Oph The Record 2019 by OPHTEC

Published by OPHTEC BV /// Edition 2019 / 2020 /// #14

PRECIZON™ PRESBYOPIC SPECIFICATIONS & EXPERIENCES

ARTISAN® APHAKIA’S MAGICAL MYSTERY TOUR

PLUS

Dr. Moon

about RingJect and why he he Prof. Dr Tetz The Practice routinely implants a CTR during Augentagesklinik Meet Group PCIOLSpreebogen, implantation Berlin OphtAlliance, France Interview

Interview

Dr Yi-Tau Ho

About the use of capsular tension rings Interview

Dr Moon, Hyun Seung Gang Nam First Eye Clinic & Precizon Presbyopic; a perfect match Interview

www.ophtec.com

Content

4. A perfect match Gang Nam First Eye Center & Precizon Presbyopic OPHTEC’s Precizon Presbyopic IOL has been used at Gang Nam First Eye Clinic since it became available in 2018. Dr Moon tells us why the clinic and the IOL are a great match.

8. Artisan Aphakia’s Magical Mystery tour

10. Professor Dr Tetz interview

The Artisan Aphakia lens has a remarkable track record; it is 41 years old and still alive and kicking. the lens received CE marking for this retropupillary fixation method another milestone in its long history. A retrospective.

In the heart of Berlin, on the Spree river, is the ‘Augentagesklinik Spreebogen’ eye clinic. This is the domain of Professor Dr Manfred Tetz. For over 20 years, the Artisan lens has been implanted here and Professor Tetz tells why.

Meet OPHTEC at the congresses below 14 -18 September

Paris

France

ESCRS

25 - 28 September

Madrid

Spain

SEO

3 - 5 October

Kyoto

Japan

APACRS

12 - 15 October

San Francisco

USA

AAO

1 - 3 November

Seoul

Korea

KOS

13 - 15 February 2020

Mainz

Germany

DGII

21 - 23 February 2020

Marrakech

Morocco

ESCRS Winter Meeting

24 - 28 March

Düsseldorf

Germany

AAD

1 - 3 April 2020

Groningen

The Netherlands

NOG

9 - 12 May 2020

Paris

France

SFO

6 - 10 June 2020

Boston

USA

ASCRS

18 - 20 June 2020

Nürnberg

Germany

DOC

9 - 12 July 2020

Singapore

APACRS

3 - 7 October 2020

Amsterdam

The Netherlands

ESCRS

ArtiLens Training Courses 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

Founder OPHTEC 90 years

Mrs. Anneke Worst - van Dam, founder of OPHTEC BV, celebrated her 90th birthday in December

Colofon OphTheRecord is published by OPHTEC BV Text & Interviews: Roelien den Besten E-mail: r.den.besten@ophtec.com Graphic design: www.mennoschreuder.nl Print: Scholma Druk, Bedum All rights reserved. © OPHTEC BV 2019 | P.O. Box 398, 9700 AJ Groningen T: +31 50 5251944 | F: +31 50 5254386 | www.ophtec.com

Content 3

14. The Practice: Meet Group OphtAlliance

16. Dr Yi-Tau Ho CTR & RingJect interview

18. Precizon Presbyopic Specifications

OphtAlliance is a medical group of 47 ophthalmologists located in western France, in the Pays de Loire region. Interview with Marie-Sylvie Sander, Director OphtAlliance.

Dr Ho is the chairman of B&B Eye Center in Taiwan. We asked him why it is important to use a Capsular Tension Ring (CTR) routinely with every cataract surgery and why he likes OPHTECâ&#x20AC;&#x2122;s Ringject CTR inserter.

The Precizon IOL Family offers the opportunity to choose the best IOL model for your patients. When you treat cataract patients with presbyopia, you can choose between the Precizon Presbyopic model and the Precizon Presbyopic NVA model. Both make use of the CTF technology.

