Oph The Record 2018 by OPHTEC

OPH the RECORD Published by OPHTEC BV /// Edition 2018/2019 /// #14 /// €9,-

Precizon Presbyopic IOLs

New:

35th Anniversary Erik-Jan Worst reflects on 35 years of OPHTEC And more: 6 New Series

Women in Ophthalmology: Dr Edna Almodin & Prof. Tae-Im Kim

20 Dr Chiun-Ho Hou

Celebrating four years of Precizon Toric accuracy

22 Steps for Toric IOL implantation

Compiled by: Dr M. Royo, Á. Jiménez and OPHTEC

27 Miradas

Touring art exhibition raises awareness of visual impairments and blindness

www.ophtec.com

>> EVENTS 2018 / 2019 20-26 September

Vienna

Austria

ESCRS & Euretina

26-29 September

Granada

Spain

SEO

27-30 September

Bonn

Germany

DOG

3-6 October

Nice

France

EVER

27-30 October

Chicago

AAO

2-4 November

Seoul

South-Korea

KOS

Belgium

21-23 November

Brussels

28 Nov.-1 Dec.

Rome

Italy

SOI

15-17 February

Athens

Greece

ESCRS Winter Meeting

6-9 March

Bangkok

Thailand

APAO

12-16 March

Dusseldorf

Germany

AAD

20-24 March

Cape Town

South Africa

OSSA

27-29 March

Maastricht

The Netherlands

NOG

29 March

Brussels

Belgium

AMICO

3-7 May

San Diego

ASCRS

11-14 May

Paris

France

SFO

22-25 May

Santiago de Compostela

Spain

SECOIR

23-25 May

Nuremberg

Germany

DOC

14-18 September

Paris

France

ESCRS

Colofon OphTheRecord is published by OPHTEC BV Interviews: Marij Thiecke; Concept & Copy, Groningen Roelien den Besten, OPHTEC Editorial E-mail address: r.den.besten@ophtec.com Lay-out: www.mennoschreuder.nl Print: Scholma Druk, Bedum All rights reserved. Â©OPHTEC BV 2018 Postbus 398, 9700 AJ Groningen T: +31 50 5251944 | F: +31 50 5254386

www.ophtec.com

In this issue

35 years of OPHTEC

Mrs. Anneke Worst started OPHTEC back in 1983. After 17 years at the helm, she passed on the baton to her son Erik-Jan Worst, who has just completed 17 years in charge. Time to reflect. An interview with OPHTEC President and CEO Erik-Jan Worst.

New series: Women in ophthalmology

We are proud to start this new series with Dr Edna Almodin (Brazil) and Prof. Tae-Im Kim (South Korea).Two extraordinary ophthalmologists with very special careers.

Precizon Presbyopic IOLs

With its recently developed Continuous Transitional Focus optic, this new presbyopia correcting IOL offers patients a more Natural Vision. Read all about this new milestone in presbyopia correction.

35 years of IOLs

In 35 years, OPHTEC has developed and marketed many different types of intraocular lenses. We asked our engineers to compile an overview with their favorites.

Dr Chiun-Ho Hou

Dr Chiun-Ho Hou from Taiwan likes clean, confined, predictable procedures with a maximal result for patients. That is why he uses Precizion Toric. A lens that lives up to his expectations. An interview.

Steps for toric implantation

OPHTEC in cooperation with Dr Mariano Royo and his Optometrist Ángel Jiménez Hospital San Rafael, Madrid composed these steps for toric IOL implantation.

Vienna

Did you know that Vienna, host of the 2018 ESCRS is the world’s best city to live in? What more do you know about Vienna? A few tourist tips and interesting facts.

The Miradas

‘Miradas’ is a Spanish word for: look, gaze, glance or peek. This word names a traveling art exhibition that aims to raise awareness of visual impairments and the prevention of blindness.

35 years of

OPHTEC Anneke Worst started OPHTEC back in 1983. After 17 years at the helm, she passed on the baton to her son Erik-Jan Worst, who has just completed 17 years in charge. Time to reflect.

OPHTEC President & CEO Erik-Jan Worst and OPHTEC’s founder and former President Mrs Anneke Worst van Dam

How would you characterise those first 17 years of OPHTEC? Erik-Jan Worst: “Let me start by saying that my mother did something extraordinary. She started OPHTEC from scratch at the age of 54. She then managed to obtain support from doctors and to sell products all over the world. I have massive amounts of respect for that achievement! My mother started OPHTEC because my father, Jan Worst, ophthalmologist and inventor, was a never-ending source of new ideas for lenses and ophthalmic instruments. They wanted to use all that creative energy in some way and that turned out to be OPHTEC. In those first 17 years we were extremely product-led. We were close to the ophthalmologist and the ophthalmologist was Jan Worst. He had fabulous notions and was a constant source of new ideas. I remember a research meeting where we were talking about the notion of ‘irrigation knives’. We had at least 15 prototypes in front of us and I asked ‘Which one will we develop?’ My father responded ‘Actually, I’ve thought of something better, glass cannulas.’ It was difficult to deal with that. It meant we struggled to finish something and we simply continued researching.”

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Did you continue that same product-led method when you took over in 2000? “No, that changed during the course of 2000. We came to an impasse with the arrival of folding lenses. The market had started to express a demand, but my father was totally and utterly against it. His creed was ‘small incision - big trouble’. So OPHTEC’s discussions about the folding lenses were almost finished before they started - we weren’t having them. At that time our focus was on the Artisan lens, but the market moved on and the demand for folding lenses kept growing. It made me realise that you need to listen to your clients and that you need to track the market with proper care and attention.” Over the past 17 years you have turned OPHTEC into a flourishing company with 8 sites abroad. Was that a preconceived idea? “It actually all happened more or less by coincidence. Although these days I have a wish list for the coming years, I did not have one back then. Early 2000 we had some issues with a few distributors, and I decided that the time had come to do something about that, that

Erik-Jan Worst speeches at OPHTEC’s user meeting during the 2018 ESCRS congress in Lissabon.

