Eyeworld Supplements

by Jonathan Frantz, MD, FACS Apodization and light distribution of the ReSTOR Lens Please refer to pages 7 and 8 for important product information about the Alcon products described in this supplement. EW San Diego 2015 4 T he AcrySof IQ ReSTOR +3.0 D IOL (Alcon, Fort Worth, Texas) uses a combina- tion of 3 complementary technologies (apodization, diffraction, and refraction) to allow patients to achieve a full range of high-quality vision generally with- out the need for reading glasses or bifocals. Apodization is the gradual reduction or blending of diffractive step heights. This unique technolo- gy optimally distributes the appro- priate amount of light to near and distant focal points, regardless of lighting. The apodized diffractive optic of the AcrySof IQ ReSTOR IOL improves image quality while minimizing visual disturbances. 1 The result is an increased range of quality vision that delivers a high level of spectacle freedom. 1 This lens is the first and only apodized diffractive IOL in the U.S., and the apodized diffractive optics are found within the central 3.6-mm inner diffractive optic zone of the lens. This area comprises 9 concen- tric steps of gradually decreasing (1.3 to 0.2 µm) step heights that allocate energy based on lighting conditions and activity, providing high-quality vision at all distances. The refractive region surrounds the apodized diffractive zone of the optic. This area directs light to a distance focal point for larger pupil diameter and is dedicated to dis- tance vision. We all know that when patients are reading, their pupils get small and when they are driving at night, their pupils get large. Because of this, we needed a mechanism to optimize near vision when the pupil is small and to minimize any rings or halos around lights at night when the pupil is large. Some ophthal- mologists are using other lenses so that patients can read better in dim illumination, but the vast majori- ty of people who are getting these lenses are reading in relatively good light. They are more concerned with retaining their night driving ability. In my experience with the ReSTOR, while patients may experience rings and halos around lights, for the most part, they find it very tolerable. In many instances, it goes away. With an apodized lens, there are basically 2 focal points: a distance focal point and a near focal point. With a nonapodized lens, both images are on the retina at the same time, which results in more glare and halos. When people are driving at night, they still have the same light distribution for near as they would have if they were trying to read, and that can lead to some ad- aptation issues. Any patient with a multifocal lens will experience some adaptation problems, but they are minimized with the ReSTOR lens. Because of the constantly evolving technology that we have right now—femtosecond lasers, laser relaxing incisions, the ORA with VerifEye (Alcon), and these new technology lenses—we are constantly updating and optimiz- ing our outcomes assessment. I have found that the vast majority of patients who are implanted with the ReSTOR lens do extraordinarily well. Approximately 90% of them don't need glasses after surgery; that exceeds what was achieved in the FDA clinical trial, which was 78%. 1 Now, we can correct astigmatism with precise incisions during the surgical procedure and by choosing the correct lens implant power. All of those things combined provide outstanding results. I do tell people who need to read in conditions with dim illumi- nation that this lens requires that light be able to reach it. With the ReSTOR +4, there was an issue where people felt like they had to get too close to the computer screen to read it. With the ReSTOR +3, we rarely hear that complaint. Reference 1. AcrySof® IQ ReSTOR® +3.0 D IOL Directions for Use Dr. Frantz is in private practice in Fort Myers, Fla., with other locations in Cape Coral, Punta Gorda, Lehigh Acres, and Naples. He can be contacted at jfrantz1@aol.com or 239-418-0999. Tecnis Multifocal ZMB00 AcrySof ® IQ ReSTOR ® SN6AD1 AcrySof ® IQ SN60WF " The apodized diffractive optic of the AcrySof IQ ReSTOR IOL improves image quality while minimizing visual disturbances. The result is an increased range of quality vision that delivers a high level of spectacle freedom " Jonathan Frantz, MD, FACS Pinhole photographs (shot through a modified ISO model eye) are used to simulate halos that occur at nighttime while driving. Parameters of measurement included a 5-mm pupil, distance focus at 360.

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