CTF optic designed for: P NATURAL VISION AT ALL DISTANCES P REDUCING GLARE & HALOS

PRESBYOPIA CORRECTION REINVENTED

P PUPIL INDEPENDENCE P DECENTRATION TOLERANCE

Gang Nam First Eye Clinic & Precizon Presbyopic IOL

A perfect match An interview with Dr Moon, Hyun Seung

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Fred Wassenburg

dr. Ramón Ruiz Mesa

In 2017 Dr Moon, Hyun Seung opened his own ophthalmic clinic, Gang Nam First Eye Clinic, 10 years after his career as ophthalmologist started. Located in Seoul’s Gangnam area, one of the city’s most affluent, dynamic, and influential areas, the clinic became a success almost immediately. Dr Moon’s professionalism, high standard of excellence and his good business mind, together with the clinic’s excellent location and good market conditions, assure this success. OPHTEC’s Precizon Presbyopic IOL has been used in the clinic since it became available in 2018. Gang Nam First Eye Clinic and Precizon Presbyopic are a perfect match. Dr Moon tells us why.

Can you tell us about your career and Gang Nam First Eye Clinic? Dr Moon: ‘After I became an ophthalmologist in 2007, I started my career as an army surgeon for three years. After that, I completed a fellowship course as a medical specialist of cataract surgery at Gachon University Gil Medical Center in 2010. From 2011, I have extended my surgical experience by working in several private clinics. In 2017, I started my own clinic, Gang Nam First Eye Clinic. It opened in May of that year. Gang Nam First Eye Clinic offers various ophthalmic treatments such as refractive laser surgery (SMILE, PRK, LASIK), refractive intraocular lens implantation (Artiflex and posterior phakic IOLs) and multifocal cataract surgery. We use advanced laser surgery devices such as VisuMax, Amaris 1050RS and LENSAR. I performed my first operation with a three-piece monofocal IOL in 2005. Since then, I have taken more than 10,000 cases using various multifocal and toric IOLs.

In 2014, I started performing surgeries by using FLACS (femtosecond laser assisted cataract surgery). For the first three years I used AMO’s Catalys for these laser assisted surgeries, since Gang Nam First Eye Clinic opened, I work with LENSAR’ When and why did you start implanting Precizon Presbyopic? ‘I started with Precizon Presbyopic in October 2018. It is a refractive type multifocal IOL, which has its strong points: 1. Good contrast sensitivity; 2. Relatively low impact from IOL decentration; 3. Proven IOL material and safety of the platform; 4. Expectation of a release of a toric version in the near future.’ How are the outcomes? ‘Since October 2018, Precizon Presbyopic has been used in more than 450 cases. Patient feedback shows high satisfaction for far, intermediate and near vision in >>

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everyday life. Photopic phenomenon occurs remarkably less than with other refractive type segmental multifocal IOLs. So it can be concluded that patients adapt much easier to this IOL.’ About patient selection; what is the ideal candidate for this lens? ‘Basically, the ophthalmic examination should show no abnormalities. The most important thing, however, is the patient’s need. Since multifocal intraocular lenses do not restore accommodation completely, it is important to explain this to them in detail, for them to have realistic expectations. Precizon Presbyopic comes closest to a monofocal IOL, therefore I believe this lens is suitable for patients who need a good contrast sensitivity for outdoor activities and driving, for instance.’

OphTheRecord ESCRS 2019

Over time, patients’ demands for refractive cataract surgery will expand and become more common”

According to you, what will cataract surgery be like in 10 years? ‘As the average life span of people grows, expectations for good vision are also increasing in old age. Over time, patients’ demands for refractive cataract surgery will expand and become more common. Additionally, there will be more and more post-refractive surgery cataract patients. In order to meet their expectations, multifocal intraocular lenses will have to evolve. I am expecting accommodative intraocular lenses for clinical use to be released on the market within 10 years. Development of more accurate biometry formulas and measuring devices is required due to the growing number of cataract patients with a history of refractive surgery. The use of a piggyback IOL as a complementary method will increase. Surgeons should prepare for these changes.’

OPHTEC | Cataract Surgery

COMPREHENSIVE PLATFORM MANAGEMENT ASTIGMATISM

If you want to go fast, travel alone. If you want to get far, travel in company African Proverb

OphTheRecord ESCRS 2019

Artisan Aphakia’s Magical Mystery Tour OPHTEC’s Artisan Aphakia lens has a remarkable track record; it is 41 years old and still alive and kicking. It evolved from a cataract lens from the ICCE era through a role as back-up lens during the period of phacoemulsification and folding lenses to a lens that increasingly plays the lead in zonulopathy and one that is used in vitreoretinal surgery. Is there any lens that can come close to the Artisan Aphakia? On top of that, the lens slowly found its way from the front of the iris to the back to retropupillary fixation. Recently, the lens received CE marking for this retropupillary method - another milestone in its long history. The invention “Necessity is the mother of invention” is an expression that Jan Worst often used when he talked about his invention of the Iris claw lens, as the Artisan Aphakia was

