DIAGNOSTICS-IMPACT ON THE PREMIUM CHANNEL - Carl Zeiss Meditec AG

OIS symposium Diagnostics: Impact on the premium Channel

May 2016

Dr. Karlheinz ReinVice President FOB Cataract & Retina Surgery

Impact of technology in diagnostics on premium outcomes

1 Connors R.et. al. Accuracy and reproducibility of biometry using partial coherence interferometry. J Cataract Refractive Surgery 2002; 28: 235-2382 Reitblat O. et. al. Accuracy of predicted refraction with multifocal intraocular lenses using two biometry measurement devices and multiple intraocular lens power calculation formulas. Clinical and Experimental Ophthalmology 2015; 43: 328–334

• The number of refractive surprises have decreased with the introduction of new technologies, but:

1. Are all patients eligible for gold standard technology?2. Can gold standard technology be optimized to further improve biometry?3. Are pathologies sometimes overlooked?4. Do intra-operative tools for toric patients reach the same precision as pre-operative

biometry?

• How can technology help to overcome these remaining reasons for refractive surprises?

% of patients within +/- 0.5D of the predicted refractive cylinder

Ultrasound imposes a substantial risk of refractive surprises

In some cases even with gold standard

technology something goes wrong

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ZEISS IOLMaster 700 – Better cataract penetration to treat more patients with better technology1

• AL measurements with PCI biometry fail in 6% of patients2

• The IOLMaster ® 700 with SWEPT Source Biometry® shows a cataract penetration of > 99%2

• That means 92% fewer ultrasound cases1

• Fewer ultrasound cases result in fewer refractive surprises

1 Clinical study of Dr. Akman, Evaluation and comparison of the new swept sourceOCT-based IOLMaster 700 with the IOLMaster 5002 Clinical data of Dr. Hirnschall, Hanusch Clinic Vienna, Austria, based on >1.200 European eyes;

„From one or two ultrasound cases a day to one every 2-3 weeks!“ (Dr. Hirnschall, Hanusch Hospital, Vienna)

Figure 1. White intumescent cataract (Case 1)

Figure 2. Slit lamp image of the Cataracta rubra eye (Case 2)

Figure 3. ZEISS IOLMaster 700 OCT image with measurement calipers

ZEISS IOLMaster 700 – Better repeatability for better outcomes

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• Distance-independent telecentric keratometry for robust and repeatable keratometry measurements - even with unexperienced users

• Repeatability of AL measurement differs up to 26 µm between devices

• Depending on the device used the refractive outcome may differ > 0.3D

Repeatability comparison of AL measurement1

1 Sources: LENSTAR LS900, HS-Art.No. 1511.7220032.02060, standard deviation (1,σ); IOLMaster 500, Vogel A, Dick B, Krummenauer F: Reproducibility of optical biometry using partial coherence interferometry. Intraobserver and Interobserver reliability. J Cataract Refract Surg 27: 1961-1968, 2001 standard deviation (1,σ); IOLMaster 700 see technical data* Based on technical device specifications

26 µm difference Constant spot distance

> 0.3D difference

Device Comparison of in-vivo Repeatability (1 SD, Range in DPT.)*

ZEISS IOLMaster 700 – Helps to visualize unusual eye structures for better patient selection

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• The unique Fixation Check supports to detect poor patient fixation

• It may also help to indicate unusual eye structures for better patient selection1

• An incidential finding (e.g. BRVO as shown here) may prompt for a comprehensive OCT examination.

1 As the ZEISS IOLMaster 700 is clearly not intended to be used for diagnostics, findings need to be verified and pathologies diagnosed with a dedicated retina OCT* Image courtesy of Prof. O. Findl, Hanusch Hospital Vienna, Austria

Figure 1. SWEPT Source Biometry of our patient with the IOLMaster 700 showing intraretinal fluid (Fixation Check image on the right)*

Figure 2. SD-OCT image of the left eye of our patient*

1 Visser N, Berendschot T, Bauer NJ, Jurich J, Kersting O, Nuijts RM. Accuracy of toric intraocular lens implantation in cataract and refractive surgery. J Cataract Refract Surg 2011; 37: 1394-1402. 2 Clinical data of Prof. Findl / Dr. Hirnschall presented at ESCRS 2013 – technically verified pre- / intraoperative matching precision ± 1.0° in mean* Image courtesy of Prof. E. Fabian, Augencentrum Rosenheim, Germany

ZEISS CALLISTO eye – Bring pre-operative precision into the OR for astigmatism planning

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• Traditional ink marks may get blurred or may even disappear leading to an error in IOL alignment of approx. 5° in mean1

• ZEISS IOLMaster 700 integrates keratometry, biometry, imaging and a reference image – in one device!

• The CALLISTO eye matches the reference and the live image with a technically verified matching precision of +/- 1.0° in mean for precise2 markerless toric IOL alignment

Figure 3: Blurred ink mark and digital overlay*Figure 1: Ink mark Figure 2: Reference image IOLMaster 700

1 Clinical data of Prof. Findl / Dr. Hirnschall presented at ESCRS 2013 – technically verified pre- / intraoperative matching precision ± 1.0° in mean2 Elhofi AH, Helal HA, Comparison Between Digital and Manual Marking for Toric Intraocular Lenses - A Randomized Trial, Medicine (Baltimore). 2015 Sep; 94(38): e16183 Black D. Evaluation of markerless alignment system for toric IOLs. Paper presented at: ASCRS/ASOA Annual Symposium & Congress; April 20, 2015; San Diego, CA

ZEISS Cataract Suite markerless – Combining excellent biometry with precision in the OR

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The number of refractive surprises have decreased substantially with the introduction of new technologies. Will technology help refractive outcomes to be within +/-0.25D?

• Astigmatism planning and precise alignment of toric IOLs starts with excellent biometry

• The ZEISS Cataract Suite markerless combines excellent biometry with precise1 markerless toric IOL alignment

• Achieving up to 99% of patients with post-operative refractive cylinder within +/- 0.50D3

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