1 Bimanual Microincision Cataract Surgery with Stellaris Advanced Flow Module Mark Packer, MD, FACS Clinical Associate Professor Oregon Health & Science University Consultant-Advanced Medical Optics, Inc.; Advanced Vision Science, Inc.; Bausch & Lomb, Inc.; Carl Zeiss Meditec, Inc.; Carl Zeiss Surgical GmbH; Celgene Corporation; Gerson Lehman Group, Inc.; Ista Pharmaceuticals, Inc.;i- Therapeutix, Inc.; Johnson & Johnson Vision Care, Inc.; Leerink Swann & Company; Sirion Therapeutics, Inc.; Transcend Medical, Inc.; Visiogen, Inc.; VisionCare, Inc.; WaveTec Vision Systems. Travel & Honoraria: Endo Optiks, Inc Financial Interest: Consultant-Advanced Medical Optics, Inc.; Advanced Vision Science, Inc.; Bausch & Lomb, Inc.; Carl Zeiss Meditec, Inc.; Carl Zeiss Surgical GmbH; Celgene Corporation; Gerson Lehman Group, Inc.; Ista Pharmaceuticals, Inc.;i- Therapeutix, Inc.; Johnson & Johnson Vision Care, Inc.; Leerink Swann & Company; Sirion Therapeutics, Inc.; Transcend Medical, Inc.; Visiogen, Inc.; VisionCare, Inc.; WaveTec Vision Systems. Travel & Honoraria: Endo Optiks, Inc

2 Purpose  To assess facility of use, safety and efficacy of the Stellaris Vision Enhancement System for bimanual microincision cataract surgery

3 Method  30 unselected eyes of 26 patients presented for cataract surgery  Pre-existing pathology other than cataract Pseudoexfoliation glaucoma1 Pseudoexfoliation glaucoma1 Strabismus/amblyopia2 Strabismus/amblyopia2 Epiretinal membrane2 Epiretinal membrane2 Pigment dispersion syndrome1 Pigment dispersion syndrome1  Previous ocular surgery S/P LASIK4 S/P LASIK4

4 Patient Profile  13 women, 13 men  Mean age 64.2 ± 8.3 years  Mean nucleus NS

5 Technique  Bimanual microincision cataract surgery Temporal clear corneal incisions, 1.4 mm Temporal clear corneal incisions, 1.4 mm Trapezoidal diamond bladeTrapezoidal diamond blade 20 g irrigating chopper, 30º straight phaco tip 20 g irrigating chopper, 30º straight phaco tip LRIs performed prior to IOL insertion LRIs performed prior to IOL insertion 90% depth, 10 mm OZ, Nichamin nomogram90% depth, 10 mm OZ, Nichamin nomogram IOL implanted via 3rd incision, 2.2 – 2.8 mm IOL implanted via 3rd incision, 2.2 – 2.8 mm

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7 Machine Parameters PhacoPhaco IA Cortex IA Viscoelasti c Removal Vit ChopFlipIABI/COAX Hi speed Regular(pneum) Power% 20 Linear (waveform not enabled) 20 Linear Cut rate: 1500 cpm Cut rate: 600 cpm Mode 30 pps Fixed burst Duration: 10 msec Interval: 30 msec (yaw to turn cutter on/off) Duty cycle % 3025 Vac (yaw for max) linear 500 fixed 150 linear 150 linear Flow NA 30 fixed NA30 fixed 25 fixed Vacuumresponse 22 Bottle ht / In programs Linear vac ACF Fixed flow Linear vac Linear flow Fixed vac

8 IOL Selection & Astigmatism  40% Presbyopia correcting IOLs 45% ReZoom 45% ReZoom 36% crystalens 36% crystalens 18% ReStor 18% ReStor  53% Cornea customized aspheric IOLs 56%Tecnis 56%Tecnis 25% IQ 25% IQ 19% AO 19% AO  30% Limbal relaxing incisions

9 Intra-Op Outcomes  Mean surgery time start to end = 19.7 ± 5.5 min  Mean effective phaco time = 0.77 ± 1.58 sec  Average phaco power = 2.04 ± 2.25 %

10 Post-Op Outcomes  20/30 mean uncorrected acuity 2 – 24 hours post-op Excluding eyes with pre-existing pathology and prior surgery Excluding eyes with pre-existing pathology and prior surgery 75% 20/40 or better 63% 20/30 or better 53% 20/25 or better 32% 20/20 or better 75% 20/40 or better 63% 20/30 or better 53% 20/25 or better 32% 20/20 or better  No complications  No complications

11 Summary  30 consecutive eyes operated with the Stellaris,10/4/07 to 2/14/08.  Mean age 64 years.  Average nucleus 1.4+ NS.  Average nucleus 1.4+ NS.  40% had presbyopia correcting IOLs (45% ReZoom, 36% crystalens, 18% ReStor)  30% had LRIs  53% has corneal-customized aspheric IOLs (56%Tecnis, 25% IQ, 19% AO)  53% has corneal-customized aspheric IOLs (56%Tecnis, 25% IQ, 19% AO)

12 Conclusion  Stellaris with advanced flow module is efficient, safe and effective for bimanual microincision cataract surgery