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Laser Blended Vision for Presbyopia:

An Eight-in-one procedure

Dan Z Reinstein MD MA(Cantab) FRCSC FRCOphth1,2,3,4

1. London Vision Clinic, London, UK


2. St. Thomas’ Hospital - Kings College, London, UK
3. Weill Medical College of Cornell University, New York, USA
4. Centre Hospitalier National d’Ophtalmologie, (Pr. Laroche), Paris, France

This indication for use is not cleared by the


FDA for distribution in the United States
Financial Disclosure

The author (DZ Reinstein) acknowledges a


financial interest in Artemis™ VHF digital
ultrasound (ArcScan Inc, Morrison, CO)

The author (DZ Reinstein) is a consultant


for Carl Zeiss Meditec AG (Jena, Germany)

©DZ Reinstein 2010


dzr@londonvisionclinic.com
Laser Blended Vision: 8-in-1 Mechanism
1. Monovision principle 5. Retinal image processing [edge
detection]
2. Depth of field to reduce anisometropia
6. Neural summation
3. Spherical aberration control 7. Blur adaptation
[DOF without decrease quality of vision] 8. Neural suppression
4. Vertex centration of spherical aberration
[OSA coma, on-axis symmetry of image blur]

©DZ Reinstein 2010


dzr@londonvisionclinic.com
Laser Blended Vision: 8-in-1 Mechanism
1. Monovision principle 5. Retinal image processing [edge
detection]
2. Depth of field to reduce anisometropia
6. Neural summation
3. Spherical aberration control 7. Blur adaptation
[DOF without decrease quality of vision] 8. Neural suppression
4. Vertex centration of spherical aberration
[OSA coma, on-axis symmetry of image blur]

©DZ Reinstein 2010


dzr@londonvisionclinic.com
Presbyopia: Ideal Solution
Right Eye Left Eye
Far Distance

Distance

Intermediate

Near

©DZ Reinstein 2010


dzr@londonvisionclinic.com
Influence of Spherical Aberration on Depth of Field
without spherical aberration

with spherical aberration

Slides courtesy Hartmut Vogelsang, PhD


©DZ Reinstein 2010
dzr@londonvisionclinic.com
Influence of Spherical Aberration on Depth of Field

0.00 D -0.50 D -1.00 D -1.50 D -2.00 D


without
spherical
aberration

with
spherical
aberration

Slides courtesy Hartmut Vogelsang, PhD


©DZ Reinstein 2010
dzr@londonvisionclinic.com
Influence of Pupil Diameter on Depth of Field

0.00 D -0.50 D -1.00 D -1.50 D -2.00 D


@ 7 mm

@ 4 mm

Slides courtesy Hartmut Vogelsang, PhD


©DZ Reinstein 2010
dzr@londonvisionclinic.com
Influence of Pupil Diameter & Spherical Aberration on Depth of Field

0.00 D -0.50 D -1.00 D -1.50 D -2.00 D


@ 7 mm

with
spherical
aberration
@ 4 mm

Slides courtesy Hartmut Vogelsang, PhD


©DZ Reinstein 2010
dzr@londonvisionclinic.com
Non-Linear Aspheric Presbyopic Ablation Profiles

• New Presbyopic Profile


• Increases depth of field
• Based on non-linear changes in asphericity

Linear Aspheric Non-Linear Aspheric

©DZ Reinstein 2010


dzr@londonvisionclinic.com
Simulation for -1.50 D defocus
-1.50 D @ 7 mm

Reduce pupil size to 4 mm Add spherical aberration

With spherical aberration


and @ 4 mm

Central neural processing


©DZ Reinstein 2010
dzr@londonvisionclinic.com
Laser Blended Vision: 8-in-1 Mechanism
1. Monovision principle 5. Retinal image processing [edge
detection]
2. Depth of field to reduce anisometropia 6. Neural summation
3. Spherical aberration control 7. Blur adaptation
8. Neural suppression
[DOF without decrease quality of vision]
4. Vertex centration of spherical aberration
[OSA coma, on-axis symmetry of image blur]

©DZ Reinstein 2010


dzr@londonvisionclinic.com
Presbyopia: Ideal Solution
Right Eye Left Eye
Far Distance

Distance

Intermediate

Near

©DZ Reinstein 2010


dzr@londonvisionclinic.com
Current Possible Depth of Field Increase
Right Eye Left Eye
Far Distance