‘I believe that this will be the future: Smart factory, the shortest course between diagnosis and the individual product’ we needed to sell our own products with our own story. Before 2000 we had a site in the US, but that was an office for regulatory purposes to obtain the FDA approvals. The first up and running sales organisation was in Spain and the rest followed after that. Now we work with the perfect mix of our own offices and extremely good distributors. It enables us to achieve virtually global coverage with our products.” What will the next 17 years of OPHTEC look like? “They will be very different years again. We are in a technological maelstrom, and ordinary cataract surgery is becoming more like refraction surgery. In a few years’ time, the purpose of cataract surgery will be emmetropia and glasses independence. The ultimate custom design situation will be where a doctor supplies us with the diagnostic data and the lenses will be customised and supplied in the patient’s name. I think that will be the future - Smart Factory, the shortest possible line from diagnosis to customised product.

of things. I have plenty of thoughts about these topics and our research people look out for those things at conferences; what is being presented in this field? At OPHTEC we now research in short cycles, because it needs to produce immediate gains or benefits. My objective is to continue growing over the coming years, so that we can afford to finance more long-term research projects. I have every confidence that we will manage, because we have excellent products, including Precizon Toric IOL, a lens with a unique TCT optical design (Transitional Conic Toric) that was recently awarded an American patent and that is qualified by global peers as ‘excellent’. This year we will have our latest model, Precizon Presbyopic, a lens with a CTF optical design (Continuous Transitional Focus) developed by us. There are still many other wonderful things in the pipeline, including an Artiflex Presbyopia with the same CTF design. I’m setting out on the next 17 years full of joy and confidence!”

Alternatively, you can ask yourself whether we will continue to put lenses in eyes. Cataracts is a degeneration process. Will there come a time when we start working on the gene tree? Not great when you are in the lenses business, but it is the way OPH//THE//RECORD 5

Women in Ophthalmology

This series consists of interviews with women who focus their professional career on ophthalmology, as Mrs. Anneke Worst did when she founded OPHTEC 35 years ago. Women who made it to the top in ophthalmology. Yvonne HernĂĄndez, General Manager of OPHTEC Spain, who has been working

in ophthalmology since 1998, reflects on this subject and kicks off this new series.

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Mrs Anneke Worst-va n Dam at the start of the construc tion of Ophtecâ&#x20AC;&#x2122;s head office in Gron ingen, The Netherlands in 1986;

By Gustav Klimt - Great Hall ceiling of the Vienna UniversityFinearts. hku.hk, Public domain, https://commons.wikimedia.org/w/index.php?curid=37723819

NEW SERIES

From left to right: Maite del Pozo, OPHTEC Area Ma nager Catalonia & Bale Dr Ma Ángeles del Buey, aric Islands; Hosp. Universitario Loza no Blesa; Dr Margarita Clínica Baviera Sevilla; Dr Cabanás, Cristina Peris, Medical Dire ctor at Fisabio, FOM, Vale Yvonne Hernández, Gen ncia; eral Manager OPHTEC Spa in

Yvonne Hernandez: “It’s been 35 years since Mrs. Anneke Worst founded OPHTEC and started the production and sale of lenses and instruments developed by her husband. She was an exception in her time and still is today. Most women have to choose between running a company and their family and usually choose their family, because running a company requires investing a lot of personal and family time. Mrs. Worst however, chose to run a company and, with her visionary husband by her side, founded a company that has helped generations of ophthalmologists. It’s not common these days for one person to follow an idea and create a legacy. This is why OPHTEC is different today and will be, as long as they keep the legacy of Jan and Anneke Worst alive.” When looking at the business today, I do not see many women at our side in the industry. It has always and still is a man’s world. This makes Mrs Worst’s founding of OPHTEC even more special. What I do see however is a change in the number of male and female ophthalmologists. This side of the ophthalmic industry, doctors, is more and more feminine than when I started in 1998. Many women doctors and surgeons make this industry bigger and stronger. I see a definite growth but unfortunately not anymore in creating companies like OPHTEC, in our side, or present at international podiums, in doctors’ side. There is still work to do to convince our women to create legacies in the ophthalmic field.

, varez Holgado : ht:Dr Marta Ál m left to right fro from left to rig p m to , tto Bo rid ad te. M en Dona OPHTEC Wom r, Dr Carolina die z. Ira e de ait án M rn ro, Dr onne He Dr Ana Macar Álvarez and Yv nate, Dr Maite Dr Carolina Do

I have a nice relationship with the women ophthalmologists I work with in Spain. It was during a SECOIR in Barcelona some years ago when we organized a quick business lunch and since then we are seeing each other on a regular basis. We enjoy quality time together -eat and drink good wine-. The best, or the worst thing for my business, is that we don’t always talk about ophthalmology! These women have a lot in common and they do not know that until they spend some time together. I see how they are in their private and professional lives, I love how strong and hard workers are. Our OPHTEC Women face many similarities to our founder Mrs Anneke Worst and each one of these meetings shows how women, in general, are: passionate; like our founder Mrs Anneke Worst. I am proud of kick off this new series about women ophthalmologists and I would like to show how passion and professionalism lead the lives of our OPHTEC Women. Said this, it is my pleasure to introduce you to two of our OPHTEC Women: Dr Edna Almodin, from Brazil; and Prof. Tae-Im Kim from South Korea. I kindly invite you to read their interviews and discover them. Yvonne Hernández General Manager of OPHTEC Spain OPH//THE//RECORD 7

///Women in Ophthalmology â&#x20AC;˘ Dr Edna Almodin

Dr Edna Almodin is president of the Brazilian Ophthalmology Society and one of the female doctors that OPHTEC has been working with for years. Because she also wants to treat myopic patients beyond the limitations of laser treatment, she has been implanting OPHTECâ&#x20AC;&#x2122;s Artisan and Artiflex lenses for high myopia since 1999.

