This document discusses different types of intraocular lenses (IOLs) used to correct presbyopia. It begins by explaining that monofocal IOLs only correct far vision and do not provide near vision correction without glasses. It then describes multifocal IOLs, including bifocal and trifocal lenses, which aim to provide both near and far vision corrections simultaneously. The document discusses key principles and technologies used in multifocal IOLs, specifically refractive lenses with multiple zones, diffractive lenses using interference patterns, and apodized diffractive lenses. It provides details on specific IOL models and compares technologies between traditional bifocal, trifocal, and newer trifocal lenses.

1. Principle
of
Presbyopia Correcting IOLs
M.Khanlari , MD

2. Introduction
What are Monofocal IOLs?
• Monofocal IOLs have only one optical power
• Monofocal IOLs are usually implanted to correct the patient’s FAR
VISION
• As a matter of fact, the pseudophakic patient implanted with a
monofocal IOL has lost accommodation, therefore needs glasses for
NEAR CORRECTION
Far correction Near correction

3. Application
What are Multifocal IOLs?
• Bifocal IOLs bend or spread the light in two different focus points:
• one for NEAR VISON
• one for FAR VISION
• The goal of a multifocal implantation is to provide the
pseudophakic patient both corrections for FAR and NEAR VISION
simultaneous distance and and near correction

4.  Hoffer in 1982 was the first to hit upon the idea of a multifocal IOL
after observing a patient who had 6/6 vision in spite of an IOL that
was decentered by more than 50% of the pupillary area
 The credit goes to Dr John Pierece in 1986 who was to implant the
bull’s eye style of the multifocal IOL

5. Concepts for multifocal and presbyopia
correcting lenses
• Refractive bifocal lenses
• NaturaLens(Eyekon)
• Refractive birefringent bifocal lenses
• Refractive multifocal lenses
• Rezoom(Amo), Mflex(Rayner), Array(Amo)
• Asymmetric zonal refractive lenses
• Oculentis Mplus (Oculentis)
• Diffractive bifocal lenses
• Diffractive Multifocal lenses
• Restor(Alcon) , Tecnis (Abbot)
• Enlighten new trifocal
• Panoptix(Alcon)
• Hybrid diffractive/refractive trifocal lenses (LISA)
• ATlisa(zeiss), PhysIOL(Finevision)
• Extended depth of focus

6. Refraction vs. Diffraction
• Refraction: An optic with a smooth, continuous surface that bends light rays,
focusing them into a single image.
• Diffraction: An optic surface that contains physical steps, that divides light waves into
wavelets that form the near & distant images on the retina

7. Asymmetric zonal refractive lenses

8. Asymmetric zonal refractive lenses
• LENTIS Mplus IOL (Oculentis GmbH) one-piece zonal
refractive lens was the first commercially available IOL to
have a rotationally asymmetric design.
• It features plate haptics and two refractive segments,
• a large aspheric distance- vision zone and
• a sector-shaped near vision zone with an addition of 3.00 D to
direct light to a near focal point.

9. Compared with the LENTIS Mplus IOL (left), the Mplus X IOL (right)
features additive paraxial asphericity(APA) and surface desighn
optimisation(SDP)

10. Conventional refractive bifocal lenses
ReZoom RaynerMflexArray

11. Optical Principles
Refraction
Refraction is a fundamental property of light.
•Refraction is created when light passes media with different refractive indices
•Snell’s (Descartes‘) law of refraction provides the basis of calculation:
n sin i = n‘ sin i‘
• Essential characteristics:
– The law of refraction is non-linear!
Most types of aberrations are due to these non-linear effects!
– Also applies to reflection (negative refractive index!)
– For small angles of incidence, the law of refraction
can be linearized:
n i = n‘ i‘ (paraxial approximation)
n‘
n
i
i‘

12. Optical Principles
How do refractive multifocal IOLs work?
• 2 to 7 refractive zones, alternating for near and far focus
• function depends on the pupil size and centration
• segmented surfaces with well defined power
• Distance / Near energy split accomplished by geometric
segmentation of pupil
21.10.2009
near focus far focus

13. near power zone
in the distance focus ray 1 and ray 2
exhibit an optical path length difference
consequence: partially destructive
interference
wavefront
ray 1 through a zone
of distance power
ray 2 through a zone
of distance power
additional
path t
Drawbacks:
•Pupil size dependent
•Wave optics conditions “phase matching” not fulfilled
•“diffractive mismatch“ causes image degradation
Conventinal refractive bifocal lenses

