ZEISS TRIFOCAL RESULTS WITH THE 839 AND 939 AT-

LISAZeiss user group meeting

18th July 2015Anil Arora

Introduction to my experience with the 839 and 939 and MFIOLs in general

Personal experience – began using the 839MP in November 2012. Have implanted over 200 of these IOLs.

Began using 939MP in November 2013. Have implanted just over 100 of these IOLs.

In the past 2 ½ years have implanted about 600 MFIOLs – 300 of the 839/939, about 60 Alcon ReStor +3 (SN6AD1), about 80 ReStor 2.5 (SV25T0), about 50 B&L FineVision trifocal, about 50 AMO Symfony (ZXR00) and about 30 Oculentis MF15

During the same period I have implanted about 2000 IOLs in total (average about 800 per year), so about 30% of all my IOLs implanted are MFIOLs

Introduction to the study This study/survey is of 192 eyes of 96 patients who have been

bilaterally implanted 64 patients with bilateral 839MP (128 IOLs) 22 patients with bilateral 939MP (44 IOLs) 10 patients with one 839 and one 939 (20 IOLs)

Study involved checking patient’s monocular and binocular unaided VA for three distances: Distance (6metres) Intermediate (80cm) Near (40cm)

Patients were asked to complete a questionnaire on the subjective quality of their unaided vision for these distances before and after surgery, on their need for glasses for these distances before and after surgery, on the incidence and severity of photic phenomena before and after surgery and on whether or not they would use the same IOL again and recommend it to a friend.

Survey typically carried out at 2 weeks after second eye surgery, so not much time for “neuroadaptation”.

Acknowledgement

A big thanks to my orthoptists Jocelyn and Jo for collecting the data and doing the patient surveys.

A big thanks to another one of my orthoptists, Stacy, for data analysis and producing the graphs .

Patient survey Generally given to

patients at about 2 weeks after second eye surgery

Quality of unaided vision graded subjectively from excellent to very poor before and after surgery for distance, intermediate and near

Incidence of halos and glare and spectacle dependency graded never, sometimes or regularly before and after surgery

Binocular distance VA after surgery 839MP

86.44%

13.56%

n=59

6/6 or Better 6/9

Both Eyes Non-ToricDistance Binocular VA After Surgery

51

8

010

20

30

40

50

Num

ber

of

Eye

s

6/6 or Better 6/9

Without GlassesNon-Toric Lenses in Both Eyes

Binocular Distance VA After Surgery

Binocular distance VA after surgery 939 MP

95.45%

4.545%n=22

6/6 or Better 6/9

Both Eyes ToricDistance Binocular VA After Surgery

21

10

510

15

20

Num

ber

of

Patien

ts

6/6 or Better 6/9

Without GlassesToric Lenses in Both Eyes

Binocular Distance VA After Surgery

Overall binocular unaided VA for the 3 groups (bil839, bil939, mix 839/939)

