1. Presbyopia CT Zyoptix Hyperopia Advanced (Rochester) Nomogram Scott MacRae MD Professor of Ophthalmology Professor of Visual Science University of Rochester The author of this poster have received consultant, research, and travel reimbursement from Bausch & Lomb.

2. Presbyopia CT Advanced (Rochester) Nomogram Rochester Nomogram (Univ. of Rochester) –1. Uses preoperative manifest refraction Spherical Equivalent, J0 (astigmatic), and J45 (astigmatic) NOT wavefront refraction sphere Why? Because manifest refraction is gold standard of refractive aberrations measures & it enhanced our predictability –2. Compensates for aberration interactions Preoperative coma, trefoil and spherical aberration subtly affect postop sphere Optical convolution Myopia degree & astigmatism coupling compensated –3. Treatment sphere based on Individual eye parameters NOT a constant surgeon offset

3. Presbyopia CT Aberration Interactions: Cause Sphere Overcorrection & Undercorrection 1. Aberration interaction between preop 3 rd & 4 th order (coma, trefoil & spherical aberration) with postop sphere and cylinder causing overcorrection and undercorrection 2. Aberration Interaction Hyperopic overcorrection noted with >5 laser platforms:  A. Bausch and Lomb (current studies)  B. Alcon: Myopic Retreatment eyes with + spherical aberration tend to get hyperopic overcorrection (Two studies: #1 D. Durrie JRS 2005, #2 G.S. Schwartz JCRS 2005) #3 Krueger AAO 07  C. Nidek: Hyperopic Overcorrections with Myopic Retreatments: O. Kermani ESCRS 2006  D. VISX: Hyperopic Overcorrections with Myopic Retreatments: E. Manche  E. Wavelight: Hyperopic Overcorrection with high + SA

4. Presbyopia CT Zyoptix Hyperopia: Results w/ Advanced Nomogram ParameterPreoperative (149 eyes) 6-month PT (143 eyes) 12-month PT (145 eyes) AN (108% base nomogram) (149 eyes) MRSE (D)+2.22-0.02+0.11+0.00 SD (D)1.060.530.520.23 Min (D)+0.38-1.63-1.25-0.56 Max(D)+4.88+1.75+1.25+0.75 MRSE within ±0.25 D N/A55.2% (79/143) 51.7% (75/145) 71.8% (107/149) MRSE within ±0.50 D N/A75.5% (108/143) 68.3% (99/145) 96.0% (143/149) MRSE within ±1.00 D N/A93.0% (133/143) 96.6% (140/145) 100% (149/149)

5. Presbyopia CT Custom Hyperopia Predictability with Advanced (Rochester) Nomogram Without Advanced Nomogram: 34/145 (23.4%) eyes had postop undercorrection (hyperopia > 0.50 D) w/o Advanced Nomogram 12/145 (8.3%) eyes had postop overcorrection (myopia > 0.50 D) With Application of Advanced (Rochester) Nomogram: 5/149 (3.4%) eyes would have postop undercorrection (hyperopia > 0.50 D) 1/149 (0.7%)eyes would have postop overcorrection (myopia > 0.50 D)

6. Presbyopia CT Advanced (Rochester) Nomogram for Zyoptix Myopia Global cohort data (24 sites, 478 eyes in 2008) –preop MRSE: -4.19 ± 1.88 D (up to -10 D) –1M MRSE: 0.03 ± 0.37 D –MRSE within ± 0.25D : 74% –MRSE within ± 0. 50D : 91% US data (8 sites, 118 eyes in 2008) –preop MRSE: -3.55 ± 1.40 D (up to -7 D) –1M MRSE: -0.04 ± 0.27 D –MRSE within ± 0.25D : 77% –MRSE within ± 0. 50D : 97%

7. Presbyopia CT Zyoptix Hyperopia w/ Advanced (Rochester) Nomogram Zyoptix Hyperopia offers good safety and effectiveness Enhanced outcomes with use of Advanced Nomogram –Same nomogram for both myopia and hyperopia correction –96% + 0.50 D Customized Hyperopia –97% + 0.50 D Customized Myopia –Results are excellent in LASIK Surgery with Advanced Nomogram

8. Presbyopia CT Hyperopic Customized Treatment Using Advanced (Rochester) Nomogram Aberration Interaction is important in enhancing predictability of sphere and cylinder outcomes for both myopic and hyperopic customized correction The use of manifest refraction also enhances the predictability of postoperative sphere and cylinder

9. Presbyopia CT