Oph The Record 2020 / 2021 by OPHTEC

Published by OPHTEC BV /// Edition 2020/2021 /// #15

ARTIFLEX

EYES EVERY WHERE

BEST OF TWO WORLDS

ARTISAN APHAKIA IN PRACTICE

PRECIZON PRESBYOPIC DR LUIS OLIVEIRA

PROF. KIM MIN

Dr. Moon

PLUS

PRECIZON

about RingJect and why he he PRESBYOPIC routinely implants a CTR during TORIC IOL PCIOL implantation Erik de Haas

Interview

THE CLINIC: OMC HANZEKLINIEK

Geke Hoekstra Interview

IRIS PROSTHESIS By Reper A foldable implant with customized colours

www.ophtec.com

Content

4. ARTISAN® APHAKIA IN PRACTICE Prof. Kim Min

8. PRECIZON™ PRESBYOPIC TORIC Erik de Haas

10. PRECIZON™ PRESBYOPIC NVA Dr Luis Oliveira

Prof. Kim Min from Korea developed a special technique for retropupillary iris fixation. We asked him to explain this technique and why he likes the Artisan Aphakia.

Following the successful introduction of the Precizon Toric and the Precizon Presbyopic, Precizon Presbyopic Toric saw the light this year. A promising new concept developed by OPHTEC’s engineers, with the unique characteristics of its ancestors.

Dr Luis Oliveira from Porto, Portugal on what makes the Precizon Presbyopic IOL special.

EYES EVERY WHERE

OPHTEC Events Please check our website for upcoming events, or follow us on Facebook, Twitter, Linked In & Instagram

Editorial

ArtiLens Training Courses

One would think the hashtag #I see eyes everywhere comes from an ophthalmologist after a hard day’s work. But that’s not the case. It refers to collections of photos depicting objects and situations showing imaginary eyes in all kinds of places.

To obtain the best results with Artisan and Artiflex IOLs, OPHTEC continuously conducts specialized ArtiLens certification courses throughout the world. By providing lenses only to certified professionals, OPHTEC guarantees the constant high quality of the results with the product. For more information and upcoming courses, please visit: www.ophtec.com/about-artilens/courses

This phenomenon called Pareidolia is defined as ‘the tendency to perceive a specific, often meaningful image in a random or ambiguous visual pattern’ 1). Why does our brain trick us into seeing eyes or faces everywhere? There are several theories. It could be because we see so many eyes in our lifetime, we expect to see them everywhere. Or because our brain is wired to quickly detect eyes to protect us from danger in the bushes. Anyway, the internet collection is hilarious and that is why we chose this subject for our front page in these stressful corona times. But be aware, no more imaginary eyes or imagination in the rest of this magazine. Real products and treatments for physical eyes only! 1) Meriam-Webster

Content 3

13. The Clinic: OMC HanzeKliniek Geke Hoekstra Managing director Geke Hoekstra from OMC HanzeKliniek in Groningen, the Netherlands answers our questions about the clinic, the ties with OPHTEC and the impact of the coronavirus crisis.

16. ARTIFLEX® BEST OF TWO WORLDS Dr Mariano Royo / Harry Simon The Artiflex (Toric) PIOL is one of few IOLs to stand the test of time. For over 15 years, it combines the advantages of iris fixation with the advantages of a foldable lens.

PLUS: 18. OPHTEC NEWS 19. IRIS PROSTHESIS By REPER A foldable implant with customized colours.

PRECIZON PRESBYOPIC

OPHTEC PREMIUM IOLs

CTF optic designed for: • Natural vision at all distances • Tolerant to the kappa angle • Reducing glare and halo’s • Decentration Tolerance

Visit our website for more information

ARTIFLEX TORIC Designed for spherical and cylindrical correction of myopic eyes.

ARTISAN APHAKIA

PRECIZON TORIC

A predictable, safe, high precision implant

TCT surface designed to be more tolerant of misalignment

Artisan Aphakia in practice An interview with Prof. Kim Min

Prof. Kim Min is ophthalmologist at the prestigious, high-end Gangnam Severance Hospital and Yonsei University College of Medicine both located in Seoul. He has an extremely busy schedule seeing clinic patients, performing surgeries (cataract, retina surgeries, and tumor surgeries) and conducting research projects. In addition he travels frequently to various international meetings to give talks and meet with other retina specialists around the world.

