1. Mike P. Holzer, MD Annett Mannsfeld, MSc Angela Ehmer, MSc Gerd U. Auffarth, MD mike.holzer@med.uni-heidelberg.dewww.lasik-hd.de International Vision Correction Research Centre Dept. of Ophthalmology, University of Heidelberg, Germany Acting chairman: G.U. Auffarth, MD Corneal changes following INTRACOR femtosecond laser treatment Study and research has been supported by Technolas Perfect Vision GmbH, Heidelberg, Germany

2. Femtosecond Laser: Femtec Mike P. Holzer, MD Femtec (Technolas Perfect Vision GmbH, Heidelberg, Germany) CE mark FDA 510k clearance 40 kHz FEMTEC fixation of eye: Curved patient interface  less stress on cornea  less suction pressure

3. INTRACOR Purely intrastromal refractive treatment with Femtec Laser No cut of epithelium, Bowman‘s or Descemet No incision, pockets etc. Cut design and stromal depth algorithm depending on refractive error Duration approx. 20 seconds Mike P. Holzer, MD

4. Patients & Methods Ongoing prospective, multicenter study Approval of Ethics Committee (Univ. of Heidelberg) Intrastromal correction of presbyopia 25 patients treated between July & Sept. 2008 Age 56.2 ± 5.79 years (range 47 – 67 years) Up to 6 months postoperative follow up Minimum near add +2.0 D Non dominant eye treated Mike P. Holzer, MD

5. 4 days preop INTRACOR Presbyopia Mike P. Holzer, MD 4 days preop 1 hour postop 1 week postop 1 hour postop Cavitation gas in ring cuts 1 day postop Gas escaped from cornea

6. Development near UCVA Mike P. Holzer, MD 0.7 = 20/100 0.26 = 20/30 n=25 n=24 * p < 0.01 Friedman-Test * DCNVA: 0.23 ± 0.08 logMAR

7. Development near UCVA Mike P. Holzer, MD preop 3M postop

8. Near and distance visual acuity Distance correction preop 3M postop Sphere +0.75 D ± 0.23 D+0.15 ± 0.31 D Cylinder -0.33 D ± 0.17 D -0.42 ± 0.23 D preopD1W1M1M3 UCDVA 0.11 ± 0.110.09 ± 0.100.06 ± 0.080.06 ± 0.090.05 ± 0.10 BCDVA -0.06 ± 0.06na -0.02 ± 0.060.00 ± 0.07 UCNVA 0.70 ± 0.160.39 ± 0.250.39 ± 0.220.36 ± 0.180.26 ± 0.21 DCNVA 0.59 ± 0.12na 0.33 ± 0.170.23 ± 0.18 BCNVA -0.04 ± 0.08na 0.01 ± 0.10-0.03 ± 0.07 Mike P. Holzer, MD

9. Pentacam pre- / 3M postop: Exp. 1 Mike P. Holzer, MD Preop3M postop central steepening

10. Pentacam pre- / 3M postop: Exp. 2 Mike P. Holzer, MD Preop3M postop central steepening

11. Corneal asphericity Mike P. Holzer, MD pre anterior pre posterior 1M anterior 1M posterior 3M anterior 3M posterior Mean value -0.20-0.34-0.25-0.43-0.26-0.41 Std. Dev.0.16 0.18 Q-value (6.0 mm)  Q-value more negative following INTRACOR treatment

12. Summary: INTRACOR High potential for correction of presbyopia Non invasive  very low risk for infections Stable refractive outcome during follow up period Significant gain in uncorrected near visual acuity Slight central steepening and negative q-value No weakening of cornea Future treatments: low myopia / hyperopia / astigmatism, retreatments of remaining refractive errors following IOL- or Excimer Laser Surgery Mike P. Holzer, MD