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Can you describe the Provisão Hospital de Olhos and the city of Maringa? Dr Edna Almodin: “Provisão Hospital de Olhos was established in Maringá, a young city, 71 years old, in 1995. Its 450,000 inhabitants live in a city with tree-lined streets and parks, rendering its nickname “Green City”. In a recent survey, based on the human development index (HDI), Maringá came first among the 100 best cities to live in, in Brazil. Provisão has grown in symphony with Maringá. We are proud to have pioneered several new developments in ophthalmology in our region. We were the first service to offer Excimer laser, phacoemulsification, intracorneal rings (1995), multifocal, accommodative, and phakic (Artisan, Artiflex and ICL) IOLs, crosslinking, customized myopia surgery using wavefront laser, topolink and pentacam, anterior lamellar corneal transplant. That was followed by femtosecond laser-assisted in cornea and cataract surgery.

‘Women are so resourceful; I think we can manage family life and our jobs’ In 2008, my oldest daughter, Juliana, a glaucoma specialist from the Wills Eye Institute, joined the service, together with Dr Rodrigo Oliveira (retinologist) and we started to offer optic nerve and retina OCT and endo-cyclophotocoagulation surgery. In 2016, my middle daughter, Flavia, a cornea specialist, also joined us, and we introduced DSAEK, DMEK, and Angioplex. Moreover, we established in Maringá the International Symposium on Ophthalmology Update. With the support of the local Medical Society and national Ophthalmic Societies we have brought here important names in ophthalmology, such as Drs. Howard Fine, Steve Arshinoff, Jack Singer, Peter Labson, George Spaece. In 2015, I was accepted as a member of the prestigious International Intraocular Implants Club, and more recently, I was elected as the new president of the Brazilian Ophthalmology Society for 20192021.”

What field in Ophthalmology has your special interest and why? “I am a specialist in the anterior chamber of the eye. I have used Artisan since 1999, when I worked with Dr José Ricardo Redher, who was responsible for the research and certification of Artisan in Brazil. Similarly, I participated in Ferrara intracorneal rings research. I started using Artisan and Artiflex because I could not treat high myopes with Eximer Laser and I wanted to help them as well. This new form of treatment has greatly increased the range of care I provide to my patients, bringing an important differential to our service. I would certainly advise colleagues who perform refractive surgery to consider a wider range of possibilities, and not be limited to Excimer laser.” You have two daughters both working in the same hostpital. How unique is that? “My family has always been very connected to medicine. My husband, Dr Carlos Gilberto Almodin is an exponent in Gynecology and obstetrics. We have been married since 1978 and have 3 daughters who grew up listening about medicine practically every day. Perhaps, because of our joy in exercising such a rewarding profession, our children naturally got interested in medicine. Today, my youngest daughter, Paula, works with her father, while Flavia and Juliana work with me. Every Tuesday and Thursday, we find ourselves together in the surgical center. For me it is a privilege to be able to work with my daughters side by side.” A paper headline in 2017: “Being a Doctor Is Hard. It’s Harder for Women”. Do you agree with this headline? “I became an ophthalmologist in 1980, at a time when there were few female doctors. As a matter of fact, I have been blessed for having received great support, since the time when I was a resident student under Dr Flávio Resende. My husband and children have always been at my side. So, I did not really find it difficult to practice my profession. Women are so resourceful; I think we can manage family life and our jobs. Anyway, I think the result was positive, since my daughters have also decided to follow the same path.” Can you describe the cooperation with OPHTEC? “My relationship with OPHTEC has always been the most cordial possible, since the time of House of Vision to Adapt nowadays. OPHTEC international, represented by Tiago Guerreiro and Teresa Filho, have always assisted me to ensure the best Artisan wet lab training possible.”

OPH//THE//RECORD 9

///Women in Ophthalmology â&#x20AC;˘ Prof. Tae-Im Kim

Prof. Tae-Im Kim is professor at the Yonsei University in Seoul. She works close together with OPHTEC on the research of new lenses. We asked her about her experience with the Precizon Toric IOL, about her career, about the Yonsei University and we asked her to reflect on a statement about woman doctors.

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Can you describe your career? I felt an interest in ophthalmology when I was preclinical medical student. First of all, ophthalmology is one of the fields where surgery and outpatient management can be done at the same time. Secondly, I think vision is critical to quality of life. Finally, the postoperative satisfaction of an eye-surgery patient is higher than in any other field. For these reasons I chose ophthalmology as my major. My specialty is the anterior part of the eye, the cornea and the cataract. Among ophthalmologists, cataract and refractive surgeons experience the most dramatic improvement of vision after surgery. So, in this field patients and doctors have the greatest satisfaction. I graduated from medical school in 1997, went through a training course for ophthalmologists, started working at Yonsei University College of Medicine in 2006 and became a professor in 2016. My career is unique. In Korea it is common that professors were trained at the same university and the same hospital where they work now. However, I graduated from Ewha women’s University, then trained at the Asan Medical Centre and finally became a professor at Yonsei University. This diverse experience allows me to develop broad relationships with various doctors and to expand my knowledge of clinical and basic research fields.

‘I’ve been working hard to get more opportunities for junior woman doctors’ Can you tell us something about Yonsei University? The history of Yonsei University began on April 10th, 1885, as Korea’s first modern hospital “Gwanghyewon”. Gwanghyewon was established in Seoul (Korea) by Dr Horace N. Allen, missionary doctor. His missionary work was based in Chejungwon and became the foundation of Yonsei. Yonsei University supported the independence and modernization of Korea during the Japanese colonization and during times of crises. As a university, it also bore the responsibility of demo-cratizing and modernizing the country after the Korean War. The current number of students totals 30,729 and there are 4,065 international students. Because the university originated from a medical missionary, it will prepare for the next 100 years by sharing and practising the values of Christianity, Creativity, and Connectivity that constitute the founding spirit of Yonsei.

You are using Ophtec’s Precizon Toric lens; what are the outcomes? are you satisfied? I very much like the concept of a transitional conic toric IOL that provides a broader Toric meridian, designed to be more tolerant of misalignment.