14. n=near
e.g. IOLAB
NuVue
e.g. Storz
True Vista
Zonal Refractive Multifocal Lenses
d=distance
e.g. AMO
Array
d n
d
n
d
n
d
2 zones 3 zones
5 zones
d
Zonal Refractive
• Uses the concept of refraction to create an optic that provides multiple
images
• Intermittent refractive rings are placed in different zones of the optic
• One ring is dedicated to distance, another to near

15. Zonal Refractive Multifocal Lenses
 Lens surface is not continuous (i.e., smooth)
The boundaries between zones are optical
discontinuities
 Annular (ring-shaped) lens regions have reduced
image quality
Light spreads out at the inner & outer boundaries
d n
d
n

16. Refractive Multifocal IOL
d n
d
n
Light energy equally shared
over broad range of
pupils/lighting conditions,
contributes to halos at night
Light energy equally shared for
bright to moderate lighting/pupils
– apodization gradually increases
distance energy with larger pupils
- reduces halos at night
Zonal Refractive (5 Zones) – AMO Array
Full Optic Diffractive – 3M/Pfizer 811E
Apodized Diffractive - Alcon
d
0
0.1
0.2
0.3
0.4
0.5
0.6
0.7
0.8
0.9
1
1 2 3 4 5
Pupil Diameter (mm)
RelativeEnergy
0
0.1
0.2
0.3
0.4
0.5
0.6
0.7
0.8
0.9
1
1 2 3 4 5 6
Pupil Diameter (mm)
RelativeEnergy
Distance Focus
Near Focus0
0.1
0.2
0.3
0.4
0.5
0.6
0.7
0.8
0.9
1
1 2 3 4 5
Pupil Diameter (mm)
FractionalEnergy
AMOd AMOn
Light energy dramatically varies
with number of zones exposed by
pupil, contributes to halos at night
0
0.5
1
1.5
2
2.5
3
Distance
Distance
Distance
Near
Near

17. Conventional Diffractive lenses
Tecnis FinevisinRestor

18. What is a wavefront?
plano wavefront
circular wavefont distorted wavefront
Light ray = wave train

19. Wave trains in parallel phase relation
Constructive interference
•two light trains (blue & red) oscillate in parallel
•the resultant light train (green) has an amplitude
which is twice the individual
amplitudesWave trains in opposite phase relation
Destructive interference
•two light trains (blue & red) oscillate in
opposite direction
•the resultant light train(green) amplitude
is 0General case:
Partially destructive interference
•two light trains (blue & red) oscillate in
arbitrary, but constant phase relation
•the resultant light train(green) amplitude
is between 0 and total sum of both aplitudes
Phase relation and interference of
waves

20. Optical Principles
Principles of Diffraction
Diffraction
•Diffraction is the bending of waves round an obstacle or through a hole
•Plane waves are transformed into spherical waves after diffraction
•Spherical wave propagation form different diffraction points leads to wave interference
according to the Huygens-Fresnel principle
•Interference refers to the combination of two or more wave fronts
• Wave interference patterns depend on phase shifts between
different wave fronts
• Destructive interference due to opposite phase relation leads
to 0 amplitude
• Constructive interference due to parallel phase relation results
in new wave with2x the amplitude, creating focal points
•Diffraction technology and interference patterns are utilized in IOLs to create more than one focal point

21. Optical Principles
Diffraction
• Described by Thomas Young for the first time
• Occur when a wave encounters an obstacle or a slit
• Interference of waves according the the Huygens–Fresnel
principle
• Plane wave transformed into spherical waves after diffraction
• light waves incident on two slits will spread out and exhibit an interference pattern in
the region beyond.
02/21/19 21

22. incident wave
step
index n1
lens
index n2
> n1
index n1
destructive interference
(zero intensity)
constructive interference(first diffractive order)
constructive interference
(zeroth diffractive order)
• With the introduction of an optical step between lens zones it can be achieved that
Light interferes constructively in more than one direction
• Mind: the refractive power of the zones is different from both the zeroth and the first
diffractive lens power
Optical Principles
How do diffractive IOLs work?