OphTheRecord 2020/2021

Prof. Kim Min is a user of the Artisan Aphakia IOL. An IOL that can be implanted quickly, a great feature that fits the busy life of the medical specialist. But that is certainly not the only reason why he uses this IOL. There are lots. He developed a special technique for the retropupillary iris fixation. We asked him amongst other things to explain this techniques and why he likes the Artisan Aphakia. Why ophthalmology? I have always been fascinated by the intricacy and complexity of the human eye and how it all works to create a dynamic visual system. I fell in love with ophthalmology during clinical rotations in medical school after observing the clinical interactions with patients in the office-based practice, while also providing the necessary surgical interventions when required. This combination of medical and surgical

treatment, while challenging, enables comprehensive care and this was something that especially appealed to me. I subspecialize in intraocular oncology and uveal/vitreoretinal diseases, both as a medical specialist and surgeon, which is a very demanding subspecialty that requires strong knowledge of all the bodyâ&#x20AC;&#x2122;s organ systems. Can you tell about Severance Hospital? I am always deeply honored to be a part of Severance Hospital and a faculty member of the ophthalmology department at Yonsei University. Severance Hospital was founded under royal approval as the first Western-style hospital in 1885 by an American doctor and medical missionary, Horace N. Allen. Over the next 135 years, both the hospital and the affiliated Yonsei University have advanced tremendously, in line with South Koreaâ&#x20AC;&#x2122;s own dramatic socioeconomic development.

J Refract Surg. 2018 Aug 1;34(8):564-566. (A) After successful removal of the dislocated intraocular lens (IOL), a 27-gauge cannula connected to the viscoelastics device is carefully bent with forceps to form an approximately 60º angle. (B) A single side port incision is created 90º from the main incision site. (C) The bent cannula is inserted, and the chamber is deepened with viscoelastics.

Fred Wassenburg

dr. Ramón Ruiz Mesa

(D) Grasping the IOL with forceps, the distal haptics are gently enclavated with the tip of the bent cannula while viscoelastics are being injected to provide counter pressure on the iris against the haptics, facilitating precise enclavation of the haptics and centration. (E) Next, the proximal haptics are enclavated in the same manner. (F) The IOL is well-centered and fixed to the iris with minimal pupil distortion.

One particularly admirable aspect is that the university hospital, without any private owners or backers, can offer and sustain excellence through the hard diligent work of all its staff and medical professors, who all share a passion for patient care and basic and translational research. The ophthalmology department of Yonsei University has over 25 board-certified faculty members, 15 clinical fellows, and 26 resident ophthalmologists-in-training spread over 5 affiliated hospitals including Severance Eye Hospital. The range of subspecialties is broad and comprehensive, and as such, patients can expect to receive cutting-edge treatment including possibly enrolling in clinical trials and participating in our research. Why use Artisan Aphakia? The Artisan Aphakia IOL is very useful in managing cases with dislocated IOLs, eyes with phakic crystalline dislocations from complete zonular dehiscence or rupture posterior capsule, or in aphakic eyes. The Artisan Aphakia IOL is a suture-less, posterior iris-fixated, polymethyl methacrylate IOL that has gained widespread

I have always been fascinated by the intricacy and complexity of the human eye and how it all works to create a dynamic visual system”

recognition and expanding use because of its efficiency in managing the aforementioned cases, with long-term intraocular safety and excellent sustained visual outcomes. IOL dislocations are particularly the source of significant patient discomfort and burden due to its related costs and difficulties of already having undergone cataract surgery. Once the learning curve is over, I have found that the Artisan Aphakia implanting can be done very quickly, inciting very minimal pain for the patient, with nearly no complications. Because the Artisan Aphakia IOL does not require use of any sutures, the patients do not need to worry about potential suture related complications, such as suture associated infectious endophthalmitis and suture breakage leading to re-dislocation of the IOL. Furthermore, because the Artisan Aphakia IOL is placed behind the iris plane, this obviates the potential corneal endothelial decompensation. As such, the retropupillary Artisan Aphakia IOL is now my go-to IOL for those aforementioned cases as long as there are no severe iris defects.