02

46

810

Num

ber o

f Pat

ient

s

6/6 or Better 6/9

One Eye Toric, One Eye Non-Toric LensBinocular Distance VA After Surgery

010

20

30

40

50

Num

ber

of

Patie

nts

6/6 or Better 6/9

Both Eyes Non-Toric LensesBinocular Distance VA After Surgery

05

10

15

20

Num

ber

of

Patie

nts

6/6 or Better 6/9

Both Eyes Toric LensesBinocular Distance VA After Surgery

Monocular distance VA - TOTAL

149

36

7

050

100

150

Num

ber

of

Eye

s

6/6 or Better 6/9 Less Than 6/9

Without GlassesBoth Lens Types, Both Eyes

Monocular Distance VA After Surgery

Monocular distance VA after surgery839 MP

75%

23.44%

1.563%

n=64

6/6 or Better 6/9Less than 6/9

Non-ToricDistance LVA After Surgery

76.92%

16.92%

6.154%

n=65

6/6 or Better 6/9Less than 6/9

Non-ToricDistance RVA After Surgery

Monocular Distance VA after surgery 939 MP

78.57%

17.86%

3.571%

n=28

6/6 or Better 6/9Less than 6/9

ToricDistance LVA After Surgery

80.77%

15.38%

3.846%

n=26

6/6 or Better 6/9Less than 6/9

ToricDistance RVA After Surgery

Monocular distance VA after surgery 839 and 939 combined

77.08%

20.83%

2.083%

n=96

6/6 or Better 6/9Less than 6/9

TotalDistance LVA After Surgery

78.13%

16.67%

5.208%

n=96

6/6 or Better 6/9Less than 6/9

TotalDistance RVA After Surgery

Monocular intermediate VA - 839

010

2030

40N

umb

er o

f E

yes

6/6 or Better 6/9 Less Than 6/9

Non-Toric LensMonocular Intermediate VA After Surgery

Binocular intermediate VA – bilat 839

010

2030

Num

ber

of

Pat

ien

ts

6/6 or Better 6/9 Less Than 6/9

Both Eyes Non-Toric LensesBinocular Intermediate VA After Surgery

Monocular intermediate VA - 939

05

1015

Num

ber

of

Eye

s

6/6 or Better 6/9 Less Than 6/9

Toric LensMonocular Intermediate VA After Surgery

Binocular intermediate VA – bilat 939

02

46

810

Num

ber

of

Pat

ien

ts

6/6 or Better 6/9 Less Than 6/9

Both Eyes Toric LensesBinocular Intermediate VA After Surgery

Binocular intermediate VA – 839/939

01

23

45

Num

ber

of

Pat

ien

ts

6/6 or Better 6/9 Less Than 6/9

One Eye Toric and One Eye Non-Toric LensBinocular Intermediate VA After Surgery

Monocular near vision - TOTAL

157

25

4

050

100

150

Num

ber

of

Eye

s

N5 or Better N6 or N8 N10 or Less

Without GlassesBoth Lenses, Both Eyes

Monocular Near VA After Surgery

Monocular near VA - 839

104

18

4

020

4060

8010

0N

umb

er o

f E

yes

N5 or Better N6 or N8 N10 or Less

Without GlassesNon-Toric Lens, Both Eyes

Monocular Near VA After Surgery

Binocular near VA – bilateral 839

52

5

010

2030

4050

Num

ber

of

Pat

ien

ts

N5 or Better N6 or N8

Without GlassesNon-Toric Lens in Both Eyes

Binocular Near VA After Surgery

Monocular near VA - 939

45

7

010

2030

4050

Num

ber

of

Eye

s

N5 or Better N6 or N8

Without GlassesToric Lens, Both Eyes

Monocular Near VA After Surgery

Binocular near VA – bilateral 939

20

1

05

1015

20N

umb

er o

f P

atie

nts

N5 or Better N6 or N8

Without GlassesToric Lens in Both Eyes

Binocular Near VA After Surgery

Binocular near VA – one 839/one 939

10

02

46

810

Num

ber

of

Pat

ien

ts

N5 or Better

Without GlassesToric Lens in One Eye, Non-Toric in The Other

Binocular Near VA After Surgery

Distance glasses before surgery

1517

64

020

4060

Num

ber

of

Pat

ien

ts

Never Sometimes Regularly

TotalPatient Reported Use of Distance Glasses Before Surgery

Distance/driving glasses after surgery

020

4060

8010

0N

umb

er o

f P

atie

nts

Never Sometimes Regularly

TotalPatient Reported Use of Glasses for Driving After Surgery

Distance glasses after surgery – bilateral 839

020

4060

Num

ber

of

Pat

ien

ts

Never Sometimes Regularly

Both Eyes Non-ToricPatient Reported Use of Glasses for Driving After Surgery

Distance glasses after surgery – bilateral 939

22

0 0

05

1015

20N

umb

er o

f P

atie

nts

Never Sometimes Regularly

Both Eyes ToricPatient Reported Use of Driving Glasses After Surgery

Distance glasses after surgery – one each of 839/939

8

1 1

02

46

8N

umb

er o

f P

atie

nts

Never Sometimes Regularly

One Eye Toric, One Eye Non-ToricPatient Reported Use of Driving Glasses After Surgery

Computer glasses before surgery

63

87

020

4060

80N

umb

er o

f P

atie

nts

Never Sometimes Regularly

TotalPatient Reported Use of Computer Glasses Before Surgery

Computer glasses after surgery TOTAL

84

74

020

4060

80N

umb

er o

f P

atie

nts

Never Sometimes Regularly

TotalPatient Reported Use of Computer Glasses After Surgery

Computer glasses after surgery – bilateral 839

010

2030

4050

Num

ber

of

Pat

ien

ts

Never Sometimes Regularly

Both Eyes Non-ToricPatient Reported Use of Glasses for Computer Use After Surgery

