1. Use of Multifocal IOLs in Patients with Age-Related Macular Degeneration Helga P. Sandoval, MD, MSCR 1 Reid B. Murphy, MD, 1 Luis E. Fernández de Castro, MD, 1 Kerry D Solomon, MD 1 1 Magill Research Center for Vision Correction, Storm Eye Institute, Medical University of South Carolina, Charleston, SC, USA

2. Financial Disclosure Helga P. Sandoval & Luis E. Fernández de Castro: –Alcon Laboratories, Inc. - D –Allergan, Inc. - D –Advanced Medical Optics - D Reid B. Murphy: None Kerry D. Solomon: –Alcon Laboratories, Inc. - A,C,D –Allergan, Inc. - A,C,D –Advanced Medical Optics - A,C,D –Advanced Medical Research - A,C,D –Bausch & Lomb, Incorporated - A,C,D –InSite Vision, Inc. - A,C,D –Eyemaginations - A,C,D

3. Background Age-related macular degeneration (ARMD) is the most common cause of visual loss in adults 50 years or older in the U.S.Age-related macular degeneration (ARMD) is the most common cause of visual loss in adults 50 years or older in the U.S. The most common complaint of these patients is their inability to read.The most common complaint of these patients is their inability to read. Current visual aids available for advanced ARMD include external devices –Often cosmetically & functionally unacceptable

4. Background AcrySof ReSTOR ® IOL –Uses apodized, diffractive technology to provide near, intermediate, and distance vision –Provides approximately 4.00 D of near add in the plane of the IOL –Improves uncorrected near vision in normal eyes

5. Background Using ReSTOR ® & creating myopic shift could improve near vision:Using ReSTOR ® & creating myopic shift could improve near vision: –Georgaras - Greece –Gayton & Mackool – 2 sites in U.S. Inducing Myopia in AMD –Image minification, may allow patients to have a better near visual field –Smaller, brighter image is easier to see than larger, dimmer one (e.g., stand magnifier)

6. Purpose To evaluate a potential method for improving near visual function and quality of life in patients with advanced AMD.To evaluate a potential method for improving near visual function and quality of life in patients with advanced AMD.

7. Methods A prospective series of patients with cataract and AMD (dry form or stable scarring)A prospective series of patients with cataract and AMD (dry form or stable scarring) –BCVA between 20/50 and 20/400 Phacoemulsification followed by off-label implantation of the ReSTOR ® SN60D3 IOLPhacoemulsification followed by off-label implantation of the ReSTOR ® SN60D3 IOL IOL power selected for target postoperative refraction of -3.00IOL power selected for target postoperative refraction of -3.00 National Eye Institute Visual Function Questionnaire (VFQ-25)National Eye Institute Visual Function Questionnaire (VFQ-25)

8. Demographics to date 7 subjects7 subjects Mean age 80.4 ±4.1 (Range 74 – 85)Mean age 80.4 ±4.1 (Range 74 – 85) GenderGender –4 ♀ –3 ♂ Mean Visual Acuity 20/160 -1 ± 1 letter (Range 20/80 – 20/250)Mean Visual Acuity 20/160 -1 ± 1 letter (Range 20/80 – 20/250) Refraction SphCylSE Preop -0.39 ±2.52 (-4.25 – +3.25) 0.71 ±0.47 (0.25 – 1.50) -0.04 ±2.56 (-4.13 – +3.00) Postop -3.75 ±0.63 (-4.50 – -2.50) 0.07 ±0.19 (0.00 – 0.50) -3.21 ±0.55 (-4.25 – -2.50)

9. ReSTOR ® in AMD Uncorrected Near Visual Acuity at Best Distance Net Change in Lines of Visual Acuity Mean = 3.2 Lines Gained

10. ReSTOR ® in AMD Best-corrected Near Visual Acuity at Best Distance Net Change in Lines of Visual Acuity Mean = 2.9 Lines Gained

11. VFQ-25 Average Change From Preop to Postop General Vision-Increased 27.14 ± 20.18 Near Vision Activities-Increased 18.52 ± 15.18 Distance Vision Activities-Increased 2.86 ± 16.04 Social Functioning Limitations-Decreased* 8.33 ± 16.67 Mental Health-Increased* 15.00 ± 22.91 Role Limitations due to Vision-Decreased* 4.17 ± 28.18 Dependency on others due to Vision- Decreased* 8.33 ± 15.73 Color Vision – Increased* 33.33 ± 28.87 Peripheral Vision Limitations-Decreased* 16.67 ± 14.43 Scale 0-100 * Data available for only 3 subjects preoperatively

12. Conclusions Largest gains in uncorrected and best corrected Near visual acuity.Largest gains in uncorrected and best corrected Near visual acuity. The ReSTOR ® IOL is a promising option to enhance quality of life in patients with AMD.The ReSTOR ® IOL is a promising option to enhance quality of life in patients with AMD. Enrollment of additional patients is continuing.Enrollment of additional patients is continuing.