Moreover, it provides constant power over each meridian, resulting in a constant spherical equivalent (SE) power, designed to provide optimal visual acuity. The design of the toric platform allows pupil-independent spherical equivalent power and is aberration neutral, designed to provide optimal visual acuity. To date I have implanted hundreds of Ophtec’s Precizon Toric IOL and currently I only use this toric IOL for all of my toric IOL cases. I have a low incidence of PCO development compared to other hydrophobic IOL. The stability and clinical performance of this IOL are perfectly satisfactory. During your booth presentation 2 years ago, you said that the number of toric cataract procedures is low in Korea, because of uncertainty and high costs. Is that still the case or is it changing? Based on highly improved preoperative evaluation of corneal astigmatism and the knowledge of the toric IOL implantation technique, the number of toric cataract procedures has increased consistently. However, femtosecond cataract surgery has become popular, and surgeons prefer to correct mild astigmatism with femtosecond laser. So, the range of the indication for toric IOL implantation has shifted to a higher astigmatism than before. I’ve recently finished the clinical study of the first model of the Precizon Presbyopic lens. The lens provided quite nice distant vision and near vision. The company is currently working on the modified platform to enhance far and intermediate vision. I’m looking forward to this newdesign Precizon Presbyopic lens and I’m anticipating outstanding results. Statement: “Being a doctor is hard, and it’s even harder for women” Do you agree with this statement? It takes a long time to become a doctor, because it requires a study at a university as well as a long periods of training. I agree that being a doctor is not easy, because you need to spend several years preparing and you have to make many sacrifices during that time. In Korea, the proportion of female students in medical schools is 30 to 40 percent. In a fair competition, the number of female students is not much below that of male students. However, it is also true that the number of female doctors who have completed professional training and become specialists, continue their careers and become professors, and finally hold important positions in universities and academies has decreased in each steps remarkably. It is not uncommon to quit midway for childbirth and child care when they have to continue training. It is also true that women doctors are still required to achieve a higher standard. So, I think that family support and help are essential to continuing a career as a woman doctor. However, I think that the field of ophthalmology is a field where female physicians can stand out in medicine. It’s not easy, but it’s a challenging part, and I’ve been working hard to get more opportunities for junior woman doctors. Can you describe your average working day? I wake up at 6 o’clock, attend the conference from 7:30 AM, and start outpatient clinic at 8:30 AM. I do 4 half-day clinics and 3 half-day surgery sessions in a week. Other times, I deal with the laboratory research and other academic tasks. The official day generally ends at around 6 o’clock. After that, I read and write an article or prepare for a presentation and usually leave my office around 8 - 9 PM. However, at the weekend I try to spend time with my family whenever possible, although there is the weekend conference schedule. I do not have much time to enjoy hobbies yet, but I try to make time for exercise.

OPH//THE//RECORD 11

f o s r a e y 5 3 s e s n e l r a l intraocu uder) OPHTEC

nd an occl types of IOLs (a nt re ffe di y an s: ion of the m e past 35 year A small select ucing over th od pr d an ng been developi

78)

ted in 19 1983 (InvenAp hakia Artisan PMMA

1988

1986

a Artisan Myopi A M PM

der Artisan Occlu PMMA

Spiral PMMA

1996

PC 283 PMMA

2009

Quadrimax rylic yd H rophilic Ac

Worst PC lens PMMA

1994

1993

1991

12 OPH//THE//RECORD

has

1998

kia Artisan Apha PMMA

2015

c Precizon Tori Hybrid

Aniridia IOL PMMA

2002

Artiflex Polysiloxane

2018

byopic Precizon Pres d ri Hyb

N EW!

CTF optic designed for: P NATURAL VISION AT ALL DISTANCES

PRESBYOPIA CORRECTION REINVENTED

P REDUCING GLARE & HALOS P PUPIL INDEPENDENCE P DECENTRATION TOLERANCE OPH//THE//RECORD 13

What makes this lens unique? • CTF (Continuous Transitional Focus) optic A CTF optic is an optic with an anterior surface with multiple segments for far and near. Between the segments a smooth transition from far to near is achieved. This transition offers a constant defocus between the two sharp focal points, delivering excellent intermediate vision. The entire anterior and posterior lens surfaces are shaped by the computer guided patent pending Transitional Conic technology. This technology has the capability to produce an aberration-neutral aspheric IOL with a plus power of 2.75 or an aspherical negative aberration lens of - 0.11 μm depending on the patient’s needs. Regular Multifocal IOLs will cause positive dysphotopsia, due to concentric rings1) but CTF uses segments that avoid such a problem as they are designed to provide a more tolerant lens to halos and glare. Saving chair time can be advantageous as CTF lenses provide a more natural experience for patients while minimizing unwanted optical side effects2). When accepting a good quality vision from 40cm to infinity and a balanced contrast sensitivity patients are likely to be satisfied with the CTF optics.

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Through-focus modulation transfer function of four presbyopia-correcting intraocular lenses with 3.0 mm pupil size. modulation transfer function was calculated at 7.40 cycles/degree. Data on file - courtesy of Dr Joo, south Korea.

CTF optic designed for: • Natural vision at all distances

Centred IOLs

Decentred IOLs

The transitional zones of the CTF optic offers a full range of vision from near to infinity with smooth continuous transition. The CTF aspheric surface forms a broad beam of light, a zone with an enhanced depth of focus, with uninterrupted high quality images for the brain to translate into clear vision at all distances.

• Reducing glare and halos

The misalignment tolerance and the use of segments instead of concentric rings reduces photic phenomena thereby helping patients to adapt more naturally to their new vision. Approx. 4 mm pupil size

Approx. 4 mm pupil size

• Pupil independence

The distribution of the zones is such that in different pupil apertures, under different lighting conditions, the patient can always benefit from the same light distribution for near and far vision. Surgeons can opt for a 50/50 or a 60/40 far/near light distribution ratio. Approx. 4 mm pupil size

Approx. 4 mm pupil size

• Decentration tolerance

In cases of tilt or misalignment, the patient can still benefit from the same near and far vision as the segmented zones allow an equal and steady light distribution.