OphTheRecord 2020/2021

What are the advantages of the Artisan IOL compared with scleral sutured IOLs? Iâ&#x20AC;&#x2122;ve found that the Artisan Aphakia delivers excellent vision both in the immediate post-op and long term, with minimal risk for endothelial decompensation, quick surgery times, and low risk for disenclavation compared to scleral-sutured IOLs. For scleral-sutured IOLs, there is always the risk for not only suture breakage over time, but deformation of the haptics leading to a tilted optic plane. Suture related infection could also be a vision threatening problem. Can you describe your enclavation technique? This modified technique is simple to learn and has many advantages over the conventional method. The cannula of the viscoelastic device (OVD), which we bend at an approximately 60-degree angle from around 13 mm from the tip, is inserted across the horizontal axis to enclavate both haptics of the Artisan Aphakia IOL serially. The advantage of this technique is that there is no need to change hands (which is not only awkward but may risk the Artisan Aphakia IOL being dropped into the vitreous cavity) and viscoelastic can be simultaneously injected to create work-space, reveal the contour of the IOL haptics behind the iris (improving visualization: no need to blindly enclavate the IOL) as the viscoelastics

OphTheRecord 2020/2021

provide counter traction and pushes the iris down against the haptics. Simultaneous injection of OVD while enclavating the haptics also helps maintain the anterior chamber and prevent unwanted chamber collapse. Overall, this modified technique facilitates easy and precise enclavation, with improved centration. Would a (possible) foldable Artisan Aphakia lens cannibalize the current version? A folding version may be advantageous in those eyes without the need to remove a dislocated IOL, as the large 5.5 mm scleral tunnel incision may not be needed at all. However, the IOL would still need to be rigid enough to enable easy enclavation. I believe it may depend on the ease of use and long-term stability outcomes for the foldable version. In essence, the foldable lens may cannibalize the current version as the target cases overlap significantly. A method for easier removal may be helpful in cases with poor initial enclavation. Can you describe the impact of Covid-19 in the hospital? There is definitely an overall trend for conservative management in the current situation, with delaying and minimizing non-essential surgeries and appointments. Of course, this depends on the disease and

condition of the patients, as those with vision-threatening diseases are of course managed appropriately regardless of the pandemic. Of course, we do our utmost to uphold safety and prevent spread in all cases, thereby protecting not only the patients and also ourselves. This includes installing plastic see-through planes on all of our slit lamps, wearing masks at all times, frequent sterilizing of all surfaces, and testing of all admitted patients.

VIDEO Video Prof. Kim Min

Award of Merit that Be it hereby known

Kim Professor Min

LATEST NEWS:

th of September 2020 on this 15 day has been made

ÂŽ bas sad or AR TIS AN Am contributions nal and clinical for his educatio over the past decade

Prof. Kim Min awarded with Artisan Ambassador award 2020. Read more on www.ophtec.com

focus on perfection

ARTISAN Aphakia

One lens, two implantation techniques prepupillary fixation

retropupillary fixation OphTheRecord 2020/2021

News from OPHTEC’s Innovation Centre

New developments:

Precizon Presbyopic Toric IOL

Erik de Haas

Following the successful introduction of the Precizon Toric six years ago and the Precizon Presbyopic two years ago, Precizon Presbyopic Toric saw the light this year. A promising new concept developed by OPHTEC’s engineers, with the unique characteristics of its ancestors. Due to COVID-19, almost nothing has gone as intended this year; but we are confident now that we will be able to launch this product in selected markets in early 2021. ‘The corona crisis will not stop us, but we had to change the existing timetable’, says Erik de Haas, Development Leader of OPHTEC’s R&D Department. ‘The lens was granted the CE mark in early spring, after which we have applied for ethical approval in the countries where we intended to start the PMS (Post Market Surveillance) study. Based on the new timetable we still can have the lens on the market by 2021.’

OphTheRecord 2020/2021

A PMS study takes a long time and it can’t be sped up. Erik explains why: ‘It starts with the patients. The ophthalmologists taking part in the study need to select suitable patients first. The lenses are then ordered and we have to make them to measure, as it is partly patient design and at that stage we do not have large stocks yet. That takes time, even though we prioritise the lenses. The protocol requires the patients to be monitored post-op after a week, a month and three months. Once all the data has been collected and the evaluation is positive, a first group of ophthalmologists who did not take part in the study begin implanting the lenses. The product is only put on the market some time after that. All in all, it can easily take six months after obtaining the CE mark.’ The new lens is a spin-off of the Precizon Toric and Precizon Presbyopic. The Toric is unique with its TCT (Transitional Conic Toric) optic, designed to tolerate misalignment, which is tried and tested, and the Precizon Presbyopic with its characteristic segments, which provide Continuous Transitional Focus (CTF) in the patient’s field of vision. Both TCT and CTF are unique patented systems. How can these two optics be combined? Doesn’t mixing them come at the expense of the characteristic properties of one or the other?