23. •the higher the grating density the
stronger is the angle deviation of
the light
•the more rings are placed on a
lens surface the higher is usually
the add power
Basic principles of diffractive elements
Grating density and diffraction angles
low ring density
medium ring density
high ring density

24. 24
Diffraction
Diffractive Steps
 Step width determines addition power+3D, +4D, +3.75D
○ Short steps  high addition
○ Wide steps  small addition
02/21/19
↖

25. 02/21/19 25
Diffraction
Diffractive Steps
ffects of the width of the diffraction steps:

26. 26
Diffraction
Diffractive Steps
 Step height determines energy repartition between far
and near vision
○ High steps  more energy for near vision
○ Small steps  more energy for far vision
02/21/19
↖

27. 27
Diffraction
Deffractive Steps
 Variable step height from center to periphery
○ Apodization
02/21/19

28. ReSTOR Single piece optic
 Optic Diameter
 Optic Type
 Haptic angulation
 Diopters
− 6.0 mm
− Apodized diffractive surface - central 3.6 mm /
Refractive - outer 2.4 mm
− +4 Diopter add power for near vision equals +3.2 Diopter
at spectacle plane
− +3 Diopter add power for near vision equals +2.25
Diopter at spectacle plane
− 0 degrees - planar
− 6 - 34 Dpt

29. Apodized Diffractive Optic
Step heights
decrease
peripherally from
1.3 – 0.2 microns
A +4.0 add at lens
plane equaling
+3.2 at spectacle
plane
Central 3.6 mm
diffractive
structure
Patented
peripherally
decreasing
zone widths
Alcon internal use only - do not distribute!

30. 0
0.1
0.2
0.3
0.4
0.5
0.6
0.7
0.8
0.9
1
1 2 3 4 5 6
Pupil diameter (mm)
Relativeenergy
Distant focus
Near focus
Above max. 82%!
Near vision: Photopic
vision (reading)
Distance vision
Mesopic vision
Alcon internal use only - do not distribute!

31. Refractive MF and Diffractive IOLs
d n
d
n
Light energy equally shared
over broad range of
pupils/lighting conditions,
contributes to halos at night
Light energy equally shared for
bright to moderate lighting/pupils
– apodization gradually
increases distance energy with
larger pupils - reduces halos at
night
Zonal Refractive (5 Zones) – AMO ARRAY
Full Optic Diffractive – 3M
Apodized Diffractive – Alcon ReSTOR
d
0
0.1
0.2
0.3
0.4
0.5
0.6
0.7
0.8
0.9
1
1 2 3 4 5
Pupil Diameter (mm)
RelativeEnergy
0
0.1
0.2
0.3
0.4
0.5
0.6
0.7
0.8
0.9
1
1 2 3 4 5
Pupil Diameter (mm)
RelativeEnergy
Light energy dramatically varies
with number of zones exposed
by pupil, contributes to halos at
night
0.1
0.2
0.3
0.4
0.5
0.6
0.7
0.8
0.9
1
1 2 3 4 5 6
Pupil Diameter (mm)
Distance Focus
Near Focus
RelativeEnergy

32. Diffractive Technology comparison
 Traditional bifocal IOLs:
• 1 step height = 1 add power
• May sacrifice good intermediate
vision for better near & distance
Step 1: 40 cm

33. Diffractive Technology comparison
 Traditional bifocal IOLs:
• 1 step height = 1 add power
• May sacrifice good intermediate vision
for better near & distance
 Current Trifocal:
• 2 step heights = 2 add powers
• Intermediate focal point of 80 cm to
maintain usable near vision
Step 1: 40 cm
Step 2: 80 cm

34. Diffractive Technology comparison
 Traditional bifocal IOLs:
• 1 step height = 1 add power
• May sacrifice good intermediate vision for better
near & distance
 Current Trifocal:
• 2 step heights = 2 add powers
• Intermediate focal point of 80 cm to maintain
usable near vision
 New Quadrafocal Technology:
• 3 step heights = 3 add powers
• More continuous vision
• May sacrifice distance contrast
Step 1: 40 cm
Step 3: 120 cm
Step 2: 60 cm

35. Diffractive Technology comparison
 Traditional bifocal IOLs:
• 1 step height = 1 add power
• May sacrifice good intermediate vision for
better near & distance
 Current Trifocal:
• 2 step heights = 2 add powers
• Intermediate focal point of 80 cm to
maintain usable near vision
 ENLIGHTEN™ Optical
Technology:
• Non-apodized new trifocal design
• Redirects light from the 3rd
step height to
distance
Step 1: 40 cm
Step 2: 60 cm

