Aspheric Balanced Curve ABC IOL Technology An Enhanced

Aspheric Balanced Curve (ABC) IOL Technology: An Enhanced Aspheric Effect with Better Clinical Outcomes Mitchell A Jackson MD Founder/Director, Jacksoneye Lake Villa, IL USA Dr. Jackson is a consultant for Hoya Surgical

Coma �Asymmetry mistake �If light rays refract slant on a optical surface, you will get a deformation as illustrated Coma

Spherical aberration �Aperture error �Abaxial rays outside of the „Gaußschen territory“ (approx. 5°around the axis) will be refracted stronger optical axis „Gauß territory“

Influence of Aspheric IOL spherical IOL -Good DOF -Worse visual Quality ++ + +++ negative SA IOL ++ - - - Worse DOF - Best Image Quality 00

Spherical aberration & IOLs spheric aberration-free negative SA SA = + SA = 0 SA = - +20. 4 +20. 0 +18. 0 Power increases from center to edge Power is uniform for all areas (B&L, Acritec, Lenstec) Power decreases from center to edge (Alcon, AMO, Acritec, HOYA)

Effect of pupil size on Image Quality is mainly significant with large pupils spherical aspheric Clear image different between both lenses with large pupil

Uday Devgan, MD devgan@ucla. edu Angle Kappa Visual Axis Angle Kappa (2 o to 5 o) Pupillary Axis 0. 36 mm ± 0. 22 Average of 18 studies This slide is © Uday Devgan, MD Fovea Mean displacement between foveal axis and center of pupil of 0. 37 mm + 0. 24 mm Rynders M, Lidkea B, Chisolm W, Thibos LN. J Opt Soc Am A 1995; 12: 2348 -2357.

Devices can measure both pupil size & angle kappa: Hoya i. Trace and Marco OPDIII examples Angle kappa = 0. 72 mm Angle kappa = 0. 62 mm

Power distributions (+20. 0 D) Hoya “Super-prolate” effect 21 Spherical IOL Power (D) 20 HOYA Modified Negative SA IOL 19 Negative SA IOL 18 17 0 1 2 Lens Radial Distance (mm) ABC=Aspheric Balanced Curve - design 3

Effect of Decentration on Contrast Optimum settings for a standard aspheric IOL Hoya’s original settings (under the condition of Z 40 = 0. 27) 1 0. 8 Contrast 0. 6 0. 4 Spheric Aspheric HOYA 0. 2 0 Decentration (mm) Hoya aspheric has better contrast, compared with a standard aspheric. Even at 0. 5 mm decentration, Hoya aspheric has better contrast than a spherical IOL. 0 0. 2 Aperture 4. 0 mm Spatial freq 50 c/mm 0. 4 Decentration (mm) 0. 6

Higher-Order aberrations 0. 35 preoperative postoperative 0. 30 Pupil size: 5 mm 0. 25 0. 20 (RMS µm) FY-60 AD (aspheric IOL) 0. 15 p<0. 005 0. 10 p<0. 05 n. s. 0. 05 0. 00 Spherical aberration Vertical coma Horizontal coma

Aspheric Balance Curve (ABC) IOL Technology �Image Quality is the key to patient satisfaction �Coma & Spherical Aberration are the bad guys �Pupil size is not the only culprit �Beware of angle kappa (especially over 0. 4 mm) �Angle kappa helpful in selecting which aspheric IOL �Hoya AF-1 “super-prolate” enhanced effect is especially advantageous in high angle kappa cases >0. 4 mm �Angle kappa measurements may also be helpful in determining multifocal vs accommodating IOL selection