Erik explains: “Both alignment tolerance and continuous transition focus are provided by this lens. You shouldn’t regard it as ‘mixing’. The explanation is very simple, but that doesn’t mean it’s simple from a technical perspective. In terms of optics it’s a unique, advanced technical design. The lens is based on the toric lens, upon which Precizon Presbyopic’s far/near segments are superimposed, as it were.

The new lens embodies the good qualities of the Precizon Toric and Presbyopic models, with no limitations”

Guus Eldering

So the profile of the toric lens is the foundation for the multifocal segments, with the strong distribution of the Precizon Presbyopic NVA lens, 60% (far) and 40% (near). The new lens embodies the good qualities of both models, with no limitations.’ At the time of the interview the first Presbyopic Toric implant was about to be performed. ‘That’s always a special moment’, says Erik. ‘The whole department looks forward to it, as we’ve been doing everything in our power to create a perfect lens. Everything has been precalculated in Zemax, tested on the dioptre meters and checked in our Model Eye Vision Analyzer, which we use to simulate a patient’s sight. But however good the calculations and results are, the proof of the pudding remains in the eating. The real proof has to come from the patient, in fact the patient’s brain, as that is the only true “image processor”, and we are anxiously awaiting that proof.’

Analyzing light distribution with Optical Bench

Follow the development of the Precizon Presbyopic Toric lens on the blog on our website.

Schematic representation of the Model Eye Vision Analyzer

OphTheRecord 2020/2021

Dr Luis Oliveira

Dr Luis Oliveira from Porto, Portugal is the head of the Cornea Department of Centro Hospitalar Universitário do Porto (CHUP) where he works as a cornea specialist. Also, he is the head of the Portuguese Group for Cataract and Refractive Surgery (CIRP) of the Portuguese Society of Ophthalmology for the 2019-2020 biennium. He started using the Precizon Presbyopic IOL in 2019. An interview: There are many Presbyopia correcting IOLs available, what makes OPHTEC’s lens special according to you? These new concepts of IOLs that favour far and intermediate vision with minimal loss of vision quality rather than all-distances vision and some degree of quality vision loss, are in my opinion much more physiological. We don’t know what the future will bring us, but for the present and near future, these type of IOL concept is, in my opinion, the way to go.

OphTheRecord 2020/2021

Precizon Presbyopic: “Excellent far and intermediate vision. Little or even no complaints about quality vision issues”

Centro Hospitalar Universitário do Porto (CHUP)

How many Precizon Presbyopic lenses have you implanted so far? How are the outcomes? Close to 100 Precizon Presbyopic IOLs. The outcomes are very promising: excellent far and intermediate vision, but most of all, little or even no complaints about quality vision issues, that as we all know, are very common with the “classic” multifocal IOLs. All patients need reading glasses for J1, but not for intermediate vision. This gives a high level of glasses independence for most daily activities. Do you use both models of the lens (NVA A1 and A0)? What do you think are the intended patients for these lenses? I’m only using the NVA A1 model. Almost all patients for cataract surgery or refractive lens exchange that are seeking glasses independence for daily activities with minimal quality vision loss are suitable for this type of IOL. The absence of toric correction is a limitation of this IOL. Therefore, patients with high astigmatism are not suitable for this model of IOL.

The best story is that with careful patient selection, the satisfaction rate is extremely high” What is your most special Precizon Presbyopic patient story? I don’t have “one” special patient story. The best story is that with careful patient selection, the satisfaction rate is extremely high, and so far, I didn’t have to explant any of these IOLs because of quality vision issues.

When did you start working with OPHTEC ? I started working with OPHTEC early during my ophthalmology residency, and cooperation have been always the best. I use both Artisan and Artiflex family models since 2005, Precizon Toric IOL since 2014 and more recently the Precizon Presbyopic IOL. Can you tell us about the impact of Covid-19 in Portugal and about the changes the virus has brought about in the daily routine of the hospitals/clinics? Will these changes last? The impact of Covid-19 was tremendous in our daily practice during March and April. Our practice have been reduced to eye emergencies only during that period. In May, under very strict measures, we slowly started our routine practice. We now realize that following these rules strictly, is possible to have a “normal” daily routine again. Unfortunately it looks like these changes will last for a long time.

