1. W. Andrew Maxwell, MD, PhD Rob Gray, PhD Disclosures: This study was funded by Alcon Research, Ltd, which also assisted with the preparation of these slides.

2.  Purpose Assess the impact of glare in pseudophakic patients implanted with blue light filtering intraocular lenses  Study Design Two groups of subjects Study group: Previously implanted (unilaterally or bilaterally) with AcrySof Natural (SN60AT) Control group: Previously implanted (unilaterally or bilaterally) with AcrySof IOL (SA60AT) Groups identical with the exception of blue-light filtering technology Eligible subjects also had… Best Corrected Distance Visual Acuity better than -0.18 logMAR (20/30) A valid driver’s license at the time of participation in the study 2

3. ParameterStudy Group: Blue light filtering IOL Control Group: Clear IOL Sample size (Men, Women) 17 (6 Men, 11 Women) 17 (8 men, 9 Women) Age71.6 ± 8.6 yrs72.7 ± 9.9 yrs Duration of Pseudophakia (Range) 69.14 ± 9.82 months (44 - 77 months) 68.81 ± 8.93 months (55- 85 months) 3 No statistically significant difference between study and control group for any of the above parameters At 2 clinical sites, a total of 34 subjects provided driving performance measures.

4.  3 Components: Steering wheel, Pedals and three 19” LCD monitors positioned side by side  Driving performance in this simulator has been shown to correlate well with real-world driving in previous studies 4

5.  Subjects performed left turn maneuvers in front of an oncoming car  Measures repeated with a glare source (150 lux) positioned at an angle of 20 degrees above simulated road  Monocular testing and subjects were best corrected for test conditions 5

6.  NUMBER OF COLLISIONS – Describes the number of times (percentage) the participants car collided with the oncoming car.  INTERSECTION APPROACH SPEED – Speed at which the participants car approached the intersection  LANE POSITION VARIANCE – Describes the variance in the position of the participants car when driving straight ahead on a lane 6

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9.  In no-glare conditions, no statistically significant difference was noted between study and control groups.  In the presence of glare, patients in the study group demonstrated significantly lower number of collisions with the on-coming car compared to controls  Within group effects showed control group had significantly more collisions in the presence of glare compared to no-glare conditions. 9

10. 10 Patients in the study group were significantly less impacted by glare as they approached the intersection compared to controls

11. StudyControlp value Glare 0.107±0.1260.076±0.0560.391 No Glare 0.144±0.2260.103±0.0610.469 Glare - No Glare 0.037±0.1080.028±0.0270.644 11 Deviations (variance) about a mean lane position (expressed in meters) were not significantly different between control and study groups

12.  Key finding: Compared to eyes with control IOLs, the patients with blue-filtering IOLs demonstrated a significantly better safe driving performance.  Proposed mechanism: The image of the oncoming car in the eye was dynamically changing (increasing in size) thereby creating a sensation of motion-in-depth. The light entering the eye from the glare source resulted in forward retinal scatter causing a reduction in the retinal image contrast. This resulted in misjudging (overestimating) the time taken by the car to reach the intersection causing unsafe left turns. Blue-filtering IOLs reduced glare, improved retinal image contrast and allowed a more accurate estimation of the oncoming car and this resulted in safe driving performance.  Real-world applications: Analogous situations could occur under day-time driving conditions (e.g. when driving towards the sun during sun-set). By improving disability glare, blue light filtering technology provide an improvement in driving performance as demonstrated in this study. Read more at:  Gray R, Perkins SA, Suryakumar R, Neuman B, Maxwell WA. Reduced effect of glare disability on driving performance in patients with blue light–filtering intraocular lenses J Cataract Refract Surg 2011;37:38-44  Hammond BR, Renzi LM, Sachak S, Brint SF. Contralateral comparison of blue-filtering and non-blue-filtering intraocular lenses: glare disability, heterochromatic contrast, and photostress recovery. Clin Ophthalmol. 2010;4:1465-1473 12