1. Multifocal lenses analysis with OQAS system Dr Alfredo Castillo Hospital Quirón Madrid ASCRS 2008. Chicago

2. Visual quality study in multifocal IOLs Multifocal IOLs potential range from near to far The out-of focus image reduce CSF (1) Refractive IOLs more visual disturbances than diffractive IOls Diffractive IOLs designed in aspheric models Analyze the optical quality of Tecnis ZM900 (AMO) vs Acri.LISA 366D (Acri.Tec) using OQAS system Montés-Micó R. Visual performance with multifocal IOL and mesopic contrast sensitivity under distance and near conditions. Ophthalmol 2004;111:85-96

3. Quality of vision measurement Based in double-pass technique Direct registration of diode laser light reflected back off the retina Scatter and higher order aberrations (HOA) are measured Quantitative and qualitative values Accomodation analysis

4. OQAS. Double-pass set up

5. Visual quality study in multifocal IOLs. Material and methods 20 eyes 20 patients in each group Tecnis ZM900Acrilisa 366 P Test Male/Female 8/12 9/11 0.42 (Z test) Age 62.5 (DE 5.9) 64.9 (DE 5.2) 0.122(t Test) Mesopic Pupil Diámeter 5.3 (DE 1.3) 5.2 (DE 1.3) 0.767(t Test)

6. Inclusion criteria Patients with cataract and lens sclerosis Age range 50 - 70 years IOL power: 18 - 25 D Pupil diameter > 3.5 mm in mesopic conditions (Colvard) IOL selection in each patient related to near visual needs, night driving, computers use…

7. Exclusion criteria Corneal Astigmatism > 1.5 D Schrimer Test < 10 mm BUT < 10 sc Ocular disease No ocular medication Systemic diseases (diabetes) Intraoperative complications Detectable post-op capsular opacity Postop BCVA < 0.8

8. Postoperative Results Distance BCVA (Snellen Test)  Tecnis : 0.96 (SD 0.35)  Acrilisa: 0.97 (SD 0.26)  No significant differences p= 0.35 Near BCVA (Reading Test)  Tecnis: 0.97 (DE 0.25)  Acrilisa: 0.95 (DE 0.28)  No significant differences p = 0.36 No significant differences in the post-op sphere (p = 0.21) and cylinder (p = 0.28) in both groups

9. Acri.LISA results GROUP WIDTH_PRO FILE_1/2 WIDTH_PROFI LE_1/10 MTF_CU T_OFF STREHL_ RATIO OQAS_VAL UE_100 OQAS_VAL UE_20 OQAS_V ALUE_9OSI ACRILISAMEAN3,9019,2136,810,201,231,201,171,83 STANDARD DEVIATION1,4510,689,560,050,32 0,290,91 MAX7,2647,9349,480,271,651,751,613,43 MIN2,269,0316,350,110,540,550,570,75

10. Tecnis ZM900 results GRUPO WIDTH_PRO FILE_1/2 WIDTH_PROFI LE_1/10 MTF_CU T_OFF STREHL_ RATIO OQAS_VAL UE_100 OQAS_VAL UE_20 OQAS_V ALUE_9OSI TECNIS ZM900MEAN4,4125,0131,220,181,041,001,012,00 SD 1,1511,338,270,040,280,270,260,74 MAX6,8252,3148,310,271,611,681,563,32 MIN2,8512,0320,590,130,690,67 0,99

11. Tecnis vs Acri.LISA GRUPO TECNIS ZM900ACRILISA RELATED TOMEAN WIDTH_PROFILE_1/2PSF4,413,90 WIDTH_PROFILE_1/10PSF25,0119,21 MTF_CUT_OFFMTF31,2236,81 STREHL_RATIOMTF0,180,20 OQAS_VALUE_100MTF1,041,23 OQAS_VALUE_20MTF1,001,20 OQAS_VALUE_9MTF1,011,17 OSISCATTER2,001,83 T student and Levene Test

12. Results OQAS PSF P=0.255 P=0.125

13. Results OQAS MTF cut-off P=0.07

14. Results OQAS MTF P= 0.07 P= 0.04 P= 0.09

15. Results OQAS scatter P=0.43

16. Tecnis

17. Acri.LISA 366D

18. Tecnis ZM900

19. Acri.LISA 366 D

20. Conclusions OQAS allows objective visual quality mesurements in vivo Tecnis ZM900 and AcriLISA 366 D achieve satisfactory results in the OQAS parameters Acri.LISA obtains slight superior values than Tecnis in MTF,PSF and scatter The unique statistical signifficant difference value was OQAS 20 (=.04)

21. Resultado OQAS agrupado por AV

24. Mejor Acrilisa 366 D

25. Peor Tecnis ZM900

26. Mejor Acrilisa 366 D

27. Peor Tecnis ZM900

28. Tecnis ZM900 LIOs multifocales

29. Acrilisa 366 D LIOs multifocales

30. Principio OQAS

31. Estudio calidad óptica de LIOs multifocales. Técnica operatoria Facoemulsificación coaxial Infinity Vision System (Alcon) Incisión eje más curvo o temporal Tamaño 2,8 mm CCC < 6 mm Pulido capsular Inyector Silver series (AMO) y Acri-Shooter A2-2000 No diferencias significativas en la esfera (p = 0.21) y en el cilindro (p = 0.28) postoperatorio en ambos grupos