OphTheRecord 2020/2021

RingJect

™

Preloaded Capsular Tension Ring in a single use injector

Prepositioned and self-loading CTR.

This CTR is made of unique, compression molded PMMA: extremely flexible and strong. Built in pre-compression ensuring better support in case of capsular shrinkage.

Beveled tip for easy entry through the incision.

Long, small tip, especially convenient in cases of deep set eyes.

Optimal position of the rosettefor maximum control.

FDA approved IOL centration at 12 months postop. Centered 97.80% 1)

1) Interim Results of the United States Investigational Device Study of the Ophtec Capsular Tension Ring. Francis W. Price et al. Ophthalmology 2005 Mar;112(3):460-5

OphTheRecord 2020/2021

The ends of the rings are gradually formed to “tip-up” like a ski tip - this allows the CTR to be easily guided in the capsular bag.

Arrows indicate the direction in which the CTR exits the device: clockwise or counterclockwise.

Action retraction mechanism for total control.

Series: The Clinic In this instalment we visit the OMC HanzeKliniek in Groningen.

OMC HanzeKliniek

The white walls of the building, about 150 metres from OPHTEC, that houses the OMC HanzeKliniek are shining in the summer sun. The car park in front of the building is fairly full: not as full as before the coronavirus crisis, but also not as empty as during the corona lockdown a few months ago. The same is true of the central waiting room. It looks hopeful. The side stairs next to the treatment and consulting rooms take us to the second floor, where we find the office of Geke Hoekstra, Managing Director of the OMC HanzeKliniek. There she answers our questions about the clinic, the ties with OPHTEC and the impact of the coronavirus crisis. An interview:

OMC Hanzekliniek

The OMC HanzeKliniek is only a few metres from OPHTEC headquarters: that can hardly be a coincidence. What’s the story? Geke Hoekstra explains: ‘The OMC HanzeKliniek and OPHTEC are members of the same family! Like OPHTEC, we are a product of the creative mind and enthusiasm of ophthalmologist Professor Jan Worst and the entrepreneurial spirit of his wife, Anneke Worst-van Dam. Jan Worst and two other ophthalmologists founded a group practice in Groningen over fifty years ago. They established it in a beautiful historic building in the old city centre. It was the first ophthalmology group practice in The Netherlands, and it developed into the OMC HanzeKliniek. Today, following various takeovers, the clinic is a subsidiary of OPHTEC and Triade. (Triade is an investment company of the University Medical Center here in Groningen (the UMCG))’.

Geke Hoekstra

‘The family ties with OPHTEC are very clear. I can say that, because I had final responsibility for human resource management at OPHTEC for ten years. The culture is the same. The staff of both companies feel strong ties to them, I think because it’s a family firm and because of Jan and Anneke Worst’s inspirational mission to help people with their eye diseases. We’ve just celebrated forty years in service by one of our staff. Just like at OPHTEC, people stay for a long time, they want to go on doing this work.’ ‘The two companies also have business ties. We use OPHTEC’s products - their premium lenses and IVI sets - and we rent this building from them. We also use OPHTEC’s IT, HR and TS. There can occasionally be some friction in the family, just as in a real family, when we buy ophthalmic products from another

supplier - because OPHTEC does not supply a particular product, or because an ophthalmologist prefers a different product. But I stand by our independence, that’s very important.’ Can you describe the clinic? Geke Hoekstra says: ‘We’re a medium-sized clinic treating patients with many kinds of ophthalmic problems. We have three prongs: general ophthalmology, refraction surgery and an optician. We have 44 staff, seven of whom are ophthalmologists. Our patients and customers are from Groningen and a wide surrounding region.’ ‘The building dates back to 1997 and was ultra-modern and spacious then, when it was opened. Nowadays, more than twenty years on, that’s not the case. It’s far too small now, and no longer so modern.

