1. Outcomes after WIOL – CF accommodative intraocular lens implantation Institute of Vision and Optics University of Crete School of Medicine Heraklion, Crete Greece Ioannis G. Pallikaris MD, PhD, Dimitra M. Portaliou MD

2. WIOL – CF Accommodative IOL Lens characteristics were selected to secure adequate contact with the biggest part of the posterior capsule but not alteration of the capsule shape. Large continuous aspheric optics assures lens centricity and reduces reflections and halos that can cause night vision problems. Large continuous aspheric optics assures lens centricity and reduces reflections and halos that can cause night vision problems. The lens design is intended to provide up to 2.0 diopters of“pheudoaccommodation” capability facilitating near vision. WIOL – CF geometry

3. WIOL – CF Material features and benefits The WIOL - CF accommodative design is based on the The WIOL - CF accommodative design is based on the biomimetic principle – imitation of the crystalline lens. biomimetic principle – imitation of the crystalline lens. Large diameter, no haptics, hydro gel material used, high water content (41%) and lens geometry simulate some of the key properties of the crystalline lens itself. Advantages: No decentration problems (lens is self – centered after impantation), no haptics complications Advantages: No decentration problems (lens is self – centered after impantation), no haptics complications

4. WIOL – CF Features and benefits Continuous sharp edge Smooth gradual transition between central and peripheral optics Aspheric hyperboloid optics Full disc configuration Less optical complications, optimum vision quality

5. WIOL- CF change of focus via lens deformation due to the action of natural focusing apparatus (cilliary muscle and zonules): F2F2 F1F1

6. WIOL – CF can be inserted through a 2.8mm incision. WIOL – CF can be inserted through a 2.8mm incision. Once the lens is inserted, it unfolds inside the capsule and gradually hydrates by the fluid present in the eye. Complete hydration is succeeded within the first 48 hours and full equilibrium with the eye fluids is achieved.

7. Materials and Methods 25 patients (50 eyes) Mean age: 65, 3 ± 8,4 years (range from 53to 83 years) 12 male, 13 female All patients underwent routine cataract surgery and WIOL – CF accommodative intraocular lens implantation. Mean follow up 11,44 ± 2,46 months (range from 9 to 17 months)

8. Exclusion Criteria Astigmatism higher than 1.25 diopters Pre-existing ocular history corneal endothelial disease, abnormal cornea, macular degeneration, retinal degeneration, glaucoma, and chronic drug miosis. Previous refractive surgery Retinal conditions or predisposition to retinal conditions, previous history of/or predisposition to: retinal detachment or proliferative diabetic retinopathy. Amblyopia Clinically severe corneal dystrophy (e.g., Fuchs') Extremely shallow anterior chamber Recurrent anterior or posterior segment inflammation of unknown etiology, or any disease producing an inflammatory reaction in the eye (e.g. iritis or uveitis). Aniridia Optic nerve atrophy Trauma Trauma

9. Implantation

10. Safety No eye has lost lines of CDVA at 1 year postoperatively 88% of patients gained ≥ 1 lines of CDVA

11. Decimal CDVA Mean±SD [Range] Decimal UDVA Mean±SD [Range] 0.61 ± 0.190.31±0.17 [0.2 to 1][CF to 0.7] Decimal CDVA Mean±SD [Range] Decimal UDVA Mean±SD [Range] 0.82±0.130.74±019 [0.4 to 1][0.2 to 1] PREOP POSTOP

12. Stability 0.00 LogMar equals at 1.00 decimal Visual Acuity

13. Uncorrected Near Visual Acuity 72% of our patients had J2 or better, at one year postoperatively, measured with Birkhauser reading charts at a distance of 33cm under photopic conditions.

14. Uncorrected Intermediate Visual Acuity 72% of our patients had J2 or better, at one year postoperatively, measured with Birkhauser reading charts at a distance of 66cm under photopic conditions.

15. Natural Accommodation NEARNEAR FARFAR DIF.MAPDIF.MAP

16. FAR NEAR Mean diff. -1.18D Max diff -7.20D Max -3.53D Range 9.35D Pseudoaccommodation assessed with the iTrace

17. NEAR FAR Mean diff. -1.00D Max diff -3.66D Max -4.84D Range 6.55D

18. Higher Order Aberrations

19. Contrast Sensitivity at 1 year postoperatively

20. Innovation Peripheral capsule reconstruction ring and accommodative IOL (WIOL - CF) implantation Intraoperative photos

21. Conclusions In our patient series all patients obtained some level of accommodation which remained stable throughout the follow – up period. WIOL – CF can be considered a very promising alternative solution for patients that lead an active life and require good vision near, intermediate and far. In our patient series all patients obtained some level of accommodation which remained stable throughout the follow – up period. No complications occurred intra or postoperatively No complications occurred intra or postoperatively. Larger series of patients and longer follow-up is necessary in order to confirm the encouraging results

22. Thank you for your attention Thank you for your attention

23. Cornea and corneal refractive surgery module February 6 – 10, 2012 Lugano, Switzerland www.esaso.ch