Distance 1.50 D 1.50 D

Intermediate

Near

©DZ Reinstein 2010


dzr@londonvisionclinic.com
Laser Blended Vision: 8-in-1 Mechanism
1. Monovision principle 5. Retinal image processing [edge
detection]
2. Depth of field to reduce anisometropia
6. Neural summation
3. Spherical aberration control 7. Blur adaptation
[DOF without decrease quality of vision] 8. Neural suppression
4. Vertex centration of spherical aberration
[OSA coma, on-axis symmetry of image blur]

©DZ Reinstein 2010


dzr@londonvisionclinic.com
Laser Blended Vision – Micro-Monovision
Dominant Eye Non-Dominant Eye
Far Distance

Distance 1.50 D 1.50 D

“Blend Zone”
Intermediate

Near

©DZ Reinstein 2010


dzr@londonvisionclinic.com
Contact Lens Monovision
Dominant Eye Non-Dominant Eye
Far Distance

Distance 1.50 D

“Blur Zone”
“Blend Zone”
Intermediate
1.50 D

Near

©DZ Reinstein 2010


dzr@londonvisionclinic.com
Contact Lens Monovision
Dominant Eye Non-Dominant Eye
Far Distance
“In contact lens monovision, there is a
need for a third focal length, for
example with computer screens at
Distance intermediate distances”

“Blur Zone”
Intermediate
Evans BJ. Monovision: a review.
Ophthalmic Physiol Opt.
2007;27:417-439.

Near

©DZ Reinstein 2010


dzr@londonvisionclinic.com
Correcting Presbyopia: Contact Lens Monovision
Evans BJ. Monovision: a review.
Ophthalmic Physiol Opt.
2007;27:417-439.

Dominant eye: 59-67%


mainly corrected Patients Tolerate
for distance

Non-dominant eye:
mainly corrected for Brain merges two images
near to see near and far without
glasses

©DZ Reinstein 2010


dzr@londonvisionclinic.com
Correcting Presbyopia: Laser Blended Vision
Reinstein DZ et al. LASIK for Hyperopic
Astigmatism and Presbyopia Using Micro-
monovision With the Carl Zeiss Meditec
MEL80. JRS. 2009;25(1):87-93

Dominant eye: ~97%


mainly corrected Patients Tolerate
for distance

Non-dominant eye:
mainly corrected for Brain merges two images
near to see near and far without
glasses

©DZ Reinstein 2010


dzr@londonvisionclinic.com
Laser Blended Vision: 8-in-1 Mechanism
1. Monovision principle 5. Retinal image processing [edge
detection]
2. Depth of field to reduce anisometropia
6. Neural summation
3. Spherical aberration control 7. Blur adaptation
[DOF without decrease quality of vision] 8. Neural suppression
4. Vertex centration of spherical aberration
[OSA coma, on-axis symmetry of image blur]

Online Feb 2010

Laser Blended Vision:


Binocular UDVA > Monocular UDVA (distance eye)

Traditional Monovision:
Binocular UDVA < Monocular UDVA (distance eye)
Evans BJ. Monovision: a review. Ophthalmic
Physiol Opt. 2007;27:417-439.

©DZ Reinstein 2010


dzr@londonvisionclinic.com
Binocular Vision: Neural Summation

Cumulative Percentage Eyes 100%


90%
80%
70%
60%
50%
40%
30%
20%
10%
0%
20/12.5 or 20/16 or 20/20 or 20/25 or 20/32 or 2
better better better better better
Near Eyes 1% 3% 15% 24% 36%
Distance Eyes 9% 45% 92% 98% 99%
©DZ Reinstein 2010
dzr@londonvisionclinic.com
Laser Blended Vision: 8-in-1 Mechanism
1. Monovision principle 5. Retinal image processing [edge
detection]
2. Depth of field to reduce anisometropia
6. Neural summation
3. Spherical aberration control 7. Blur adaptation
[DOF without decrease quality of vision] 8. Neural suppression
4. Vertex centration of spherical aberration
[OSA coma, on-axis symmetry of image blur]

©DZ Reinstein 2010


dzr@londonvisionclinic.com
Blur Adaptation
No change in Rx

Wore glasses except for


VA measurement
No glasses throughout

Wore glasses throughout

©DZ Reinstein 2010


dzr@londonvisionclinic.com
Laser Blended Vision: 8-in-1 Mechanism
1. Monovision principle 5. Retinal image processing
2. Depth of field to reduce anisometropia [edge detection]
3. Spherical aberration control 6. Neural summation
[DOF without decrease quality of vision] 7. Blur adaptation
4. Vertex centration of spherical aberration 8. Neural suppression
[OSA coma, on-axis symmetry of image blur]