36. Diffractive Technology comparison
 Traditional bifocal IOLs:
• 1 step height = 1 add power
• May sacrifice good intermediate vision for
better near & distance
 Current Trifocal:
• 2 step heights = 2 add powers
• Intermediate focal point of 80 cm to maintain
usable near vision
 ENLIGHTEN™ Optical Technology:
• Non-apodized new trifocal design
• Redirects light from the 3rd
step height to
distance

37. Enlighten new trifocal
Panoptix(Alcon)

38. Benefit #1: optimized light utilization
 Transmits 88% of light at 3 mm
pupil size to the retina1,2
• Allocates half of light to distance
• Splits the rest evenly between near and
intermediate
• Other Trifocals*
= 86%†,3
*Trademarks are the property of their respective owners.
†
At 3.0 mm aperture pupil size.
1. AcrySof® IQ PanOptix™ IOL Directions for Use. 2. Alcon Laboratory Notebook:14073:77. 3. Gatinel D, Pagnoulle C, Houbrechts
Y, Gobin L. Design and qualification of a diffractive trifocal optical profile for intraocular lenses. J Cataract Refract Surg.
2011;37(11):2060-2067.
Total Light Energy Distribution1
Distance
+
Near
+
Intermediate
=
88%†,2
PAN15013SKi

39. Benefit #2: DESIGNED FOR more comfortable near to intermediate range
•40-80 cm range of vision1
•Intermediate focal point of 60 cm1,2
○ Other trifocals = 80 cm3,4
1. PanOptix™ Diffractive Optical Design. Alcon internal technical report: TDOC-0018723. Effective date 19 Dec 2014. 2. Alcon Laboratory Notebook:14073:78. 3. ZEISS AT LISA* IOL Sales Brochure. 4. PhysIOL FineVision* Sales Brochure
*Trademarks are the property of their respective owners
Theoretical Defocus Curve2
PAN15013SKi

40. Intermediate Focal Distance Comparison1
Image-based visual acuity (VA) estimation method is computationally configured via artificial neural network architecture based on four IOLs with published
clinical VA data.
1. Alcon Laboratory Notebook:14073:78. 2. PanOptix™ Diffractive Optical Design. Alcon internal technical report: TDOC-0018723.
Effective date 19 Dec 2014. 3. Charness N, Dijkstra K, Jastrzembski T, et al. Monitor viewing distance for younger and older
workers. Proceedings of the Human Factors and Ergonomics Society 52nd Annual Meeting, 2008.
http://www.academia.edu/477435/Monitor_Viewing_Distance_for_Younger_and_Older_Workers. Accessed April 9, 2015. 4.
Average of American OSHA, Canadian OSHA and American Optometric Association Recommendations for Computer Monitor
Distances.
1
2
PAN15013SKi

41. Benefit #3: less dependence on pupil size1
Features 4.5 mm diffractive zone for less pupil
dependence1,2
•Multifocal < 4.0 mm3
•Other trifocals > 5.0 mm4,5
1. PanOptix™ Diffractive Optical Design. Alcon internal technical report: TDOC-0018723. Effective date 19 Dec 2014. 2. AcrySof® IQ PanOptix™ IOL Directions for Use.
3. AcrySof® IQ ReSTOR® +3.0 D IOL Directions for Use. 4. ZEISS AT LISA* IOL Sales Brochure. 5. PhysIOL FineVision* Sales Brochure. *Trademarks are the property
of their respective owners.
PAN15013SKi

42. Why Diffractive Zone Size matters
 4.5 mm = designed to be less dependent on
pupil size or lighting conditions
• Smaller = May compromise near and
intermediate performance in low light or in
large-pupil patients
• Larger = May compromise contrast sensitivity
and impact visual disturbances, such as glare
and halo
Distanc
e
PAN15013SKi

43. Hybrid diffractive/refractive trifocal lenses (LISA)
Atilisa(zeiss)

44. AT.LISA Principles – SMP-Technology
 SMP-Technology (smooth micro phase technology) is a worldwide unique patented
technique to create a lens surface
 The lens surface does not exhibit any square edges or sharp angles.
 Guarantees ideal optical imaging quality without any scattered light
 A diffractive focus can be generated which correlates with the theoretically required
surface structures of the lens