OphTheRecord 2020/2021

Reception

Waiting Room

The historic building in the city centre of Groningen where a group practice was founded

Prof. Dr Worst in his office at the first location of what would become OMC Hanzekliniek

Laser Surgery

As a result we started making refurbishment and conversion plans in January, but unfortunately we’ve had to put them on hold for the time being because of the coronavirus crisis.’ What makes the clinic unique? Geke replies: ‘The clinic is unique because it’s Professor Worst’s - the clinic of the man who gave the world iris-fixated lenses. He implanted them here, in his own clinic. We are proud of that history and we’re following in his footsteps. We offer a wide range of ophthalmic treatments, and refraction surgery is still one of our specialities. Nowadays we not only implement iris-fixated lenses, we also perform SMILE laser eye surgery.’ ‘Our independence also makes us unique. We are not part of the increasing number of chains that are springing up in The Netherlands. We do everything ourselves. That has advantages, as you’re your own boss, but it’s also very demanding. You have to cover a lot of areas with a relatively small

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group of people: not just ophthalmology, also the rules and regulations, marketing, purchasing, and so on. But that’s what makes it special’. ‘Another unique feature, I think, is that we have an in-house optician’s, which is not something you often find at an ophthalmology clinic. Thanks to the optician’s our eye care ends not just with a prescription for an optician but with a pair of glasses to put on. That’s convenient. Take a cataract patient, for example, who needs an interim pair of glasses after having one eye treated. Or a child, who pays their first visit to the orthoptist and walks out proudly wearing a pair of glasses. It works the other way as well: some customers come to our optician’s because the opticians always have the expertise of fellow specialists in the building to fall back on. They find that comforting.’

GRONINGEN

AMSTERDAM

THE NETHERLANDS

Laser Surgery

How have you got through the lockdown and how are things going now? Geke answers: ‘With a lot of flexibility, improvisation and good communication. We closed from the 16th of March to the 28th of April. It was a very stressful time. We needed to adapt quickly and improvise. All with that dark cloud of uncertainty hanging over our heads. How long is this going to last? How long will we need to stay closed? What’s in store for us? Will we fall sick? Will our patients fall sick?’

We needed to adapt quickly and improvise. All with that dark cloud of uncertainty hanging over our heads”

‘On the first Sunday a team of volunteers phoned all the patients who had appointments, cancelling them until further notice. We did stay open for urgent and semi-urgent cases and to treat macular degeneration, but that meant we had very little time to ensure that the work could be carried out safely. We introduced a different route through the building, we protected equipment with plexiglass screens and we took other protective measures. We kept all our staff up to date on developments through coronavirus newsletters sent daily, and later weekly, by e-mail or WhatsApp to their mobiles. We also regularly phoned staff who were more or less prevented from working due to corona. I thought it was very important to keep in touch as much as possible with the natural group of staff who make up the organisation.’

contact lenses. People were hoarding them on a massive scale. With a lot of improvisation, we were able to arrange for one of the optician’s staff to provide the contact lens service from home.’

‘The office staff and optician’s staff started working from home. That required some creativity, as an organisation like ours is not at all set up for this. The optician’s suddenly started receiving huge numbers of orders for

‘We reopened on the 28th of April, a few days after the official date when it was permitted. My stress started all over again: I felt the huge responsibility for the safety of our staff and patients.’

The outpatient clinic opened with a lot of protective equipment and a different division of responsibilities. Staff found it difficult to get used to the PPE in particular, as it makes treating patients very different: interaction with them is completely changed. It creates distance, whereas care professionals want to be up close. It goes completely against the grain for them. I noticed it made some staff very unhappy.’ ‘With all the health protection measures the waiting lists got longer. Patients were very understanding to start with, but later on people started to lose their patience. The waiting list bottleneck was due not so much to staff capability as to lack of space in the building. You need space to comply with the one-and-ahalf metre distancing rule. So we extended our opening times to provide more throughput. We now open from 8 am to 8 pm on weekdays and some Saturdays. Another reason, of course, was financial: after all, we are and remain a commercial operation.’ ‘We’ve been working in line with this protocol for a few months now and we’ve gradually got used to it. We’re finding that the new approach has positive aspects too. It’s very quiet in the waiting room, for instance, very different from before the coronavirus crisis. Patients tell us they like that, which I can understand. Patients also appreciate the extended opening times, which are appropriate for this difficult time, although it places greater demands on staff. But I think it’s important to consider the positive aspects as well when the team reviews the coronavirus period. Perhaps something positive for the future will emerge from these bleak times.’

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ARTIFLEX, the best of two worlds

Many different IOLs and PIOLs have been developed and marketed since Harold Ridley’s famous first in 1952. But most of them have already been forgotten. Only a small group of IOLs survived for a longer period of time. At OPHTEC, we can proudly conclude that the iris fixated IOLs are among them. The Artiflex PIOL is one of these lenses, developed for myopia correction. It has PMMA iris fixation haptics, like the Artisan lenses, but a foldable optic. It has the advantages of iris fixation, a safe and solid method for fixating an IOL to the iris as well as the advantages of foldable lenses, i.e. no large incision, no induced astigmatism and quick recovery. Artiflex has been on the market for fifteen years now and is still booming. Its offspring, the Artiflex Toric, is probably even more revolutionary. This lens came on the market in 2009, four years after the monofocal. Due to its anchoring to the iris, the strongest tissue in the eye, it is probably the only toric lens that does not rotate at all.