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known in the early days. That necessity existed in the rural Pakistani hospital he visited in the 1970s. He saw poor farmers come for a lens extraction from all over the area and then saw them leave without any form of correction. Glasses were too expensive and inconvenient for those people and the implant lenses available at that time were too time-consuming to implant on a large scale. These people needed a simple and effective solution, and that is what he produced. The Artisan Aphakia was born out of necessity. Back in Groningen, Jan refined the model and started to use the lens in the Netherlands. In 1997 the lens design was modified once more. The lens configuration was made convex to create more space between the lens and the iris and the format of the haptics changed a little to make enclavation easier. Besides the original format (5/8.5), two smaller sizes

were added (4.4/6.5 and 4.4/7.5). The lens became a success and found its way around the world. Retropupillary method As far we know, Dr Andreas Mohr (Bremen), was the first to use the lens as a retropupillary implant. He turned the lens around, pushed it through the pupil behind the iris and enclaved it by pushing claws from the top of the iris tissue. He started this in 1998 - during the pre Vacufix period - because he thought that fixation at the front of the iris was difficult in a soft eye following a vitrectomy, and he discovered that it was easier with a retropupillary procedure. He also concluded that this procedure was much faster than the traditional method. He made a film of the retropupillary implant, promoted it during a conference in the US and the method became popular. Initially in Germany, but subsequently in the rest of the world.

CE marking for retropupillary fixation

Retropupillary fixation of an Artisan Aphakia lens

Back to front OPHTEC followed the developments around retropupillary fixation with interest. As fixation at the front had long proven its safety and effectiveness, there was no need to certify and promote this new method. Furthermore, the Vacufix had been invented to make enclaving at the front easier. Doctors who preferred the retropupillary method were using it already anyway. However, views change and 20 years later OPHTEC was granted CE marking for the retropupillary fixation method. This method has now been added officially to the IFU, and is included in the training programme.

Preferences Studies have demonstrated that both methods are safe and effective. Sometimes there are reasons for using one method rather than the other for a specific eye, but otherwise it’s about the surgeon’s preference. The proponents of the traditional method prefer to have the lens properly visible at the front of the iris and often quote the large amount of evidence for the safety and effectiveness of this method. The fans of the retropupillary method prefer the lens to be invisible behind the iris, a position that matches the anatomical position of the natural lens. They list easier and faster fixation as the benefits.

A presentation by Dr Andreas Mohr about retropupillary fixation can be found on OPHTEC’s YouTube channel (Scan QR code below)

Either way, the lens continues to be popular. The wet labs and training courses are full of new generations of ophthalmologists who want to learn to implant the lens, and from now on that also includes the retropupillary method.

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Interview with

Professor Dr Manfred Tetz

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In the heart of Berlin, on the Spree river, close to the city

centres of former East and West Berlin, is the ‘Augentagesklinik Spreebogen’ eye clinic. This is the domain of Prof. Manfred Tetz. From this clinic and two annexes, together with three other ophthalmologists, he offers a large number of treatments that include Artisan and Artiflex lens implantations. For years now his preference has gone to these lenses, in both the phakic and the aphakic variant, over other models in the market. This preference is solidly based on research and studies. Training courses are regularly organised at the ‘Augentagesklinik Sprebogen’, as Prof. Tetz not only implants the lenses but also enthusiastically shares his immense knowledge and experience with Artisan and Artiflex. An interview:

Can you describe your clinic? Prof. Tetz: ‘My Berlin clinic is at a beautiful central location in the city. It is close to the Kurfürstendamm and the Tiergarten, five minutes from the central train station and 15 minutes from the Tegel airport. Good accessibility is important because not only locals but also patients from all over Germany and abroad come here for treatment. My wife and I designed the clinic and came up with the procedures. The connecting thread was, what do we like in a clinic when we go to the doctor. For example, I detest large waiting rooms or people sitting in hallways. So you will not find that here. We aim to have a manageable and well-maintained clinic without the feel of a hospital. There are two other locations in addition to the Berlin clinic: Lutherstadt Wittenberg and Bitterfeld. I also have a space for my Berlin Eye Research Institute, where I am involved in clinical studies. Because I didn’t stop thinking after I left the university.’ What treatments can patients come to you for? ‘I am a traditional full-blooded eye surgeon with a lot of experience. People can come to the clinic for a wide variety of treatments. I focus on the anterior segment, but not exclusively. I do keratoplasty and glaucoma, and I am an expert in canaloplasty. Patients come to Berlin for these procedures from all over the world. We also do a lot of refraction work, 50 percent laser and 50 percent lenses. We do all kinds of lenses: phakic lenses, lenses for refractive lens exchange, as well as standard cataract lenses.