©DZ Reinstein 2010


dzr@londonvisionclinic.com
Ocular Rivalry and Blur Suppression vs Multifocal
• Neuronal gates instantaneously select the better
image, or elements of each, to obtain the best image
for the task at hand
Binocular Mediating Neuron

Awareness OD

OD

OS Suppression OS

Source: Monovision in name only. William F Maloney. Ocular Surgery


News US Edition October 1, 2006

©DZ Reinstein 2010


dzr@londonvisionclinic.com
Problem With Multi-focality
Multi-focal IOLs
PROBLEM:
ReSTOR ReZoom
Two Images

Diffraction design Concentric distance


near zones

Multi-focal Ablation Profiles

Near

Far Far

Near

Anschütz,Dausch,Klein,Joly Avalos, Rozakis, Agarwal (PARM-technique, 1998)


(Meditec group, 1991) G.Tamayo (2000)
©DZ Reinstein 2010
dzr@londonvisionclinic.com
Laser Blended Vision: 8-in-1 Mechanism
1. Monovision principle 5. Retinal image processing [edge
detection]
2. Depth of field to reduce anisometropia
6. Neural summation
3. Spherical aberration control 7. Blur adaptation
[DOF without decrease quality of vision] 8. Neural suppression
4. Vertex centration of spherical aberration
[OSA coma, on-axis symmetry of image blur]

©DZ Reinstein 2010


dzr@londonvisionclinic.com
Wavefront-Guided Treatment
of Spherical Aberration
How Effective are Wavefront Repair Treatments?
Repair Group Control Group
Complaining NVDs Not Complaining
post LASIK NVDs post LASIK

16 eyes in study
4:1 matched for
Wavefront-Guided
sphere & cyl
Repair Treatment

Compare Aberrations
• Aberrations Pre-repair • Aberrations Pre-op
• Aberrations Post-repair • Aberrations Post-op

©DZ Reinstein 2010


dzr@londonvisionclinic.com
Correlation of Contrast with Wavefront
Normalized Contrast Sensitivity Ratio
Spherical Aberration
Average RAWS Parameter
Before & After Routine LASIK with the MEL80
Before & After CRS-Master Wavefront Guided Repair
Contrast Sensitivity
Before & After Routine LASIK with the MEL80
Before & After CRS-Master Wavefront Guided Repair

900 1.2
800 t 1.1
s
700 a
rt iot 1.0
600 n a
o R
C y 0.9
500 d itv
e i
2 400 iz t
l is 0.8
a n
m 300 rm e 0.7
µ o S
200 N
0.6
100
0.5
0 3 cpd 6 cpd 12 cpd 18 cpd
Pre CRS-M Post CRSM-
Control Pre Control Post Control Pre 1.02 1.02 1.03 1.04
Repair Repair
Control Post 1.04 1.01 1.03 1.01
Sph Ab Area 122 276 563 410 Pre CRSM-Repair 0.85 0.84 0.77 0.75
Post CRSM-Repair 1.04 1.02 1.02 1.00

©DZ Reinstein 2010


dzr@londonvisionclinic.com
Correlation of Contrast with Wavefront
Normalized Contrast Sensitivity Ratio
Spherical Aberration
Average RAWS Parameter
Before & After Routine LASIK with the MEL80
Before & After CRS-Master Wavefront Guided Repair
Contrast Sensitivity
Before & After Routine LASIK with the MEL80
Before & After CRS-Master Wavefront Guided Repair

900 1.2
800 t 1.1
s
700 a
rt iot 1.0
600 n a
o R
C y 0.9
500 d itv
e i
2 400 iz t
l is 0.8
a n
m 300 rm e 0.7
µ o S
200 N
0.6
100
0.5
0 3 cpd 6 cpd 12 cpd 18 cpd
Pre CRS-M Post CRSM-
Control Pre Control Post Control Pre 1.02 1.02 1.03 1.04
Repair Repair
Control Post 1.04 1.01 1.03 1.01
Sph Ab Area 122 276 563 410 Pre CRSM-Repair 0.85 0.84 0.77 0.75
Post CRSM-Repair 1.04 1.02 1.02 1.00