Computer glasses after surgery – bilateral 939

05

1015

20N

umb

er o

f P

atie

nts

Never Sometimes Regularly

Both Eyes ToricPatient Reported Use of Glasses for Computer Use After Surgery

Computer glasses after surgery – one each of 839/939

02

46

810

Num

ber

of

Pat

ien

ts

Never Sometimes Regularly

One Eye Toric, One Eye Non-ToricPatient Reported Use of Glasses for Computer Use After Surgery

Reading glasses before surgery

46

85

020

4060

80N

umb

er o

f P

atie

nts

Never Sometimes Regularly

TotalPatient Reported Use of Reading Glasses Before Surgery

Reading glasses after surgery TOTAL

75

15

6

020

4060

80N

umb

er o

f P

atie

nts

Never Sometimes Regularly

TotalPatient Reported Use of Reading Glasses After Surgery

Reading glasses after surgery – bilateral 939

05

1015

20N

umb

er o

f P

atie

nts

Never Sometimes Regularly

Both Eyes ToricPatient Reported Use of Glasses for Reading After Surgery

Reading glasses after surgery - one each of 839/939

02

46

8N

umb

er o

f P

atie

nts

Never Sometimes Regularly

One Eye Toric, One Eye Non-ToricPatient Reported Use of Glasses for Reading After Surgery

Total –73% glasses never worn after surgery, 27% glasses worn for at least

one distance

27.08%

72.92%

Glasses Worn For at Least One Distance Glasses Never Worn

73% no glasses, 19% glasses for 1 distance, 8% glasses for more than 1

distance

72.92%

18.75%

8.333%n=96

Glasses Never Worn

Glasses Worn for One DistanceGlasses Worn for More Than One Distance

Reported quality of distance VA

75

18

20 0

020

4060

80N

umb

er o

f P

atie

nts

Excellent or Very Good Good Fair Poor Very Poor

TotalPatient Reported Quality of Distance VA After Surgery

Reported quality of distance vision – bilateral 939

15

6

1

0 0

05

1015

Num

ber

of

Pat

ien

ts

Excellent or Very Good Good Fair Poor Very Poor

Both Eyes ToricPatient Reported Quality of Distance VA After Surgery

Reported quality of distance vision – bilateral 839

48

10

0 0 0

010

2030

4050

Num

ber

of

Pat

ien

ts

Excellent or Very Good Good Fair Poor Very Poor

Both Eyes Non-ToricPatient Reported Quality of Distance VA After Surgery

Reported quality of distance vision –one each of 839/939

8

2

0 0 0

02

46

8N

umb

er o

f P

atie

nts

Excellent or Very Good Good Fair Poor Very Poor

One Eye Toric, One Eye Non-ToricPatient Reported Quality of Distance VA After Surgery

Reported quality of near vision TOTAL

75

13

7

0 1

020

4060

80N

umb

er o

f P

atie

nts

Excellent or Very Good Good Fair Poor Very Poor

TotalPatient Reported Quality of Near VA After Surgery

Reported quality of near vision – bilateral 939

19

21

0 0

05

1015

20N

umb

er o

f P

atie

nts

Excellent or Very Good Good Fair Poor Very Poor

Both Eyes ToricPatient Reported Quality of Near VA After Surgery

Reported quality of near vision –bilateral 839

46

8

4

0 1

010

2030

4050

Num

ber

of

Pat

ien

ts

Excellent or Very Good Good Fair Poor Very Poor

Both Eyes Non-ToricPatient Reported Quality of Near VA After Surgery

Reported quality of near vision – one each of 839/939

6

3

1

0 0

02

46

Num

ber

of

Pat

ien

ts

Excellent or Very Good Good Fair Poor Very Poor

One Eye Toric, One Eye Non-ToricPatient Reported Quality of Near VA After Surgery