In recent years we have also treated many trauma patients from war zones, for example, explosion victims from Libya. To summarize, you could say that we do everything except whatever does not belong in an outpatient setting, such as vitreoretinal surgery.’

I’ve been using the Artisan lens for more than 20 years for different goals” In 2003 you decided to stop with your work at the university and start your own clinic – why did you take this step? ‘In 1998 I came to Berlin for a position at Charité, a renowned hospital and the largest university hospital in Europe. Ophthalmology changed in the years that I worked there. An increasing number of ophthalmological treatments were being performed on an outpatient basis at private clinics, so ophthalmology departments at hospitals shrank, merged or were altogether eliminated. I had seen this trend begin years earlier in the United States when I was studying there. In 2003 I decided not to

stay behind, to look ahead to the future and go with the trend. This is why I started my own clinic.’ You have been using Artisan and Artiflex lenses for years – can you tell us why? ‘I have been using the Artisan lens for over 20 years for many purposes, and Artisan and Artiflex for refraction surgery for over 15 years. I have implanted a considerable number of phakic lenses. And I will tell you why: Early on in my studies, I spent two years in the United States, thanks to a special scholarship I was eligible for, the Feodor Lynen scholarship, part of the Humboldt Foundation. For the research I did in the United States I went to the David J. Apple Laboratory, an ophthalmology research lab that focused on IOL-related pathology. I worked on chamber angle-fixated lenses. I saw thousands of histological sections of eyes with chamber lenses that had been removed for medical or other reasons. The problems were clear: chronic inflammations, erosion of the loops in the ciliary body with chronic lymphatic tissue infiltration. None of these eyes, not even the so-called autopsy eyes, eyes that had accepted lenses, were free of inflammation. That opened my eyes in an early stage of my career: the chamber angle is the wrong place to fixate a lens. The major problem is the size of the lens. If the lens is too big, the tissue against which the lens is supported begins to erode, resulting in chronic inflammation. If the lens is too small and moves, that movement can cause inflammatory reactions.

OphTheRecord ESCRS 2019

My conclusion: an IOL should never be fixated in the area of the moving ciliary body - not in the anterior chamber and not in the posterior chamber. Those were lenses with a diameter of 14 mm, which is too large for the anterior segment. That has changed now, but we still see that sizing remains an important problem with such lenses.

Live surgery during an ArtiLens training course at Augentagesklinik Spreebogen

At that time I also saw some pathologies and autopsies of eyes with Artisan lenses. The lens was only fixated to the iris at two points and no inflammation was visible, not even at the site where the lens was fixated. The eyes were calm. Iris fluorescein angiography subsequently showed that there was no extravasation of fluid at the fixation site either, which could be a sign of damaged vessels. For me, it became clear: the only way to attach a lens to an eye in the absence of capsular support or as an addition to a natural lens is iris fixation. That was never a question for me. Sometimes I explain it to my patients, and then I say: “Imagine a wall to which you want to hang a picture. The picture must cover the entire wall exactly. If you make the slightest mistake when measuring, the picture will be just too big or just too small, and it will not fit. You can also make the picture a lot smaller and hang it on part of the wall. The picture will then never be too big or too small. And that is exactly what we have with the Artisan and Artiflex lenses.” The 8.5-mm lens is considerably smaller than the anterior segment, so it never touches the tissue of the chamber angle or the tissue in the region of the ciliary body where a muscle moves. In the last 25 years a lot of different models of phakic chamber angle-fixated lenses have been introduced to the market, but they have all disappeared. Not a single one survived because they all had the same problem: sizing, pupil ovalisation, inflammatory reactions or endothelial cell loss. The only other lens that survived is a posterior chamber lens, in fact, a truncated contact lens, the ICL. This lens clamps between the iris and the natural lens. The risk of developing cataracts with this lens, at least in the models leading up to the current model, is between 4 and 17 percent in published studies. There are even studies that mention a percentage of 30 to 40 percent. But I find that even a chance of 4 percent, or cataracts in a 25-year-old, is too high, and that is the reason why I only use Artisan or Artiflex for phakic eyes. My percentages for cataracts are very close