• 27% Gross Reduction


• 53% Net Reduction (cf tolerable level)
• Tolerable level ~0.56 µm @ 6mm

©DZ Reinstein 2010


dzr@londonvisionclinic.com
Spherical Aberration Control: The inside scoop

-10 D

Only 27% Effect


-10 D

-10 D

-10 D

6mm Zone
-9.25D ablation

©DZ Reinstein 2010


dzr@londonvisionclinic.com
Laser Blended Vision: 8-in-1 Mechanism
1. Monovision principle 5. Retinal image processing
2. Depth of field to reduce anisometropia [edge detection]
3. Spherical aberration control 6. Neural summation
[DOF without decrease quality of vision] 7. Blur adaptation
4. Vertex centration of spherical aberration 8. Neural suppression
[OSA coma, on-axis symmetry of image blur]

©DZ Reinstein 2010


dzr@londonvisionclinic.com
Centration: Visual Axis vs Entrance Pupil
Phoroptor Manifest Refraction Excimer Laser Ablation
No Angle Kappa Large Angle Kappa
Phoroptor Lens

Phoroptor Lens

Ablation Profile
©DZ Reinstein 2010
dzr@londonvisionclinic.com
Laser Blended Vision: 8-in-1 Mechanism
1. Monovision principle 5. Retinal image processing
2. Depth of field to reduce anisometropia [edge detection]
3. Spherical aberration control 6. Neural summation
[DOF without decrease quality of vision] 7. Blur adaptation
4. Vertex centration of spherical aberration 8. Neural suppression
[OSA coma, on-axis symmetry of image blur]

Outcomes

©DZ Reinstein 2010


dzr@londonvisionclinic.com
Measurement of Effective
Depth of Field

Example: Emmetropic Patient


Laser BV Emmetropic LASIK – 56 yo Female

56 yo OD OS Binocular

Pre

Manifest +0.75 -0.75 x 158 +0.50 -0.75 x 170

BSCVA 20/16 20/16


1 Yr Post Op

UCVA 20/16 20/32 20/16 & J2

Manifest +0.25 sph -1.00 -0.50 x 20

BSCVA 20/16 20/16

©DZ Reinstein 2010


dzr@londonvisionclinic.com
Expected Distance UCVA

• Near eye Rx: -1.00 -0.50 x 20


– SEQ -1.25 D UCVA 20/63

20
Distance UCVA (logMar)

20/20 0.00
25
20/25 -0.25
32
40 20/32 -0.50
50 20/40 -0.75
63 20/50 -1.00
80
20/63 -1.25
100
125 20/80 -1.50
160
©DZ Reinstein 2010
dzr@londonvisionclinic.com
Expected Distance UCVA

• Near eye Rx: -1.00 -0.50 x 20


– SEQ -1.25 D UCVA 20/63
– Actual UCVA 20/32 -0.50 D
20
Distance UCVA (logMar)

20/20 0.00
25
20/25 -0.25
32
40 20/32 -0.50
50 20/40 -0.75
63 20/50 -1.00
80
20/63 -1.25
100
125 20/80 -1.50
160
©DZ Reinstein 2010
dzr@londonvisionclinic.com
Expected Near Addition – 56 yo Female

• Near eye Rx: -1.00 -0.50 x 20


– SEQ -1.25 D UCVA 20/63
– Actual UCVA 20/32 -0.50 D
20 Age Add
Distance UCVA (logMar)

25 50-52 +1.50 D
32
52-54 +1.75 D
40
50 54-56 +2.00 D
63 56-58 +2.25 D
80 Over 58 +2.50 D
100
125 Near UCVA: J2
160
©DZ Reinstein 2010
dzr@londonvisionclinic.com
Depth of Field – 56 yo Female

• Near eye Rx: -1.00 -0.50 x 20


– SEQ -1.25 D UCVA 20/63
– Actual UCVA 20/32 -0.50 D
20 Depth of field: 1.50 D Age Add
Distance UCVA (logMar)

25 50-52 +1.50 D
32
52-54 +1.75 D
40
50 54-56 +2.00 D
63 56-58 +2.25 D
80 Over 58 +2.50 D
100
125 Near UCVA: J2
160
©DZ Reinstein 2010
dzr@londonvisionclinic.com
Outcomes of Non-linear Aspheric Presbyopic
Micro-monovision LASIK for Myopia,
Hyperopia, and Emmetropia