Reported quality of intermediate vision TOTAL

75

13

6

02

020

4060

80N

umb

er o

f P

atie

nts

Excellent or Very Good Good Fair Poor Very Poor

TotalPatient Reported Quality of Intermediate VA After Surgery

Reported quality of intermediate vision – bilateral 939

16

5

0 0

1

05

1015

Num

ber

of

Pat

ien

ts

Excellent or Very Good Good Fair Poor Very Poor

Both Eyes ToricPatient Reported Quality of Intermediate VA After Surgery

Reported quality of intermediate vision – bilateral 839

46

8

4

0 1

010

2030

4050

Num

ber

of

Pat

ien

ts

Excellent or Very Good Good Fair Poor Very Poor

Both Eyes Non-ToricPatient Reported Quality of Intermediate VA After Surgery

Reported quality of intermediate vision – one each of 839/939

9

0

1

0 0

02

46

810

Num

ber

of

Pat

ien

ts

Excellent or Very Good Good Fair Poor Very Poor

One Eye Toric, One Eye Non-ToricPatient Reported Quality of Intermediate VA After Surgery

When were photic phenomena noticed

50

62

30 30

020

4060

Num

ber

of

Pat

ien

ts

At Night Night Driving Artificial Lighting Bright Sunlight

TotalSituations Patient Reported Glare, Halos or Starbursts

Similar across IOL subtypesAlways more problematic at night

23

39

1917

010

20

30

40

Num

ber

of

Patie

nts

At Night Night Driving Artificial Lighting Bright Sunlight

Both Eyes Non-ToricSituations Patient Reported Glare, Halos or Starbursts

18

14

8

10

05

10

15

20

Num

ber

of

Patie

nts

At Night Night Driving Artificial Lighting Bright Sunlight

Both Eyes ToricSituations Patient Reported Glare, Halos or Starbursts

7

5

2 2

02

46

8N

umbe

r of

Pat

ient

s

At Night Night Driving Artificial Lighting Bright Sunlight

One Eye Toric, One Eye Non-ToricSituations Patient Reported Glare, Halos or Starbursts

Impact on daily life 85/96 = never or sometimes

11/96 = regularly

34

51

11

010

2030

4050

Num

ber

of

Pat

ien

ts

Never Sometimes Regularly

TotalHow Often Glare, Halos or Starbursts Impact on Daily Life

Similar across IOL subtypes.Perhaps greater tendency for some impact in toric MFIOL.

4

15

3

05

10

15

Num

ber

of

Patien

ts

Never Sometimes Regularly

Both Eyes ToricHow Often Glare, Halos or Starbursts Impact on Daily Life

24

29

6

010

20

30

Num

ber

of

Patien

ts

Never Sometimes Regularly

Both Eyes Non-ToricHow Often Glare, Halos or Starbursts Impact on Daily Life

3

5

2

01

23

45

Num

ber

of

Patie

nts

Never Sometimes Regularly

One Eye Toric, One Eye Non-ToricHow Often Glare, Halos or Starbursts Impact on Daily Life

Frequency of photic phenomena before surgery

62

21

13

020

4060

Num

ber

of

Pat

ien

ts

Never Sometimes Regularly

TotalFrequency of Glare, Halos or Starbursts Before Surgery

Frequency of photic phenomena after surgery

2

28

65

020

4060

Num

ber

of

Pat

ien

ts

Never Sometimes Regularly

TotalFrequency of Glare, Halos or Starbursts After Surgery

Would you use it again and recommend it to a friend?

   

Would Use The Same Lens(es) (%) Would Recommend The Same Lens(es) (%)     Yes No Undecided Yes No Undecided   Both Eyes Toric     95% 5% 0% 95% 5% 0%   Both Eyes Non-Toric    93% 5% 2% 93% 5% 2%   One Eye Toric, One Eye Non-Toric     100% 0% 0% 100% 0% 0%   Total     94% 5% 1% 95% 4% 1%

Probably not a meaningful question as the patient has nothing else to compare it with, but gives a gauge of level of satisfaction

Conclusion

Great IOL for patients who are highly motivated to have spectacle independence.

In my experience other IOL that promise less photic phenomena (eg Symfony, ReStor 2.5, Oculentis MF15) do not provide as consistent a level of excellent unaided near vision.

B&L Fine Vision trifocal is a virtually identical IOL but is not preloaded and a little harder to rotate in the eye. ? benefit of apodisation and of being trifocal to the periphery?

839/939 still my “go to” IOL if patient keen for spectacle independence and really wants good near vision.

Intermediate vision better than with older bifocal design but still not ideal for many computer users (20% light distribution for intermediate)

Haloes and glare virtually universal but many are not troubled by them and about 95% of patients say they would have the same IOL again.

Pre-op counselling and management of expectation is essential.

Thankyou