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to zero percent. Sometimes I see a sort of nuclear sclerosis after 15 to 17 years, but in a 57-year-old person who has worn lenses for 17 years the nuclear sclerosis could have also developed because of the high myopia, you just don’t know. Cataracts can develop sooner with high myopia. To sum it up: of all the different models of phakic lenses that have been introduced only two remain, the lenses of the Artisan and Artiflex family and the ICL. For me personally, if I compare the two, Artisan and Artiflex have better safety records.’ Who do you consider eligible for a phakic Artisan or Artiflex lens? ‘Many clients come here and have been told at a laser institute that they are not eligible for laser treatment and are looking for another option. Hyperopes from +4 and hard myopes from 8 or 10 and higher, that is the first group. The second group is made of clients with an average myopia of 3, 4 with a type of keratoconus. I tell them that laser treatment would be dangerous for their cornea and that a phakic lens is a safer solution. The third group has problems with the corneal thickness and is therefore not eligible for laser treatment, but is eligible for a lens.

And then you have another group with one eye eligible for laser but not the other. For instance, one eye is 5 and the other 10. There are a couple of options for those people. One is a combination of laser and lens. I have dealt with that decision about ten times. It is a very interesting group because after everything has healed and all is behind them, you can ask them which is now their better eye in terms of healing and everything related to it. Only they can say something about that difference between laser and lens. The answer? So far no one from that group chose laser. Everyone preferred the eye with the lens. It is of course only a small group, but I find the outcome very interesting.’ In what cases do you use the Artisan Aphakia lens? ‘I use the Artisan Aphakia lens for aphakic eyes that have little capsular support and as a secondary lens. More than 10 years ago I stopped attaching posterior chamber lenses when there was insufficient capsular support. For these cases, I use the Artisan Aphakia lens and prefer retropupillary fixation, because there seems to be slightly less lens movement and it appears to be slightly better, optically speaking. Of course, not all these eyes have perfect vision after treatment because of macular problems or problems caused by trauma, previous surgery or anything else.

Reception of Augentagesklinik Spreebogen

I also do what you could call ‘crazy stuff’. I treat patients without an iris, traumatised eyes and eyes with complete aniridia. I have a handful of patients on whom I have implanted an artificial iris with an Artisan lens attached to it. This is very rewarding work because those patients had an eye that was hardly being used due to the aniridia. After the operation, they have an eye out of which they can see and which also looks normal on the outside. If I do one or two of these treatments in one year, I’m happy the whole year. These are exceptions and often long operations, but they are worth it.’ Once or twice a year you give Artilens trainings in collaboration with OPHTEC – how do you go about it? ‘Most of the time there are one or two participants interested in the implantation of phakic lenses. They are mostly more experienced surgeons that want to add the technique to their arsenal. Phakic implantations need practice; you need to develop a feel for it because the challenge lies in not making any mistakes in a phakic eye that could cause cataracts or endothelial cell loss. The largest group wants to know what you should do in complicated cases or how you do a good secondary implant. I always look at the needs of the participants.

The course is set up for both groups, but in recent years I have focused more on how to perform a good anterior vitrectomy and how to place a secondary implant there because there is more of a need for that knowledge in daily practice.’

One option is a combination of laser and lens. Very interesting, because when everything is healed and behind them, you can ask which is now their better eye”

In addition to your life as an ophthalmologist, do you have time for other things? What do you do in your free time? ‘I am very interested in a lot of different things, but unfortunately, my free time is limited. Of course, my family is very important, they come in the first place. My whole life I have been involved with rescue dogs, giving shelter to stray dogs and adoption dogs. Right now I have five of them at home, and on weekends I like to take them to the woods. My wife and I also try to make a small contribution to a better world. We support national and international good causes, including a small village in Brazil, and paying for the education of a child in India. Little drops on the hot stones’.

The next ArtiLens training course at Augentagesklinik Spreebogen will be held on 25-26 October 2019 (in German).