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The Artiflex Implantation Spatula The Artiflex implantation spatula enables the Artiflex lens to be placed in the eye. It is a unique instrument that was developed simultaneously with the lens. “Designing a lens is one thing, but designing the right tools for implantation is another”, says Ophtec’s research engineer Harry Simon. “These design processes run simultaneously. You work on the lens and in the meantime you think about the implantation procedure. You have to, because you cannot implant a lens without the right tools. In this case, we faced the unusual challenge of designing an implantation instrument for a lens with a flexible optic and PMMA haptics when there was none available. I discussed my ideas several times with Prof. Jan Worst during that time. With his input, the design of the Artiflex Implantation Spatula, as we later called it, gradually took shape. When the lens was ready, we were able to test it and we found that the spatula worked perfectly. We never changed the initial design of the instrument. It was right from the start.

1-4; Mounting an Artiflex PIOL onto the Implantation Spatula

Three questions for Artiflex specialist Dr Mariano Royo Is the lens difficult to implant? Just follow the surgical manual step by step and success is assured. With Artiflex toric lenses the use of Vacufix is decisive, since it places the lens correctly at the first attempt. With Artisan Aphakia lenses, the Vacufix helps us clamp the iris much more easily than the needle. What would you say are the main advantages of the Artiflex IOL compared to other phakic IOLs available? • One size, no sizing problems at all • No rotation • Not influenced by the crystalline rise in time • Easy control in reviews without dilation • Easy to explant if necessary

Photo: Dr T. Chazalon

When did you start using the Artiflex PIOLs? I started with the Artisan lens in 2000. Five years later I implanted my first Artiflex. I perfectly remember who my first patient was, but I no longer keep track of how many lenses I have implanted since then. Dr Mariano Royo from Madrid (Spain) is a specialist in the field of refractive surgery and the anterior eye. He is the Medical Director of the Instituto Oftalmologico, a private clinic in Madrid, head of Ophthalmology Service at San Rafael Hospital and chairman of the Board of Trustees of the Foundation for Vision Care (FUNCUVI). His study “Five-year endothelial cell loss after implantation with phakic anterior chamber lens, ARTIFLEX” is recently published during the virtual ESCRS. His data demonstrates that the Artiflex anterior chamber implant for the correction of myopia and astigmatism is a safe procedure and that it does not produce a reduction of endothelial cells greater than physiological one after surgery.

From: Artiflex Toric implantation by Dr. J. L. Güell

VIDEOS Dr Royo talking to his patient Joanna

STUDIES

Recently published long-term studies on Artiflex: Monteiro et al., 2020 “Long-term efficacy and safety results after irisfixated foldable phakic intraocular lens for myopia and astigmatism, 6 year follow-up”.

Joanna’s experience with Artiflex by Dr. Royo

Artiflex implantation by Dr. J. L. Güell

Royo et al., 2020 “Five-year endotelial cell loss after implantation with phakic anterior cham-ber lens, Artiflex”

Needle enclavation of the Artiflex PIOL

Artiflex Toric implantation by Dr. J. L. Güell

Castro de Luna et al., 2019 “Artiflex foldable lens for myopia correction results of 10 years of follow-up”

OphTheRecord 2020/2021

OPHTEC NEWS OPHTEC FOUNDER PASSED AWAY With great sorrow, we announce the passing of OPHTEC’s founder, Anna Margaretha Worst-van Dam. 1928 - 2020. Anneke Worst was born in Amsterdam, where she grew up in a family with two brothers. She was intelligent and ambitious and would have liked to have gone to university after leaving grammar school, but to her disappointment that was not possible. She became a medical analyst and worked for Philips Duphar in the Netherlands and for a year at Institut Pasteur in Paris. Ophthalmology entered her life after marrying ophthalmologist Jan Worst in 1955. She left her job and started helping her husband. She saw the commercial possibilities of the medical instruments and lenses that her husband was developing with instrument maker Klaas Otter and set up the Medical Workshop company. It was successful, and after a few years she sold it to the Swedish company Pharmacia. Anneke Worst stayed with Pharmacia as Technical Director but was subsequently removed by the Swedish board. That was a dramatic turn of events in her life, but it gave her the drive and inspiration to found OPHTEC in 1983. This she did with an associate from Pharmacia and a group of former Medical Workshop employees, who left Pharmacia to join the new company. OPHTEC became successful too. Anneke Worst remained Managing Director of OPHTEC until 2000, when she handed over control to her son Erik Jan. She remained involved in the company, however, and could often be found in her office into advanced old age. Anneke Worst-van Dam was 91.