Online Feb 2010


Blended Vision: Methods
Myopia Hyperopia Emmetropia

# Patients 136 111 119

SEQ -3.58 ± 1.80 D +2.58 ± 1.17 D +0.35 ± 0.35 D


up to -8.50 D up to +5.75 D -0.50 to +0.75 D

Cylinder -0.83 ± 0.64 D up -0.49 ± 0.50 D up -0.39 ± 0.30 D up


to -2.50 D to -3.25 D to -1.00 D

Age median 49 yrs median 56 yrs median 54 yrs


43 to 63 44 to 66 43 to 71

©DZ Reinstein 2010


dzr@londonvisionclinic.com
Routine LASIK Procedure
• Hansatome 160
• CRS-Master custom programming
– Non-linear aspheric ablation profile DOF
• MEL80 excimer laser
• Micro-monovision:
– Dominant: “plano” [plano to -0.75]
– Non-dominant: “-1.50 D” [-0.75 to -2.25]

• >90% follow up at 1 year


• Results presented including enhancements

©DZ Reinstein 2010


dzr@londonvisionclinic.com
Blended Vision: Efficacy – Distance Eye

Cumulative Percentage Eyes 100%


90%
80%
70%
60%
50%
40%
30%
20%
10%
0%
20/12.5 or 20/16 or 20/20 or 20/25 or 20/32 or
better better better better better
Myopia 13% 49% 98% 99% 99%
Hyperopia 6% 37% 86% 99% 100%
Emmetropia 8% 47% 92% 96% 99%
©DZ Reinstein 2010
dzr@londonvisionclinic.com
Blended Vision: Efficacy – Near Eye

100%
90%
Cumulative Percentage Eyes

80%
70%
60%
50%
40%
30%
20%
10%
0%
20/12.5 20/16 or 20/20 or 20/25 or 20/32 or 20/40 or 20/63 or 20/8
or better better better better better better better bet
Better than expected distance
Myopia 0% 4% 20% 31% in the48%
vision near eye60% 87% 94
Hyperopia 0% 2% 15% 25% 38% 45% 80% 94
Emmetropia 2% 3% 8% 14% 22% 27% 74%
©DZ Reinstein 2010 84
dzr@londonvisionclinic.com
Blended Vision: Efficacy – Binocular Distance

Cumulative Percentage Eyes 100%


90%
80%
70%
60%
50%
40%
30%
20%
10%
0%
20/12.5 or 20/16 or 20/20 or 20/25 or 20/32 or
better better better better better
Myopia 18% 61% 98% 99% 100%
Hyperopia 9% 47% 95% 99% 100%
Emmetropia 11% 51% 96% 97% 100%
©DZ Reinstein 2010
dzr@londonvisionclinic.com
Binocular Vision: Neural Summation

Cumulative Percentage Eyes 100%


90%
80%
70%
60%
50%
40%
30%
20%
10%
0%
20/12.5 or 20/16 or 20/20 or 20/25 or 20/32 or 2
better better better better better
Near Eyes 1% 3% 15% 24% 36%
Distance Eyes 9% 45% 92% 98% 99%
©DZ Reinstein 2010
dzr@londonvisionclinic.com
Blended Vision: Pre BSCVA vs Post UCVA
“SUCCESS!”

70%
All Groups:
60%
Percentage Distance Eyes

94% eyes in the box


50%

40%

30%

20%

10%

0%
3 worse 2 worse 1 worse Same 1 be
Myopia 0.7% 1.5% 27.9% 47.1% 22.1
Hyperopia 1.8% 7.3% 19.1% 60.0% ©DZ Reinstein 2010
10.9
dzr@londonvisionclinic.com
Blended Vision: Efficacy – Near Vision

Cumulative Percentage Eyes 100%


90%
80%
70%
60%
50%
40%
30%
20%
10%
0%
J2 or better J3 or better J5 or better J7 or better
Myopia 96% 99% 100% 100%
Hyperopia 81% 94% 100% 100%
©DZ Reinstein 2010
dzr@londonvisionclinic.com
Laser Blended Vision: Results
Emmetropic
Population
(In Press)
Online Feb 2010

20/20
J5
Myopia Hyperopia Emmetropia
20/20 & J5 20/20 & J5 20/20 & J5
98.5% 94.5% 97.7%
©DZ Reinstein 2010
dzr@londonvisionclinic.com
Blended Vision: Accuracy

100%
Cumulative Percentage Eyes

90%
80%
70%
60%
50%
40%
30%
20%
10%
0%
Within Within Within Within Within W
0.25D 0.50D 0.75D 1.00D 1.25D 1
Myopia 66% 91% 96% 99% 100% 1
Hyperopia 58% 79% 92% 95% 98%
©DZ Reinstein 2010 1
dzr@londonvisionclinic.com
Blended Vision: Safety