OphTheRecord ESCRS 2019

Meet

Group OphtAlliance France

Operating room

Can you describe OphtAlliance and explain how it is organized? ‘OphtAlliance is a medical group of 47 ophthalmologists located in western France, in the Pays de Loire region. Our objective is to provide comprehensive and quality eye care combining a network of 13 offices situated in the departments of Loire-Atlantique and Vendée and a top-level medical expertise. Some of our doctors practice general ophthalmology while others have one or more subspecialities. Our areas of expertise are glaucoma, corneal diseases, cataract and refractive surgery, vitreo-retinal diseases, neuro-ophthalmology, ocular imaging, electrophysiologic testing and low vision services. For premium lenses, we have a complete range of topographs, which allows us to use a wide range of IOLs. We were one of the first teams to use OPHTEC’s Precizon Toric lens in France, for which we use the Cassini topograph and

OphTheRecord ESCRS 2019

A unique alliance of 47 ophthalmologists and 13 practices with the aim to provide comprehensive and high-quality eye care with top-level medical expertise. This alliance can be found in the Pays de Loire region of France. Meet the OphtAlliance group. Interview with Marie-Sylvie Sander, director OphtAlliance

Rezé OphtAlliance center

also the Casia for posterior astigmatism. Next to that, OphtAlliance was the first clinic in France to start with OPHTEC’s Precizon Presbyopic IOLs last year. All centers are organized to provide the best eye care for its surrounding population. Each office has technical facilities to perform at least OCT scans, visual field testing, specular microscopy, corneal topography and laser treatments. Physicians are assisted by a staff of orthoptists who obtain medical history, perform refractive examination and diagnostic tests. All procedures performed in the office,like intravitreal injections, are assisted by nurses. Each location has its own office manager whereas support services like human resources, accountability, quality policy, communication, biomedical and computer departments are centralized. In addition, we have built a partnership with a public hospital to provide surgical treatment for patients in the rural area of Redon.

Guérande OphtAlliance center reception (Loire-Atlantique)

Surgeries are performed in the main center, located in Nantes, in the Clinique Jules Verne. This location is currently being expanded and will be re-opened soon as ‘Institut Ophtalmologique de l’Ouest Jules Verne’ with an outpatient department of 3000 m2 as well as a large surgical unit composed of 6 operating rooms, an area entirely dedicated to refractive surgery and 2 rooms for small surgeries. We also have plans to further develop our additional activities. We want to strengthen our partnership with pharmaceutical laboratories in the field of clinical trials. We also intend to develop CME activities.’ New ophthalmologists joined the group last July (news on your website). Can you explain OphtAlliance success? ‘There are several key points to explain the success of OphtAlliance. The first one is that the 47 doctors are not only associates, they are also partners in a unique medical team dedicated to their patients.

Examination room (Centre Vision Jules Verne - Clinique Jules Verne)

Cassini >

Hauts Pavés 88 center reception

Insight of the future ‘Institut Ophtalmologique de l’Ouest Jules Verne’ (located at the Clinique Jules Verne in Nantes)

Map of our 13 offices

Subspecialists doctors are organized as a team in each department. They do not only have their own patients, they are at the service of all general ophthalmologists of the group. With a shared medical records, they can easily give expert medical advice to a colleague in a distant area. This means that all patients have quick access to medical expertise, regardless of the clinic or doctor they visit.

A third key is a strong group dynamic that manifests itself by scientific communications and numerous publications as well as innovation projects regarding both therapeutics and organization.

A second key point is a great level of solidarity between associates that allows for example to maintain a high-standard of medical equipment in all centers. When he created OphtAlliance with five associates in 2005, dr J.M. Bosc not only had a lot of experience with task delegation to orthoptists and a realistic vision of the evolution of medical demography, he had also understood the importance of providing pleasant working conditions for all doctors in all areas. Because of this solidarity, we can also help ophthalmologists to provide unprofitable services like low vision.

What are the plans for the future, will you continue to grow? ‘We have several strategic priorities for the future. The first one is to develop ‘l’Institut Ophtalmologique de l’Ouest Jules Verne’ and make it the first private ophthalmologic center in France in both eye care, research and ophthalmological education. The second priority is to reinforce our network and build partnerships with ophthalmologists in other regions in France. The third is to go for innovation both in ophthalmic therapeutics as well as eye care management like telemedicine.’

FRANCE

PARIS 1

All that is reflected in our values RISE, which means Respect, Innovation, Solidarity and Excellence.’