Prof. Dr Tetz, ARTISAN Ambassador 2019

New Manager Director, Germany; Michael Frevel

Every year OPHTEC’s President & CEO Erik Jan Worst hands out the ARTISAN Ambassador Award to an ophthalmologist who endorses and promotes the iris fixation concept. The award is made at the annual ESCRS congress. In Paris it was Professor Tetz from Berlin who received the honour. He has been implanting ARTISAN lenses for over twenty years. His preference for the ARTISAN family over other lenses that are available on the market is firmly based on research and studies, which he is happy to talk about, for example on the training courses that he regularly organises at his clinic.

“Nowadays only innovative exceptional products with added value have the opportunity to play a major role in our industry. OPHTEC offers IOLs with outstanding optical properties that suit key needs of surgeons and patients. The goal is to have ‘spectacle –free’ vision after cataract surgery and we will be adding more premium products to continuing achieving and improving that goal. I trust in the family values of OPHTEC and its employees. They are motivating and encouraging me to accept this wonderful challenge as managing director.”

Erik Jan thanked Professor Tetz for his dedication and the inspirational way in which he passes on his knowledge of the lenses to new generations of ophthalmologists.

Enrique Márquez

New Managing Director, Spain; Enrique Márquez “It’s an honor for me to join a company such as OPHTEC, inspired by the legacy of Prof. Jan Worst, where innovation and R&D are the company drivers. Ophtec listens to the opinion of ophthalmic professionals and surgeons in order to develop their products and that makes a difference I believe.”

More OPHTEC News: You can find an interview with Professor Dr Tetz at www.ophtec.com

OphTheRecord 2020/2021

Michael Frevel (r) and his team

www.ophtec.com

OPHTEC | Trauma Surgery

Iris Prosthesis From OPHTEC, by Reper-NN

> 1200 COLOURS Before designing the Artificial Iris, we studied over 150 variations of human iris patterns. This helped us to implement technology that allows to reconstruct any pattern using colour. Surgeons can select one of 300 existing designs to match the patient’s fellow eye. In cases where a more tailored approach is required, our specialists can design a custom iris pattern.

> ACRYLIC HYDROPHOBIC MATERIAL

> Main features & benefits

P Fully customized colours P Foldable P Small Incision P Acrylic Hydrophobic Material

To create this foldable artificial iris prosthesis we use the same material as we’ve been using for the past 20 years in our IOLs. This is the only artificial iris manufactured from acrylic which provides it with outstanding biostability and biocompatibility parameters.

> SPECIFICATIONS Optic Type IOL Powers

C1, F1

C0, F0

Biconvex

Hole

+0,5 to +40D

(steps of 0.5D)

Optic / Haptic Material

Hydrophobic acrylic copolymer

Density

1.12 g/cm3

Refraction Index

1.5

Diameter Optic

3.5 mm

Diameter Total

Model C 13.5 mm Model F 10.0 mm

Thickness Haptic Part

0.2 mm

Thickness Optic

1D = 0.466 mm 20D = 0.750 mm

Haptic Angle

0˚

Recommended Incison Size

Injector-assisted 3.5 mm

A-constant Model C1:

119.4

A-Constant Model F1:

119.8

> DESIGN A variety of Artificial Iris models is available to fit a wide range of your clinical needs. The Artificial lens can be selected to have a built-in lens to provide optical correction, if necessary. Multiple haptic design combinations were developed to provide you with better cosmetic outcomes and more efficient ways to conduct procedures.

Manufactured by Reper-NN

OphTheRecord 2020/2021

OPHTEC | Cataract Surgery

CTF optic designed for:

PRESBYOPIA CORRECTION REINVENTED Prepupillary

www.ophtec.com

P NATURAL VISION AT ALL DISTANCES P REDUCING GLARE & HALOS P TOLERANT TO THE KAPPA ANGLE PRetropupillary DECENTRATION TOLERANCE