

θ ρ − ρ = 2 cos 3 4 I

2 2 Tetrafoil

Tetrafoil Bitmap Spatial Intensity Pattern for Input to the DMD

Digital Light Delivery Device Digital Light Delivery Device Digital Light Delivery Device

• Tetrafoil Imprint

Spherical Aberration Spherical Aberration Spherical Aberration

Cause

OPD between the paraxial and marginal rays Different annular zones of a lens focus at different

points along the optical axis

Cause Cause

• 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 points along the optical axis points along the optical axis

Paraxial Focus Marginal Focus Best Focus

Spherical Aberration Spherical Aberration Spherical Aberration

Treatment Correction

Irradiation of an annular ring on the periphery of the

LAL

Note the removal of ~2 fringes (1 Wave) of LSA

Treatment Correction Treatment Correction

• Irradiation of an annular ring on the periphery of the

Irradiation of an annular ring on the periphery of the LAL LAL

• 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

Calhoun Vision Team Dan Schwartz, MD Shiao Chang, PhD Jay Wilson, MS Veronica Jaramillo, PhD

Special Thanks Special Thanks

Calhoun Vision Team Calhoun Vision Team Dan Schwartz, MD Dan Schwartz, MD Shiao Shiao Chang, PhD Chang, PhD Jay Wilson, MS Jay Wilson, MS Veronica Jaramillo, PhD Veronica Jaramillo, PhD