Located on the Atlantic coast of France, the Loire Atlantique department (1) is the most populated region of Pays de la Loire with 1.4 million inhabitants. Although the agglomeration in Nantes has different eye clinics, there were large areas without eye care services in the peripheral areas before OphtAlliance came. The Vendée department (2) is less populated (680,000 inhabitants), more rural and less equipped with ophthalmic services.

www.ophtalliance.fr

OphTheRecord ESCRS 2019

Dr Yi-Tau Ho, Taiwan about the use of capsular tension rings

Dr Yi-Tau Ho’s versatile and impressive career started in 1979. During his 40 years in ophthalmology, he has also initiated medical conferences and clubs, directed societies and ophthalmic departments, and worked voluntarily for the prevention of blindness. Currently Dr Ho is Chairman of B&B (Bright & Beauty) Eye Center in Taipei, which has an ophthalmological and an ophthalmic cosmetic department. The ophthalmological department is leading in the field of premium cataract surgery, including FLAC (Femtosecond Laser Assisted Cataract Surgery) and premium IOL implantation, and multifocal IOL implantation. B&B is also renowned for its anterior segment surgery: Lasik and Artisan/Artiflex lens implantations. We asked Dr Ho why it is important to use a Capsular Tension Ring (CTR) routinely with every cataract surgery and why he likes OPHTEC’s Ringject CTR inserter.

OphTheRecord ESCRS 2019

When and why do you use a CTR during cataract IOL implantation? Dr Ho: ‘I implant a posterior chamber IOL (PCIOL) together with a CTR every time, whether I’m implanting a monofocal, toric or multifocal IOL. Misalignment of the IOL, together with tilt and decentration, is a very common complication, even after uneventful implantations. About 10% of the eyes suffer a > 0.5 mm decentration and > 5º tilt after an uneventful PCIOL implantation and > 1.0 mm decentration and > 5º tilt optically impairs visual quality. Routinely, implanting a PCIOL together with a CTR assures me that a well centered IOL will stay centered. My patients are very happy with their vision after surgery.’ You use OPHTEC’s RingJect to insert the CTR; can you tell us why you like this device? ‘The long, 2.4 mm diameter tip enables me to release the CTR in the middle of my microscope’s visual field; this lets me direct the CTR to where I want it and release it just below my CCC flap, to ensure the CTR is in the bag.’

How Important is a CTR in cases of weak zonules? ‘In cases of asymmetric zonular weakness, the implanted IOL may shift away from the weakened area, toward the intact zonular fibers. Implantation of a CTR can distribute forces around the equator in these situations, resulting in an improved centration of the IOL. However, the diameter of the CTR should be larger than that of the capsular bag, which, through resulting centrifugal force, expands the capsular equator and provides an equal distribution of force over the entire capsular circumference.’ How do you identify zonulopathy? Pre-operative assessment with a slit lamp: • Dialate the pupil maximally and examine with a slit-lamp; • Lens phacodonesis is graded from +1 to +4; • Lens decentration: examine the lens edge, by swinging the slit-lamp all the way to the opposite side of the lens; • Zonular dehiscence is documented in clock hours and the lens edge shape is noted. At the conclusion of a slit lamp examination, recline the patient on the examination

RingJect

™

Preloaded Capsular Tension Ring in a single use injector

I use a capsular tension ring routinely during every PCIOL implantation”

chair and examine the lens with a light source, such as an indirect ophthalmoscope, for any degree of posterior movement toward the vitreous cavity.

Prepositioned and self-loading CTR.

Beveled tip for easy entry through the incision.

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

Intraoperative assessment of zonular weakness is based on lens movement at the start of capsulorhexis. If the lens has moved more than 0.2 mm, a CTR is indicated.’ In which cases of compromised zonular support is a combination of an in the bag IOL + CTR not the right option? What do you do in these cases? ‘When lens movement is in excess of 0.4 mm at the start of capsulorhexis, that combination is not the best option. In such a case I prefer to implant an iris fixated Artisan Aphakia IOL because of its long term stability and very low complication rate.’ According to you, what will cataract surgery be like in 10 years? ‘I don’t have a crystal ball, but I hope one day we can just take a pill that will stop or cure cataract formation.’

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.

Optimal position of the rosettefor maximum control.

FDA approved

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.

IOL centration at 12 months postop • Centered 97.70% 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 ESCRS 2019

Specifications The Precizon IOL Family offers you the opportunity to choose the best model for your patients. When you treat cataract patients with presbyopia, you can choose between the Precizon Presbyopic model and the Precizon Presbyopic NVA model. Both models make use of the CTF technology. The main differences remain in the segment sizes, light distribution for far and near, and in the IOL aberrations.