Precizon Presbyopic Approx. 4 mm pupil size

OPH//THE//RECORD 15

Specifications The Precizon IOL Family offers you the opportunity to choose the best model for your patients. When you treat cataract patients with presbyopia, you can choose between the Precizon Presbyopic model and the Precizon Presbyopic NVA model. Both models make use of the CTF technology. The main differences remain in the segment sizes, light distribution for far and near, and in the IOL aberrations.

PHYSICAL CHARACTERISTICS Model Optic type

PRECIZON PRESBYOPIC 570 A0 Precizon Presbyopic One piece IOL Aberration neutral Continuous Transitional Focus (CTF) optic

0.5 / 2.0 mm

Central far zone size Y/X

Presbyopic model Cataract patients for whom an excellent depth of field is critical are better suited to a neutral aberration optic. Furthermore, some cataract patients have neutral or negative aberrations in the cornea. In these cases aspherical neutral aberration optics are a better fit, as this will avoid overcompensation providing a better vision. Finally, cataract patients who appreciate equal light distribution but have decentred pupils, might also benefit from the 50/50 light distribution and pupil independence of the Precizon Presbyopic model.

First near segment direction (in / out)

inwards

Rotated segments width

0.75 mm

Number of segment rings

UV cut off

<10% @360 nm

Refractive index

1.46

Abbe number

Optic powers

+1.0 D to + 35.0 D (0.5 D increments) Power add +2.75 D.

Haptic configuration Lens material

Open modified C-loops with offset shaped haptics Hybrid hydrophobic & hydrophilic monomers. Ultraviolet filtering HEMA/EOEMA Copolymer

Lens colour

Clear

Body Ø

6.0 mm

Overall Ø

12.5 mm

Haptic angle

0˚

0.8 to 1.3 mm

Centre thickness range Precizon Presbyopic • Key benefits Critical near & intermediate vision

A-constant* Ultrasound

50/50 far / near light distribution Neutral, positive or slightly negative corneal aberrations

0.4 mm

Body edge thickness

A-constant* Optical

* Check www.ophtec.com for up to date A-constants

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PHYSICAL CHARACTERISTICS Model Optic type

PRECIZON PRESBYOPIC NVA 570 A1 Precizon Presbyopic NVA One piece IOL Aberration Negative (- 0.11 μm) Continuous Transitional Focus (CTF) optic

1.4 / 2.6 mm

Central far zone size Y/X First near segment direction (in / out)

outwards

Rotated segments width

0.60 mm

Number of segment rings

UV cut off

<10% @360 nm

Refractive index

1.46

Abbe number

Optic powers

+1.0 D to + 35.0 D (0.5 D increments) Power add +2.75 D.

Haptic configuration Lens material

Open modified C-loops with offset shaped haptics Hybrid hydrophobic & hydrophilic monomers. Ultraviolet filtering HEMA/EOEMA Copolymer

Lens colour

Clear

Body Ø

6.0 mm

Overall Ø

12.5 mm

Haptic angle

0˚

The average human cornea has positive aberrations and you might want to compensate for these with a negative aberration lens like the NVA model. Prior myopic LASIK patients will also benefit from aspherical negative aberration optics. Furthermore, patients without prior corneal refractive surgery who value image quality may also be better off with a negative aberration lens. Finally, the Precizon Presbyopic NVA is designed to give cataract patients excellent far vision. They benefit from the 60/40 light distribution as the central zone of the lens is enlarged and can go up to a 2.6 mm zone for far vision.

0.8 to 1.3 mm

Centre thickness range Body edge thickness A-constant* Ultrasound

A-constant* Optical

Presbyopic NVA Model

0.4 mm

Precizon Presbyopic NVA • Key benefits

118.0

Excellent quality image & far vision

60/40 far / near light distribution Positive corneal aberrations

* Check www.ophtec.com for up to date A-constants

OPH//THE//RECORD 17

Evaluation of the first 400 implantations of the Precizon Presbyopic IOL, (model 570 A0)* Question 1: Who is your ideal patient for Precizon Presbyopic? Dr Ramón Ruiz Mesa, Jerez de la Frontera Doubtful Kappa and Alpha Angle. Patients with high mesopic pupils.

Dr Mariano Royo, Madrid A woman between 50 and 75 years old, moderate myopia with a healthy fundus, or hyperopia from +1.0 up to +5.0D. No emmetropes with presbyopia.

Dra. Mercedes Otero My first three patients were women - one had myopic LASIK performed 20 years ago. All of them were cataract patients, between 50 and 60 years old. They are really happy with their vision, because both far and near vision are really good.

Question 2: How are your patients? Dr Miguel Giménez de la Linde, Córdoba Very happy! No halos, good intermediate and far vision. It is like a monofocal for far with very good intermediate vision and no halos! Dr Germán Gómez Tellería, San Sebastián I started to implant Precizon Presbyopic with no changes in my standard way of selection a multifocal IOL and I got very good results. Good profile of security. Very few and very low optic phenomena. No patients with spontaneous halos: only if I ask for them.

Dr Ramón Damborenea, Bilbao Our patients are happy, comfortable, with good vision for far and intermediate and acceptable for near. They aren’t complaining and haven’t reported any halos or glare. Dra. Belén Díaz, Madrid My patients feel comfortable with perfect night vision and without distance and middle distance glasses. Furthermore, their near vision turns out better than they expected after the preoperative explanations.

Dr Carlos Gutiérrez Amorós, La Coruña Patients are happy, reporting good vision for far and near. No complaints about intermediate vision when we ask them to read. No reported difficulties working with a computer. No blurred or uncomfortable vision up to one meter, like I do see with other lenses. It is surprising how patients don’t complain about night light phenomenon even when we ask them about it.

* The opinions expressed are solely those of the surgeons and do not necessarily represent or reflect the views or opinions of OPHTEC BV.

