1. Evaluation Of The Tetraflex and Crystalens Accommodative IOLs Using the iTrace Aberrometer Donald R. Sanders, M.D., PhD. David C. Brown M.D. Deepak Chitkara, M.B., ChB. D.O.

2. DIFFERENCE Normal Accommodation – 30 Y/O Refraction Map Refraction MapNEARDISTANCENEAR

3. Normal Accommodation 3D Refraction Map (Tilted) DIFFERENCE NEARDISTANCE

4. Normal Accommodation 3D Refraction Map (Vertical) DIFFERENCE NEARDISTANCE

5. DISTANCE Mean = +0.4D 1.2DRefractive Range Range Hyperopia Hyperopia Myopia

6. Normal Accommodation 3D Refraction Map (Vertical) NEAR Mean = -4.2D 3.5DRefractiveRange

7. Normal Accommodation 3D Refraction Map (Vertical) DIFFERENCE Mean = -4.75D 2.4D Refractive Range

8. With Normal Accommodation and Near Focus - Refraction shifts to More Myopia - Refractive Range Increases

9. Monofocal IOL 3D Refraction Map (Vertical) DIFFERENCE NEARDISTANCE

10. DIFFERENCE No Refractive Difference 0.6D Refractive RefractiveRange

11. MONOFOCAL PSF @ 33 cm. DISTANCE ACCOMMODATIVE EFFORT NO DIFFERENCE IN PSF

12. MONOFOCAL Image Simulation View @ 33 cm. DISTANCE ACCOMMODATIVE EFFORT NO DIFFERENCE IN IMAGE

13. Pupil Size Same for Distance & Near DIFFERENCE NEAR DISTANCE

14. DIFFERENCE NEAR DISTANCE

15. Tetraflex in Other Eye 3D Refraction Map DIFFERENCE NEARDISTANCE

16. DISTANCE Mean = +1.6D 4.1DRefractive Range Range +2.8D -1.3D

17. Tetraflex in Other Eye 3D Refraction Map NEAR Mean = +1.1D 8.6DRefractiveRange +3.8D -4.8D

18. Tetraflex in Other Eye 3D Refraction Map DIFFERENCE Mean = -0.4D 5.5DRefractive Range Range +1.1D -4.5D

19. TETRAFLEX PSF @ 33 cm. DISTANCE ACCOMMODATIVE EFFORT SUBSTANTIAL CHANGE IN PSF

20. TETRAFLEX Image Simulation View @ 33 cm. DISTANCE ACCOMMODATIVE EFFORT SUBSTANTIAL IMPROVEMENT IN NEAR

21. Tetraflex Accommodative IOL 3D Refraction Map DIFFERENCE NEARDISTANCE

22. DISTANCE Mean =+1.3D 1.9DRefractive Range Range 2.1D 0.2D

23. Tetraflex Accommodative IOL 3D Refraction Map NEAR Mean = +1.2D 5DRefractive Range Range 2.6D -2.4D

24. Tetraflex Accommodative IOL 3D Refraction Map DIFFERENCE Mean = 0.1D 4.2DRefractiveRange 1.4D -2.8D

25. Tetraflex Accommodative IOL 3D Refraction Map DIFFERENCE NEARDISTANCE-3.8D -5.5D -5.2D Widened Refractive Range and More Myopia at Near and in Difference Map

26. Tetraflex Accommodative IOL 3D Refraction Map DIFFERENCE NEARDISTANCE-3.5D -5.2D -3.1D Widened Refractive Range and More Myopia at Near and in Difference Map

27. Tetraflex Accommodative IOL 3D Refraction Map DIFFERENCE NEARDISTANCE-0.6D -1.4D -2.1D Widened Refractive Range and More Myopia at Near and in Difference Map

28. Summary The Tetraflex Accommodative IOL is associated with a widened refractive range and more myopia with near fixation, which can explain the enhanced near acuity compared to monofocal IOLs.

29. Patient AB – OD Crystalens 3D Refraction Map DIFFERENCE NEAR DISTANCE-3.5D -3.5D

30. Patient GB – OD Crystalens 3D Refraction Map DIFFERENCE NEAR DISTANCE-2.3D

31. Patient GB – OS Crystalens 3D Refraction Map DIFFERENCE NEAR DISTANCE

32. Patient RC – OD Crystalens 3D Refraction Map DIFFERENCE NEAR DISTANCE-2.3D -2.8D

33. Patient DB – OD Crystalens 3D Refraction Map DIFFERENCE NEAR DISTANCE

34. Patient DB – OS Crystalens 3D Refraction Map DIFFERENCE NEAR DISTANCE

35. Patient GF – OD Crystalens 3D Refraction Map DIFFERENCE NEAR DISTANCE-1.3D -1.4D

36. Patient PS – OS Crystalens 3D Refraction Map DIFFERENCE NEAR DISTANCE -2.5D -2.5D

37. Patient ER – OD Crystalens 3D Refraction Map DIFFERENCE NEAR DISTANCE

38. Patient ER – OS Crystalens 3D Refraction Map DIFFERENCE NEAR DISTANCE

39. Patient BV – OD Crystalens 3D Refraction Map DIFFERENCE NEAR DISTANCE

40. Patient MA – OS Crystalens 3D Refraction Map DIFFERENCE NEAR DISTANCE

41. Summary The Crystalens Accommodative IOL is associated with a widened refractive range and more myopia with near fixation in some cases. In others no clear accommodative effect is obvious