45. AT LISA Principles
Smooth Micro Phase (SMP) Lathing Technology

46. Concept LISA
L : Light distributed asymmetrically (between F
and N : halos and glare)↓
I : Independency from pupil size
S : SMP technology no right angles for reduced light
scattering
A : Aberration correcting optimized aspheric
optic ( contrast sensitivity, depth of field and sharper↑
vision)

47. True Living Vision
For excellent optical efficiency by day

48. Extended Depth of Focus (EDOF or EDF)
Extended Range of Vision
Tecnis Symphony AT Lara (Zeiss) IC8

49. Basic principles of diffractive elements
Chromatic aberration

50. Tecnis Symphony
 TECNIS Symfony IOL is the first FDA approved lens of its class.[1]
 The IOL has a biconvex wavefront-designed anterior aspheric surface
and a posterior achromatic diffractive surface with an echelette design.
 This proprietary format creates an achromatic diffractive pattern that
elongates a single focal point and compensates for the chromatic
aberration of the cornea.

51. IC 8 IOL
 Applying the same small-aperture principle optics as the
KAMRA inlay,the IC-8 IOL incorporates a non-diffractive 3.23
mm diameter opaque mask with a 1.36 mm central aperture
embedded within a 6.0 mm one-piece hydrophobic acrylic lens.
 The mask creates a pinhole effect, which delivers nearly 3.0
diopters of extended depth of focus by blocking unfocused
peripheral light rays and isolating more focused central and
paracentral rays through the central aperture2.

52. Maximizing outcomes
 Accurate selection of patients
 Biometry : Calculation of lens power
 Choice of lens model
 Con-struction of astigmatically neutral incision
 No perfect device available for correction of presbyopia
 Patients should have reasonable expectations
 Operate on healthy eyes
 Best candidates presbyopic hyperopes
 Pa-tients who must drive at night not generally good
candidates for multifocal IOLs

53. Choice of lens model
 Refractive Multifocal IOLs
ReZoom:
M-flex:
Sulcoflex:
AF-1 iSii:
 Diffractive Multifocal IOLs
ReSTOR: spectacle independence of 88% reported
TECNIS: 93% spectacle independence reported
TECNIS SYMPHONY
Acri.LISA:, toric version corrects £12 D
PANOPTIX

54. Multifocal IOLs
Restore ,Rezoom and …
 Accurate preoperative biometry is essential to attaining optimal results with the Multifocal IOLs.
Preoperative biometry measurements include axial length and corneal curvature.
 Axial Length
Use of a IOLMaster (optical biometry ) or standard immersion A-scan is recommended
 Keratometry
manually or by an automated method.
 Personalisation
It is important to target emmetropia and to personalise the A constants for all IOLs.
 Formula
Calculations on patients with axial lengths of between 22 and 25 mm with corneal powers of between
42.00 and 46.00 D will do well with current third-generation formulas (the Holladay 1,SRK/T,and
Hoffer Q). For cases outside this range, the Holladay 2 or optimized haigis should be used to ensure
accurac
 Astigmatism
Post-operative astigmatism needs to be reduced to one diopter or less. For patients with astigmatism
greater than this, limbal relaxing incisions, LASIK, or other corneal refractive procedures may be
needed

55.  Although IOL design is the primary factor in the constant , variation in surgical technique such as
The placement of the Iol
The location of the incision
design of the axiometers and keratometers also affects the personalized lens constant
 Most surgeon must perform 20 to 40 cases in order to personalize their lens constant
A constant
nominal
A constant
SRKII
A constant
SRKT
Haigis
A0
Haigis
A1
Haigis
A2
P ACD SF
Restor
SA60D3
118.1 118.7 118.5 -0.123 0.099 0.189 5.23 1.46
Restor
SA60D1
118.9 119.3 119.1 0.385 0.197 0.204 5.61 1.83
Acrilisa
tri839MP
118.3 119.0 118.9 -1.477 0.058 0.262 5.48 1.72
AMO Tecnis
ZMB00
118.8 119.7 119.7 1.73 0.40 0.10 5.96 2.15
Alcon Panoptix
TFNT00
119.1 119.3 119.1 1.39 0.40 0.10 5.63 1.83
AMO Tecnis 1
ZCB00
118.8 119.6 119.3 -1.302 0.210 0.251 5.80 2.02
Multifocal IOLs
Personalization…