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Treat astigmatism with confidence P ASPHERICAL CYLINDER P PUPIL INDEPENDENCE 1) Precizon Toric is part of OPHTEC’s

P ENHANCED TOLERANCE TO MISALIGNMENT 2) P PROVEN STABILITY 3) 1) Bench study Kim MJ, Yoo YS, Joo CK, Yoon G; (J Cataract Refractive Surg. 2015;41(10:2274-2282)) 2) Data on File - study report Dr Erik Mertens, ESCRS 2014 3) Vale C, Menezes C, Firmino-Machado J, Rodrigues P, Lume M, Tenedório P, Menéres P, Brochado MC; (Clinical Ophthalmology 19, January 2016) This product is not available in the US

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Dr Chiun-Ho Hou Celebrating four years of Precizon Toric accuracy in Taiwan’s Chang-Gung Memorial Hospital Four years ago, OPHTEC’s Precizon Toric IOL saw the light to help prevent, among other things, visual disturbances caused by post-op rotation. This promise led Dr Chiun-Ho Hou to include the lens as an option for certain patient groups. One of a total of 27 dedicated ophthalmologists at Taiwan’s Chang-Gung Memorial Hospital Opthalmology Department, Dr Hou has accepted our invitation to fill us in on his experience with the Precizon Toric: “I like clean, confined, predictable procedures with a maximal result for my patients. The design of the Precizion™ lives up to my expectations: it minimizes the effect of misalignment.” interview: Marij Thiecke

Chang-Gung Memorial Hospital in Taiwan

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In 2012, National Geographic Channel aired ‘Taiwan’s Medical Miracle’. This documentary describes Chang-Gung Memorial Hospital as a safe haven for millions of both domestic and foreign patients. Could you elaborate on this ‘medical miracle’ theme? Dr Hou: “Any documentary needs a gripping title. In a hospital context, however, strategies are not based on the occurrence of miracles. I think our success story is based on hard work and excellent patient care. Clear, dedicated communication is essential in that respect. So our miracle is man-made. My colleagues and I share another important disposition as well: we want to improve each day. One way to secure improvement is engaging in research. I have just finished an article in which I investigated if cancer patients are likely to suffer more or increased side effects when they undergo cataract surgery. The idea that sparked this article was that higher infection rates are observed in cancer patients. I will present and discuss my findings at the ESCRS Congress in Vienna in September.

Could you, on a more practical level, fill us in on your daily activities? “As a refraction specialist, I prescribe corrective glasses and contact lenses. No surprises there. Of course, refractive surgery is on the menu as well. In addition, I perform around 40 cataract procedures each month. And, as a member of the rehabilitation team for bionic eye patients, I specialize in low vision diagnosis and rehabilitation.” 40 cataract procedures? No more? No less? “Our hospital thrives in a healthcare environment in which our much-praised National Health Insurance (NHI) plays an essential role. This truly wonderful system is based on solidarity. Today, almost 100% of Taiwan residents and foreigners residing in our country for more than 6 months have health insurance. It goes without saying that choices need to be made to safeguard this exemplary coverage level. As a result, the number of cataract procedures is limited to 40 per month (per specialist, that is).” Does the NHI cover all IOLs you have at your disposal? “No. The Precizon Toric, to answer the obvious next question, is not covered. A generic spherical IOL is covered though. So, when I meet a patient with more than 0.75 D and astigmatism who, in my view, would be better off with a high-end tech lens, I will recommend the Precizon Toric. In many cases, patients are willing to pay extra for a better visual outcome and minimal visual disturbances. However, financial or other motives can and will lead to different decisions.”

‘The surgical careers I deemed cool were much like an infantry lieutenant’s: groveling towards a solution through a possibly hostile landscape that sometimes seems barely recognizable’ Could you describe your experience with the Precizon Toric so far? “I enjoy the predictability of the Precizion Toric IOL outcomes. Several factors are known to hinder the precise correction of astigmatism. Think of the head position during the initial examination process, and its position during surgery. In addition, the axis marking process and the outcome of examinations can cause bias. And of course, problems with the positioning of the IOL itself occur due to (late) post-op axis rotation. In some cases, the corrective effect of the toric IOL can decrease rapidly. The design of the Precizion minimizes the effect of these misalignment issues. As a result, I’ve witnessed an increase in happy, satisfied patients. I do think that it would be interesting to look into the step-like design of the lens. I think that some visual disturbances might be caused by this trait. However, so far my patients haven’t reported complications I could link directly.” You seem a perfectionist. Does it bother you that some patients willingly and knowingly select the second best option? “If I would answer your question affirmatively, I wouldn’t consider myself a good doctor. Today, the road toward reaching informed decisions defines the quality of any physician.” I’ve found out that the best role for me is to regard my patients as if they were close friends. When I supply the exact amount of information needed, I know my patient will be better off, even if the result doesn’t come close to 1.0 vision.”

Point taken! Did you arrive at this insight in college? “When I was in college, I could easily imagine myself performing ‘cool’ surgical procedures. ‘Cool’, I thought, were neurosurgery, general surgery, and similar specialisms. Discovering the surgical career to seamlessly fit my passion, however, proved to be a different story altogether. The much-needed revelation manifested itself in the unlikely surroundings of a minute islet off the coast of Taiwan. This confined land mass is 1,400 meters long, and no more than 250 meters wide. If it weren’t for the 140 troops who had to experience 2 years of military service upon graduation just like me, it would be uninhabited – for a reason. So there I was, performing my duties as a secondary lieutenant, surrounded by similarly dressed colleagues. It was boring at times and, in all honesty, my situation and appearance were incomparable to my college years in so many ways. But, as the saying goes: a man’s got to do what a man’s got to do. And yet, I think I needed this drastic change of scenery. Because at some point, the following thought hit me: general surgery, neurosurgery, and similar specialisms are mostly long-term, complex, and multi-faceted. Procedures are not easily standardized, nor predictable. In addition, I felt that the immediate effect of surgical interventions would be too minimal to my taste, and too marginal at that. For me, the surgical careers I deemed cool up to that point were much like an infantry lieutenant’s: groveling towards a solution through a possibly hostile landscape that sometimes seems barely recognizable. As a contrast, I continued, an air force fighter pilot can sort a huge effect with one well-aimed action. The elegant, dense eye allows for precisely that kind of intervention: quick, smooth, well-thought, and aimed at one isolated target to cause a huge impact – in a positive sense, that is. So I decided to follow this wonderful dream of mine and to engage in the profession that, in my opinion, compares to that of the air force fighter pilot. And so far, I haven’t regretted my decision at any time.”