70%

60%

50%
Percentage Eyes

40%

30%

20%

10%

0%
Loss 2 or More Loss 1 No Change Gain 1
Myopia 0.0% 8% 55% 36%
Hyperopia 0.0% 17% 62% 19%
©DZ Reinstein 2010
dzr@londonvisionclinic.com
Emmetropia BV: Contrast Sensitivity

Myopia Hyperopia Emmetropia

* * *
* * *

Statistically significant improvement (p<0.05)

©DZ Reinstein 2010


dzr@londonvisionclinic.com
Achieving Excellent Results

©DZ Reinstein 2010


dzr@londonvisionclinic.com
Stereo Acuity
Stereo Acuity: Patients & Methods
• 22 myopes, 38 hyperopes, 16 emmetropes

• Stereo acuity measurements (4-dot test)


– Pre-op: near-corrected
– Post-op: near-corrected
– Post-op: uncorrected # Patients 76
SEQ -0.40 ± 2.69 D
-7.13 to +3.75 D

• Analysis Cylinder -0.73 ± 0.54 D


up to -2.25 D
– Safety: post-op near corrected – pre-op near
Age median 57 yrs
corrected
45 to 69
– Efficacy: post-op uncorrected – pre-op near
corrected

©DZ Reinstein 2010


dzr@londonvisionclinic.com
Stereo Acuity: Safety
(near-corrected pre vs near-corrected post)
• 4-5% of patients with excellent pre-op stereo acuity (40-50 sec) lost 1 patch
• Post-op near-corrected stereo acuity equivalent to pre-op for ≥60 sec
• No statistically significant difference (p=0.376)

All Patients- Stereo Acuity- Safety


100% 99% 100% 99% 100% 100% 100% 100% 100% 100%
98% 98%
100% 95% 94%
s
tn 90% 87%
83%
e
it
a 80% 72%
P 68%
e
g 70%
a
ta 60%
n
e
c 50%
r
e 40%
P
e
iv
ta 30%
l 20%
u
m
u 10%
C
0%
40 50 60 80 100 140 200 400 800
Pre-Corrected 72% 87% 95% 98% 100% 100% 100% 100% 100%
Post-Corrected 68% 83% 94% 98% 99% 99% 100% 100% 100%
StereoAcuity(seconds)

©DZ Reinstein 2010


dzr@londonvisionclinic.com
Stereo Acuity: Efficacy
(near-corrected pre vs uncorrected post)
• Post-op uncorrected stereo acuity lower than pre-op near-corrected (p<0.001)
• But, majority of patients maintained functional stereo acuity
– 68% achieved 100 secs
– 93% achieved 200 secs

All Patients- Stereo Acuity- Efficacy


100% 100% 100% 100% 100% 100%
98% 96%
100% 95%
s
tn
93%
90% 87%
e
it
a 80% 77%
P 72%
e
g 70% 68%
a
ta 57%
n 60%
e
c
r 50% 46%
e 38%
P 40%
e
v
it 30% 23%
a
l
u 20%
m
n 10%
u
C
0%
40 50 60 80 100 140 200 400 800
Pre-Corrected 72% 87% 95% 98% 100% 100% 100% 100% 100%
Post-Uncorrected 23% 38% 46% 57% 68% 77% 93% 96% 100%
StereoAcuity(seconds)

©DZ Reinstein 2010


dzr@londonvisionclinic.com
Non-linear Aspheric Micro-Monovision:
Summary
Summary
• Non-linear aspheric micro-monovision
– Correction of pure presbyopia (distance normal)
– Wide range of refractive error: +5.00 to -9.00
– Simultaneous accurate correction of cylinder
– Easily enhanced in future if required
– Centration on visual axis
– Minimal compromise to contrast sensitivity and night
vision disturbances
– Tolerated by >95% of patients
– Functional stereo acuity maintained
– Performed as bilateral simultaneous 10 minute
procedure with fast recovery
©DZ Reinstein 2010
dzr@londonvisionclinic.com
Laser Blended Vision for Presbyopia:
An Eight-in-one procedure

Dan Z Reinstein MD MA(Cantab) FRCSC1,2,3,4

1. London Vision Clinic, London, UK


2. St. Thomas’ Hospital - Kings College, London, UK
3. Weill Medical College of Cornell University, New York, USA
4. Centre Hospitalier National d’Ophtalmologie, (Pr. Laroche), Paris, France

This indication for use is not cleared by the


FDA for distribution in the United States
Thank You