56. Multifocal toric IOLs and online calculation

57. Multifocal toric IOLs and online calculation

58. Multifocal IOLs
CHOOSING THE POSTOPERATIVE REFRACTIVE TARGET
 Determining the desired postoperative refractive target for multifocal IOLs is
slightly different than for monofocal IOLs, where a slight amount of myopia may be
beneficial.
 With the refractive ReZoom and AcrySof Restor ,Panoptix, Acrilisa or Tecnis
multifocal the target should be
exactly zero (plano) or the nearest hyperopic choice to zero. Patients' near vision with each
of these lenses is excellent, but slight myopia moves the near point too close for comfortable
reading.
 With the Symphony aim for plano in 1 eye and -0.75 in the second eye to get
excellent reading and distance vision
 This choice must be discussed with patients, however, especially if they may
compare their two eyes for distance.
 They should understand the possibility of a slight sacrifice in depth perception to
have near vision in one eye.

60. •all diffraction orders occur simultaneously
•blazed structures help to suppress disturbing and unwanted orders
•unwanted orders create stray light and reduce overall contrast
Basic principles of diffractive elements
Diffraction orders

61. 61
Diffraction
Diffractive Steps
 Same step height over whole optic surface
○ Same energy repartition between far/near whatever pupil aperture
02/21/19

62. Diffraction/Refraction
0
0.5
1
1.5
2
2.5
3
3.5
4
4.5
5
Cornea ReSTOR Retina
Near focus Distant focus
5 mm pupil
Distant
object
Alcon internal use only - do not distribute!

63. Step width determines the addStep width determines the add
power (+4.0D)power (+4.0D)
Step height determines theStep height determines the
amount of light at near focusamount of light at near focus
• Geometry is very important:
– Diffractive steps developed
to direct the light
– The light from every step is
focused at near and distant
focal points
Alcon internal use only - do not distribute!

64. Binocular Defocus Curve
Refraction (D)
IQ ReSTOR®
IOL +3.0 D [N=117] IQ ReSTOR®
IOL +4.0 D [N=114]
70 cm
(28 in)
50 cm
(20 in)
40 cm
(16 in)
33 cm
(13 in)
∞
20/25
20/32
20/40
20/50
20/63
20/80
20/100
20/20
+1.00 +0.50 0.00 -0.50 -1.00 -1.50 -2.00 -2.50 -3.00 -3.50 -4.00
Snellen

65. • Optical performance of the ReSTOR +3.0 Aspheric and ReSTOR +4.0 Aspheric
IOL are similar
Optical Performance Comparison
Measured Distance and Near Optical Quality
Modified ISO Model Eye
MTF @ 100 lp/mm (30 cpd)
0.00
0.05
0.10
0.15
0.20
0.25
0.30
0.35
0.40
0.45
0.50
5mm, distance 3mm, distance
MTF
ReSTOR® Asph. +4 D (n=10)
ReSTOR® Asph. +3 D (n=10)