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Steps for toric implantation Cataract surgery is perceived as a quick and relatively simple procedure. However, in case of astigmatism, the work of a multidisciplinary team and a specific surgical approach of its pre-, per- and postoperative phases is necessary for best outcomes. These steps are composed by OPHTEC in cooperation with Dr Mariano Royo and his Optometrist Ángel Jiménez, Hospital San Rafael, Madrid. 1. Select patients with healthy corneas and symmetrical astigmatism. Irregular astigmatism is a ‘relative’ contraindication. 2. ATR astigmatism ≥ than 0.75D should be corrected with Toric IOLs. WTR astigmatism ≥ 1.25 D should be corrected by Toric IOLs. 3. It is vital to understand the devices you work with. Think about maintenance and calibration and how to best operate them. 4. The effect of the posterior cornea on the total corneal astigmatism should not be disregarded. In case it cannot be measured directly with a device, it is best to implement the Barrett Formula. 5. In case the main incision is always placed on the same place on the cornea (superior / temporal), it is best to use a SIA value of 0.10 D.* 6. For the toric calculation, it is best to use corneal topography for the axis of the corneal astigmatism. 7. Optimize IOL calculation constants based on your own personal data. 8. Use Toric IOLs that are aspheric in both sphere and cylindrical powers. 9. Be a perfectionist in the marking of the cornea.

OPHTEC’s specialized team offers support with the analysis and performing of (toric) lens calculations. We help interpreting data and advise on the right choice of IOLs. For more information contact: calculations@ophtec.com

10. It is recommended to use a Capsular Tension Ring that stabilizes the IOL and ensures its effective position.

Precizon Toric online information Prof. George Beiko, Canada ‘Initial experience with toric lens tolerant of misalignment’

Prof. Dr Mike Holzer, Germany ‘Diagnostic and surgical specifications for toric IOL implantation and experiences with the Precizon toric IOL’

Dr João Paulo Cunha, Portugal ‘Evaluation of a Precizon Toric Intraocular lens. Stability and Aberrometry’

Dr Tiago Ferreira, Portugal ‘How to improve results with the Precizon Toric by evaluating astigmatism with a new color-LED topographer’

Prof. Tae-Im Kim, Korea ‘Korean experience of Precizon Toric IOL’

Dr Emilio Segovia, Spain ‘12 months experience with the Precizon Toric intraocular lens’

Dr Eunice Guerra, Portugal ‘Visual Performance and Stability of a Monofocal Toric IOL Precizon by Ophtec’

Dr Mercè Morral, Spain ‘Astigmatism Management in Cataract Surgery with a New Aspheric Toric Intraocular Lens’

Dr Carolina Vale, Portugal ‘Astigmatism management in cataract surgery with Precizon Toric IOL: Prospective study’

Zie: www.youtube.com/ophtecbv Playlist: Preciozn Toric 22 OPH//THE//RECORD

COMPREHENSIVE PLATFORM MANAGEMENT ASTIGMATISM

Precizon Toric

Robomarker

Cassini EKR and TCA

‘If you want to travel fast, go alone; If you want to travel far, go together’ African proverb

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, a n n Vie ...the world’s best city to live in!

There are many exciting places everywhere, but this year’s host of the ESCRS, Vienna, is the best city in the world to reside. This is the outcome of a new ranking by Mercer, one of the world’s largest international human resources consulting firms. Each year, Mercer carries out a study in order to assess the quality of life in 231 cities around the world. The survey compares the political, social and economic climate, medical care, education, and infrastructural conditions such as public transportation, power and water supply. It also takes into consideration recreational offers such as restaurants, theaters, cinemas, sports facilities, the availability of all kinds of consumer goods from food to cars, as well as environmental conditions - from green space to air quality. www.mercer.com

By Thomas Ledl [CC BY-SA 4.0 (https://creativecommons.org/licenses/by-sa/4.0)], from Wikimedia Commons

AAKH-1784By Josef & Peter Schafer [Public domain], via Wikimedia Commons.jpg

Vienna Giant Wheel; Treasure of European film culture

Vienna: home of the world’s oldest University Eye Clinic

You can find this huge eye, the Wiener Riesenrad (Vienna Giant Wheel) at the entrance of the Prater amusement park. It is one of the city’s symbols and offers a breathtaking view of the city on the Danube. It was constructed in 1897, to mark the golden Jubilee of Emperor Franz Josef I. It was one of the earliest Ferris wheels ever built and the world’s tallest Ferris wheel from 1920 until 1985. It was built with 30 gondolas, but was severely damaged in World War II and when it was rebuilt only 15 gondolas were replaced. The diameter of the wheel is almost 61 meters, the entire iron structure weights 430 metric tons. The wheel turns at a speed of 2.7 km/h.

The world’s oldest university eye clinic is celebrating its 200th birthday this year. Located at the Medical University of Vienna, the Department of Ophthalmology and Optometry was officially founded in 1818 when an ophthalmology chair had been established. Two years before that memorable date, an eye clinic had already seen the light of day at Vienna’s General Hospital (in those pioneering days, this eye clinic was part of the Viennese Medical School). George Joseph Beer (1763-1821) was the first chair of the Eye Clinic and he achieved a considerable international reputation for both scientific research and education. Famous students of the eye clinic include William Mackenzie (1791-1868), Philipp Franz von Walther (1782-1849), Carl Ferdinand von Graefe (1787-1840), Johann Nepomuk Fischer (1777-1847), Konrad Johann Martin Langenbeck (1776-1851), Anton von Rosas (1791-1855), Maximilian Joseph von Chelius (1794-1876), Francesco Flarer (1791-1859), and Christoph Friedrich Jaeger Ritter von Jaxtthal (1784-1871). Boasting a wide array in both academic and medical ophthalmic topics, Vienna’s Eye Clinic has developed into one of Europe’s largest eye clinics. www.meduniwien.ac.at