PHYSICAL CHARACTERISTICS Model Optic type

PRECIZON PRESBYOPIC 570 A0 Precizon Presbyopic One piece IOL Aberration neutral Continuous Transitional Focus (CTF) optic

0.5 / 2.0 mm

Central far zone size Y/X

Presbyopic Model Cataract patients for whom an excellent depth of field is critical are better suited to a neutral aberration optic3). Furthermore, some cataract patients have neutral or negative aberrations in the cornea. In these cases aspherical neutral aberration optics are a better fit, as this will avoid overcompensation providing a better vision. Finally, cataract patients who appreciate equal light distribution but have decentred pupils, might also benefit from the 50/50 light distribution and pupil independence of the Precizon Presbyopic model.

First near segment direction (in / out)

inwards

Rotated segments width

0.75 mm

Number of segment rings

UV cut off

<10% @360 nm

Refractive index

1.46

Abbe number

Optic powers

+1.0 D to + 35.0 D (0.5 D increments) Power add +2.75 D.

Haptic configuration Lens material

Open modified C-loops with offset shaped haptics Hybrid hydrophobic & hydrophilic monomers. Ultraviolet filtering HEMA/EOEMA Copolymer

Lens colour

Clear

Body Ø

6.0 mm

Overall Ø

12.5 mm

Haptic angle

0˚

0.8 to 1.3 mm

Centre thickness range Precizon Presbyopic • Key benefits Critical near & intermediate vision

A-constant* Ultrasound

50/50 far / near light distribution Neutral, positive or slightly negative corneal aberrations

0.4 mm

Body edge thickness

A-constant* Optical

* Check www.ophtec.com for up to date A-constants

OphTheRecord ESCRS 2019

PHYSICAL CHARACTERISTICS Model Optic type

PRECIZON PRESBYOPIC NVA 570 A1 Precizon Presbyopic NVA One piece IOL Aberration Negative (- 0.11 μm) Continuous Transitional Focus (CTF) optic

1.4 / 2.6 mm

Central far zone size Y/X First near segment direction (in / out)

outwards

Rotated segments width

0.60 mm

Number of segment rings

UV cut off

<10% @360 nm

Refractive index

1.46

Abbe number

Optic powers

+1.0 D to + 35.0 D (0.5 D increments) Power add +2.75 D.

Haptic configuration Lens material

Open modified C-loops with offset shaped haptics Hybrid hydrophobic & hydrophilic monomers. Ultraviolet filtering HEMA/EOEMA Copolymer

Lens colour

Clear

Body Ø

6.0 mm

Overall Ø

12.5 mm

Haptic angle

0˚

The average human cornea has positive aberrations and you might want to compensate for these with a negative aberration lens like the NVA model. Prior myopic LASIK patients will also benefit from aspherical negative aberration optics3). Furthermore, patients without prior corneal refractive surgery who value image quality may also be better off with a negative aberration lens. Finally, the Precizon Presbyopic NVA is designed to give cataract patients excellent far vision. They benefit from the 60/40 light distribution as the central zone of the lens is enlarged and can go up to a 2.6 mm zone for far vision.

0.8 to 1.3 mm

Centre thickness range Body edge thickness A-constant* Ultrasound

A-constant* Optical

Presbyopic NVA Model

0.4 mm

Precizon Presbyopic NVA • Key benefits

118.0

Excellent quality image & far vision

60/40 far / near light distribution Positive corneal aberrations

* Check www.ophtec.com for up to date A-constants Michelle Dalton , Eyeworld, an ASCRS publication, April 2014 Available at: https://www.eyeworld.org/article-understanding-positive-dysphotopsia Ramón Ruiz Mesa, Tiago Monteiro Continuous Transitional Focus (CTF): A New Concept. Ophthalmology and Therapy. 2018. Available at: https://link.springer.com/article/10.1007/s40123-018-0134-x 3) Dr. Devgan’s Decision Tree. Linda Roach, How to Choose an Aspheric Intraocular Lens. AAO December 2010 Availabe at https://www.aao.org/eyenet/article/how-to-choose-aspheric-intraocular-lens 1)

OphTheRecord ESCRS 2019

Simple, Fast & Versatile ARTISAN® Aphakia Iris Fixation

Prepupillary

www.ophtec.com

Retropupillary