*Center for Excellence in Eyecare Open-Label Evaluation of Degree of Accommodation in Pseudophakic Patients With Bilateral Monofocal Intraocular Lenses Daniel R. Neal, PhD** Pinar Haytac* **Employees of Abbott Medical Optics William Trattler, MD* *Center for Excellence in Eyecare Miami, FL Measurements Wavefront Refraction Pupil size 6 readings per second 1

Financial Disclosure: William Trattler: Consultant/Research Funding &/OR Speaking Honoraria: AMO, Lenstec, Wavetec Pinar Haytac: No Disclosures Daniel R. Neal, PhD: Employee of Abbott Medical Optics

30 yr old phakic patient 6 D of accommodation measured on COAS wavefront aberrometer 3/18/2009 14:06 Phakic OS 13 13.2 4/19/1978 30 12 second video showing wavefront aberrometry with COAS 0-4 seconds: Distance target 5-8 seconds: Near Target 9-12 seconds: Distance Target Presentation Title:Quantitative measurement of accommodation in pseudo-phakic eyes with a wavefront aberrometer 2009/04/06

Phakic accommodation follows normal age curve, and is reproducible All Phakic Eyes We excluded data where the pupil did not respond to the accommodating stimulous. Usually this was indicative that the subject either couldn’t see the target, or didn’t attempt to focus on it. N = 27 eyes Age range 22-51 Spherical Equivalent: -4.25 to +5.00 When spherical aberration is subtracted Reproducibility improves 8 eyes were measured 5 times each The SA contribution amounts to about 17%

Total Accommodation Total Accommodation – SA Spherical Aberration Subtracted from Total Accommodation Phakic A A Pseudophakes Pseudophakes Pseudophakes Pseudophakes Pseudo-phakic eyes show very little evidence of objective accommodation Total Accommodation (D) Total Accommodation (D) – SA Contribution Crystalens Crystalens Crystalens HD Crystalens HD Tetraflex Tetraflex Total accommodation is large on young phakics and a few pseudophakics. When SA is subtracted, no true focus changes occur on pseudophakics. 5

89 year old with Crystalens HD 12 Second Evaluation with COAS wavefront aberrometer 12/16/2008 11:32 Crystalens HD520 OD 20 20.1 5/21/1920 89 Total Accommodation Accommodation w/o SA 12 second video showing wavefront aberrometry with COAS 0-4 seconds: Distance target 5-8 seconds: Near Target 9-12 seconds: Distance Target When Spherical aberration is subtracted from the wavefront, there is little change in refraction during accommodation Accommodation for this 89 year old pseudophakic is predominantly due to the spherical aberration contribution. Presentation Title:Quantitative measurement of accommodation in pseudo-phakic eyes with a wavefront aberrometer 2009/04/06

Central 3mm of 43 year old Crystalens 5.0 patient Refraction change during attempted accommodation is related to pupil size -More SA in central OZ PATIENT RF, OD Male 43 YO SA: Mypopic shift, but reduced quality of Vision

Conclusions Objective accommodation can be measured accurately with a dynamic wavefront aberrometer Initial analysis found minimal objective accommodation in pseudo-phakic subjects Pseudo-accommodation: Spherical Aberration: Mypopic shift, but at the expense of quality of vision