66. Halo Performance Comparison
Line Spread Function generated by near add when viewing distance target
 The apodized diffractive optic in the ReSTOR IOLs generates significantly less
halos on the bench.
 The ReSTOR +3.0 D Aspheric IOL decreases halos on the bench as compared with
the existing ReSTOR +4.0 D IOL.
Comparison of measured halos
of 3 ReSTOR IOLs to 2 other multifocal IOLs
(in model eye with 0.2 um spherical aberration and 5 mm pupil)
0.000
0.050
0.100
0.150
0.200
0.250
0.300
0.00 0.03 0.06 0.09 0.12 0.15 0.18 0.21 0.24
Image location (mm)
Intensityrelativetopeak
Array SA40N
ReSTOR Apsheric +4 D Add
ReSTOR Aspheric +3 D Add
Current ReSTOR +4 D Add
Tecnis MIOL ZM900
Halos
Focused
distance images
Array SA40N
ReSTOR Apsheric +4 D Add
ReSTOR Aspheric +3 D Add
Current ReSTOR +4 D Add
Tecnis MIultifocal ZM900
(Modified ISO Model Eye with 5 mm pupil)
Array SA40N
ReSTOR Apsheric +4 D Add
ReSTOR Aspheric +3 D Add
Current ReSTOR +4 D Add
Tecnis Multifocal ZM900
Comparison of measured halos
of 3 ReSTOR IOLs to 2 other multifocal IOLs
(in Modified ISO Model Eye with 5 mm pupil)
®
Comparison of measured halos
of 3 ReSTOR IOLs to 2 other multifocal IOLs
(in model eye with 0.2 um spherical aberration and 5 mm pupil)
0.000
0.050
0.100
0.150
0.200
0.250
0.300
0.00 0.03 0.06 0.09 0.12 0.15 0.18 0.21 0.24
Image location (mm)
Intensityrelativetopeak
Array SA40N
ReSTOR Apsheric +4 D Add
ReSTOR Aspheric +3 D Add
Current ReSTOR +4 D Add
Tecnis MIOL ZM900
Halos
Focused
distance images
Array SA40N
ReSTOR Apsheric +4 D Add
ReSTOR Aspheric +3 D Add
Current ReSTOR +4 D Add
Tecnis MIultifocal ZM900
Comparison of measured halos
of 3 ReSTOR IOLs to 2 other multifocal IOLs
(in model eye with 0.2 um spherical aberration and 5 mm pupil)
0.000
0.050
0.100
0.150
0.200
0.250
0.300
0.00 0.03 0.06 0.09 0.12 0.15 0.18 0.21 0.24
Image location (mm)
Intensityrelativetopeak
Array SA40N
ReSTOR Apsheric +4 D Add
ReSTOR Aspheric +3 D Add
Current ReSTOR +4 D Add
Tecnis MIOL ZM900
Halos
Focused
distance images
Comparison of measured halos
of 3 ReSTOR IOLs to 2 other multifocal IOLs
(in model eye with 0.2 um spherical aberration and 5 mm pupil)
0.000
0.050
0.100
0.150
0.200
0.250
0.300
0.00 0.03 0.06 0.09 0.12 0.15 0.18 0.21 0.24
Image location (mm)
Intensityrelativetopeak
Array SA40N
ReSTOR Apsheric +4 D Add
ReSTOR Aspheric +3 D Add
Current ReSTOR +4 D Add
Tecnis MIOL ZM900
Halos
Focused
distance images
Array SA40N
ReSTOR Apsheric +4 D Add
ReSTOR Aspheric +3 D Add
Current ReSTOR +4 D Add
Tecnis MIultifocal ZM900
Array SA40N
ReSTOR Apsheric +4 D Add
ReSTOR Aspheric +3 D Add
Current ReSTOR +4 D Add
Tecnis MIultifocal ZM900
(Modified ISO Model Eye with 5 mm pupil)
Array SA40N
ReSTOR Apsheric +4 D Add
ReSTOR Aspheric +3 D Add
Current ReSTOR +4 D Add
Tecnis Multifocal ZM900
Array SA40N
ReSTOR Apsheric +4 D Add
ReSTOR Aspheric +3 D Add
Current ReSTOR +4 D Add
Tecnis Multifocal ZM900
Comparison of measured halos
of 3 ReSTOR IOLs to 2 other multifocal IOLs
(in Modified ISO Model Eye with 5 mm pupil)
®

67.  Human hair thickness: 60 microns
 Red blood cell diameter: 7 microns
 Step height at periphery IOL: 0.2 microns
Technology of the ReSTOR apodization IOL in ‘human’ terms

68. Add Power Comparison*
Spectacle plane
IOL & Add Effective Add Reading Distance
ReSTOR®
4.0D 3.00D 33.3 cm / 13.5”
ReSTOR®
3.0D 2.25D 43.5 cm / 17.8”
ReZoom** 3.5D 2.63D 38.5 cm / 15.7”
Tecnis** 4.0D 2.66D 37.0 cm / 15.1”
* Bench Data: Actual reading distance will depend on biometry, lens* Bench Data: Actual reading distance will depend on biometry, lens
position and other patient-related factors. Clinical experience withposition and other patient-related factors. Clinical experience with
ReSTORReSTOR 4.0 demonstrated an effective add power of 3.2D.4.0 demonstrated an effective add power of 3.2D.
****
ReZoom and Tecnis trademarks of Abbott Medical Optics, Inc.ReZoom and Tecnis trademarks of Abbott Medical Optics, Inc.
Alcon internal use only - do not distribute!

69. Optical Principles
Principle of Diffraction
•Diffraction is the ability of light to bend around edges
•Waves are subject to diffraction if they encounter, e.g.
Obstruction
Aperture
•Diffraction depends on wavelength:
Green light has a wider wave length than the blue light
Therefore the green picture is more expanded than
the blue one