1. Outcomes Update for an Aspheric Accommodating IOL John A. Hovanesian, M.D. Clinical Instructor, UCLA Jules Stein Eye Institute Harvard Eye Associates, Laguna Hills, California Consultant to: Allergan (1, 3) Abbott Medical Optics (1) Baxter (1) Bausch & Lomb (1, 2) Diopter, Inc. (1) Essex Woodlands (1) Glaukos (1, 2) IOP (1, 2) Inspire (1) Ista (1, 2, 3) Ivantis (1) Ocular Therapeutix (1, 2, 3) Kurtis Eyewear, (1) ReVision Optics (1) Sirion Therapeutics (1) Vistakon (1) Vista Research (1) 1 = consulting fees, 2 = research support, 3 = equity interest

2. Hovanesian, 2008 Hovanesian 2011 Crystalens: How it Works Primary Force: Ciliary Muscle Accommodation causes the ciliary muscles to contract, displacing the vitreous mass & forcing the lens forward

3. Hovanesian, 2008 Hovanesian 2011 Crystalens: How it Works Secondary Force: Optic Arching Capsular contraction slightly distorts the optic as it is forced anteriorly, changing the radius of the lens Distance Near Δ 2.50 D

4. Hovanesian, 2008 Hovanesian 2011 Crystalens AO Accommodating IOL Aberration-free optic design Maintains depth of focus of spherical IOL Improves contrast sensitivity over spherical IOLs Aspheric surface on anterior and posterior surfaces Less sensitive to decentration

5. Hovanesian, 2008 Hovanesian 2011 Effect of SA on Image Quality Spherical aberration degrades retinal image quality. Reduces contrast sensitivity and low-contrast visual acuity High-contrast visual acuity usually not affected Creates halos SA = 0 SA = +0.45 mm 20/40 Letter E

6. Hovanesian, 2008 Hovanesian 2011 Crystalens AO Outcomes Data Collection Uncorrected distance (UCDVA) and near (UCNVA) visual acuities entered into SurgiVision ® DataLink IOL Registry Data from: Our site: all eyes with data entered Global data: all Crystalens AO eyes entered into database Data from 1 and 3 month postoperative visits

7. Hovanesian, 2008 Hovanesian 2011 Mean Postoperative Refraction Our ResultsGlobal Results* Postop Visit NMean MRSE (D) ± SDN 1 Month39-0.36 ± 0.472779-0.27 ± 0.59 3 Months17-0.32 ± 0.471182-0.29 ± 0.61 *Global Results from SurgiVision® DataLink IOL Registry

8. Hovanesian, 2008 Hovanesian 2011 Our Results: Monocular UCDVA

9. Hovanesian, 2008 Hovanesian 2011 Our Results: Monocular UCNVA

10. Hovanesian, 2008 Hovanesian 2011 One Month Results Summary Our ResultsGlobal Results* Postop Visit N %20/25 or better %20/40 or better N %20/25 or better %20/40 or better UCDVA4457%91%322852%85% UCIVANA 286674%93% UCNVA3269%97%282539%82% *Global Results from SurgiVision® DataLink IOL Registry

11. Hovanesian, 2008 Hovanesian 2011 Conclusion Crystalens AO provides acceptable distance vision and functional near vision. Predictable outcomes: Mean MRSE within 0.5 D of plano in both groups

12. Hovanesian, 2008 Thank you! John A. Hovanesian, M.D. Laguna Beach, California jhovanesian@harvardeye.com