Evaluation Of The Tetraflex and Crystalens Accommodative IOLs Using the iTrace Aberrometer Donald R. Sanders, M.D., PhD. David C. Brown M.D. Deepak Chitkara, M.B., ChB. D.O.

DIFFERENCE Normal Accommodation – 30 Y/O Refraction Map Refraction MapNEARDISTANCENEAR

Normal Accommodation 3D Refraction Map (Tilted) DIFFERENCE NEARDISTANCE

Normal Accommodation 3D Refraction Map (Vertical) DIFFERENCE NEARDISTANCE

DISTANCE Mean = +0.4D 1.2DRefractive Range Range Hyperopia Hyperopia Myopia

Normal Accommodation 3D Refraction Map (Vertical) NEAR Mean = -4.2D 3.5DRefractiveRange

Normal Accommodation 3D Refraction Map (Vertical) DIFFERENCE Mean = -4.75D 2.4D Refractive Range

With Normal Accommodation and Near Focus - Refraction shifts to More Myopia - Refractive Range Increases

Monofocal IOL 3D Refraction Map (Vertical) DIFFERENCE NEARDISTANCE

DIFFERENCE No Refractive Difference 0.6D Refractive RefractiveRange

MONOFOCAL 33 cm. DISTANCE ACCOMMODATIVE EFFORT NO DIFFERENCE IN PSF

MONOFOCAL Image Simulation 33 cm. DISTANCE ACCOMMODATIVE EFFORT NO DIFFERENCE IN IMAGE

Pupil Size Same for Distance & Near DIFFERENCE NEAR DISTANCE

DIFFERENCE NEAR DISTANCE

Tetraflex in Other Eye 3D Refraction Map DIFFERENCE NEARDISTANCE

DISTANCE Mean = +1.6D 4.1DRefractive Range Range +2.8D -1.3D

Tetraflex in Other Eye 3D Refraction Map NEAR Mean = +1.1D 8.6DRefractiveRange +3.8D -4.8D

Tetraflex in Other Eye 3D Refraction Map DIFFERENCE Mean = -0.4D 5.5DRefractive Range Range +1.1D -4.5D

TETRAFLEX 33 cm. DISTANCE ACCOMMODATIVE EFFORT SUBSTANTIAL CHANGE IN PSF

TETRAFLEX Image Simulation 33 cm. DISTANCE ACCOMMODATIVE EFFORT SUBSTANTIAL IMPROVEMENT IN NEAR

Tetraflex Accommodative IOL 3D Refraction Map DIFFERENCE NEARDISTANCE

DISTANCE Mean =+1.3D 1.9DRefractive Range Range 2.1D 0.2D

Tetraflex Accommodative IOL 3D Refraction Map NEAR Mean = +1.2D 5DRefractive Range Range 2.6D -2.4D

Tetraflex Accommodative IOL 3D Refraction Map DIFFERENCE Mean = 0.1D 4.2DRefractiveRange 1.4D -2.8D

Tetraflex Accommodative IOL 3D Refraction Map DIFFERENCE NEARDISTANCE-3.8D -5.5D -5.2D Widened Refractive Range and More Myopia at Near and in Difference Map

Tetraflex Accommodative IOL 3D Refraction Map DIFFERENCE NEARDISTANCE-3.5D -5.2D -3.1D Widened Refractive Range and More Myopia at Near and in Difference Map

Tetraflex Accommodative IOL 3D Refraction Map DIFFERENCE NEARDISTANCE-0.6D -1.4D -2.1D Widened Refractive Range and More Myopia at Near and in Difference Map

Summary The Tetraflex Accommodative IOL is associated with a widened refractive range and more myopia with near fixation, which can explain the enhanced near acuity compared to monofocal IOLs.

Patient AB – OD Crystalens 3D Refraction Map DIFFERENCE NEAR DISTANCE-3.5D -3.5D

Patient GB – OD Crystalens 3D Refraction Map DIFFERENCE NEAR DISTANCE-2.3D

Patient GB – OS Crystalens 3D Refraction Map DIFFERENCE NEAR DISTANCE

Patient RC – OD Crystalens 3D Refraction Map DIFFERENCE NEAR DISTANCE-2.3D -2.8D

Patient DB – OD Crystalens 3D Refraction Map DIFFERENCE NEAR DISTANCE

Patient DB – OS Crystalens 3D Refraction Map DIFFERENCE NEAR DISTANCE

Patient GF – OD Crystalens 3D Refraction Map DIFFERENCE NEAR DISTANCE-1.3D -1.4D

Patient PS – OS Crystalens 3D Refraction Map DIFFERENCE NEAR DISTANCE -2.5D -2.5D

Patient ER – OD Crystalens 3D Refraction Map DIFFERENCE NEAR DISTANCE

Patient ER – OS Crystalens 3D Refraction Map DIFFERENCE NEAR DISTANCE

Patient BV – OD Crystalens 3D Refraction Map DIFFERENCE NEAR DISTANCE

Patient MA – OS Crystalens 3D Refraction Map DIFFERENCE NEAR DISTANCE

Summary The Crystalens Accommodative IOL is associated with a widened refractive range and more myopia with near fixation in some cases. In others no clear accommodative effect is obvious