The wheel is not only famous because of it’s history, or it’s amazing view. It has played the “lead role” in several films, such as “The Third Man” with Orson Wells or in the James Bond film “The Living Daylights” with Timothy Dalton. Therefore, the wheel was placed on the list of Treasures of European Film Culture by the European Film Academy in June 2016. The Giant Feris Wheel is open all year round. www.wienerriesenrad.com

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A look (or feel) at The Kiss (Lovers) The Kiss (Lovers) by Gustav Klimt is one of the most famous Austrian paintings and the highlight of the permanent collection at the Upper Belvedere museum in Vienna. The painting dates from 1907/08 at the height of Klimt’s ‘Golden Period’ when the artist started combining gold leaf with oils and bronze paint. Next to the original painting of The Kiss, there is a version for blind and visually impaired people. The Kiss has been transformed into an interactive tactile relief to enable visually impaired people to experience this work of art. The paintings can be seen / felt in the Upper Belvedere palace. www.belvedere.at

Gustav Klimt [Public domain], via Wikimedia Commons (2)

Vienna view with video animations For the perhaps most beautiful view of the city of Vienna, you can visit the top floor of the Sofitelhotel. Here is a restaurant and bar Das Loft with high windows around that offer a beautiful view of the city. It has a spectacular ceiling with video animations, designed by media artist Pipilotti Rist. In the evening, the building looks spectacular from the outside as well. www.dasloftwien.at

Palais Ferstel; Italian architecture for a Viennese bank and stock exchange. Palais Ferstel is one of the amazing buildings in Vienna’s city centre. It was built in 1856-1860 by a young architect, Heinrich Ferstel. Brimming with inspiration following a trip to Italy, he built the opulent Palais Ferstel in the Venetian/Florentine Trecento style. He used steel to support a glass ceiling for the first time and a water-based cooling system. At that time, it was the most modern building in the capital. Palais Ferstel was built on behalf of the National Bank. The advancing industrialization in 19th century Vienna brought about a rapid development of money transactions and banking. The existing premises of the National Bank were no longer sufficient. That is why a new building was necessary. According to the wishes of the then governor of the National Bank, Franz von Pipitz, The building was supposed to offer the National Bank, the stock exchange, a coffee house and a bazaar. Today the Palais offers a uniquely versatile for unforgettable celebrations and business-related events.

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OPHTEC News ARTISAN Ambassador 2017

OPHTEC expands

In 2017 the Artisan Ambassador award was given to Dr Roberto Fernández Buenaga from Madrid. He was presented with this award directly from Erik-Jan Worst during the OPHTEC user meeting in Lisbon. Erik-Jan Worst praised the manner in which Fernández inspires young ophthalmologists during the ArtiLens trainings he gives for OPHTEC. The Artisan Ambassador award is an annual prize given to doctors who commit themselves to the promotion of the Artisan lens. The next ambassador will be announced during the ESCRS.

The building next to the current OPHTEC premises on the Schweitzerlaan in Groningen was bought and has been renovated. Later this year the OPHTEC Innovation Centre will become fully functional in this building. In the current OPHTEC premises, a new production facility was set up after the internal renovation was completed in 2017.

2018 Roberto Fernández Buenaga (2nd left) together with Erik-Jan Worst and Ambassadors of the years before; Left to right: Dr S. Mahoeb, Dr R. Fernández Buenaga, Dr F. Pérez, Erik-Jan Worst, Dr C. Budo, Dr J.L. Güell, Prof. M. Izák, Dr M. Forlini.

The OPHTEC Innovation Center

Upcoming ArtiLens courses

New production facility in the current OPHTEC premises, set up after the internal renovation was completed in 2017.

ArtiLens Phakic IOLs

2018, October 20, Madrid, Spain 2018, October 26/27, Berlin, Germany 2018, November 16, Groningen, the Netherlands (Full) 2018, November 24, Barcelona, Spain

ArtiLens Aphakic IOL

2018, October 6, Düsseldorf, Germany

Wetlabs

2018, October, 27 - 29 Chicago, USA, AAO (OPHTEC organizes in-booth ArtiLens wetlabs during all major ophthalmic conferences worldwide) Visit our website www.ophtec.com for more information on ArtiLens courses.

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Engineers Bert Bodewes and Erwin Kerstholt in OPHTEC’s new production facility.

The Miradas

2018 Touring art exhibition Miradas is a Spanish word for: look, gaze, glance or peek. This word is also the name given to a traveling art exhibition that once started in Spain but has found its way beyond the Spanish borders today. The aim of this exhibition is to promote and attract the attention of both artists and society, to raise awareness for visual impairments and to assist in the prevention of blindness. The Jorge Alió Foundation, in collaboration with OPHTEC, public and private entities, organize the exhibition. The Miradas exposition is also a competition. There are prizes in several categories, such as ‘Best Miradas’, ‘Best Professional and Artistic Trajectory’, as well as the ‘Jorge Alió Foundation Award’ and ‘Best Novel Artist’. Furthermore, there are honourable mentions. OPHTEC’s Yvonne Hernández had the honour to announce the names of the prize winners of the Spanish edition of the Miradas last April. These winners will represent Spain at the international edition of Miradas in the USA. The names of the winners there will be announced during the AAO in Chicago, by OPHTEC’s president and CEO Erik-Jan Worst. More information: www.fundacionalio.com

Left to right: Yvonne Hernández (OPHTEC), Ana Beltrán Porcar (prize winning artist) and Maria López Iglesias (organizing director of Miradas).

Winning art works:

Muchachito Ana Beltrán Porcar Oil on Canvas, 75 x 120 cm

Mirada Virtual José Enrique Gómez Perlado Oil on Canvas, 130 x 130 cm

Ameninatropia José Antonio Hinojos Morales Oil on Canvas, 130 x 110

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Aspheric Monofocal IOL

Aspheric Toric IOL

www.ophtec.com