THE ARTIST AND THE EYE

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THE ARTIST AND THE EYE

• Dr. Inderjit Singh
• FRCS.,FRCOPHTH.,FRANZCO
• Chatswood Eye Centre
• Suite 5, 16-18 Malvern Av.
• Chatswood.(tel [phone])

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THE ARTIST AND THE EYE

• ASTIGMATISM
• PRESBYOPIA
• CATARACT
• Ref
• The influence of Eye Diseases on Pictorial
  art- P.D.Trevor Roper,MD,FRCS,Proceedings of the
  Royal Society of Medicine,Dec 1957
• The Eye Of The Artist-Michael Marmor-Prof Of
  Ophth, Stanford
• James
  Ravin-Ohio

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ASTIGMATISM EL GRECO
El Greco,St. Martin and the Beggar,Widener
Collection St Andrew ,Met. Museum of Art
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ASTIGMATISM-EL GRECO HOLBEIN
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PRESBYOPIA
Rembrandt-"Portrait of Saskia",1633. (Cassel
Gallery
Rembrandt - Self-portrait, 1669. (Aix-en-Provence
Museum.)
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CATARACT
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CATARACT MONET
House seen from the Rose Garden Oil on canvas
1923 Musee Marmottan,Paris
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CATARACT

• 79 yr old lady with bilateral cataracts
• Cataract surgery and IOL on the LE
• Painted the same flower twice after viewing the
  flower with each eye in turn.
• Carolyn Cates ,SHO
• Anthony Moore, Consultant
• Addenbrooke Hosp. Cambridge

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10.00/4.00x90
Rev. Mr. Cross, Vicar of Chew Magna in Somerset,
who declared "The newly invented optick glasses
are immoral, since they pervert the natural
sight, and make things appear in an unnatural and
false light" (Hardy,1934),
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AGEING EYES, CHANGING VISION

• Increased ocular densities
• Blue end of visible spectrum filtered out
• Older lens absorbs 1000xgtat 400nm
• Increased higher order aberrations
• Scatter due to cataract formation
• Decreased cone sensitivity-25 for each decade
  starting at adolescence
• Neural losses

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CURRENT PREMIER IOL CHOICES

• Dr. Inderjit Singh
• FRCS(E)..,FRCOPHTH.,FRANZCO
• Suite 5, 16-18 Malvern Av.
• CHATSWOOD.
• 69, Albany St. Coffs Harbour

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Current IOL Design

• Hydrophobic Acrylic material
• Thin Aspheric design
• One piece with flexible angulated
• loops
• Multifocal IOL for near and distance
• Toric IOL for astig correction
• Blue light filter

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Modulation Transfer Function

• MTF optical benchmark for evaluation of
  performance of of a lens system
• visual performance of the eye
• Ability of the lens to tranfer an objects
  contrast to its image
• Ratio of image contrast to object contrast
• Snellens is poor measure of this

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MTF value at 100lp/mm with a 4mm pupil1(20.0D
lenses)
Modulation Transfer Function (MTF) comparison
Comparative MTF data with 4mm pupil1(20.0D
lenses)
1. Data on File, Alcon Labs, Inc TDOC 0003337
(Alcon Eye Model)
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RETINAL DAMAGE BY BLUE-WAVELENGTH LIGHT
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MULTIFOCAL IOL-ReSTOR

• Based on AcrySof Natural Single piece platform
• Central 3.6mm
• Apodized diffractive optic
• ReSTOR apodized diffractive design controls
  both image quality and energy balance
• 6.0D to 30.0D
• SN6AD13D Add,9 instead of 12 rings

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AcrySof ReSTOR Aspheric IOL
SN6AD3 Add Power 4 D Spectacle Plane 3.2
D Range 10 D to 34 D A-Constant 118.9
SN6AD1 Add Power 3 D Spectacle Plane 2.4
D Range 10 D to 34 D A-Constant 118.9
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ACRYSOF ReSTOR

• 25 pts- 54 to 78yrs
• 94 spectacles free (3 mnths)
• 6 used glasses for specific dim light tasks
• 8 c/o visual disturbances in the 1st week.
• 40 noticed some visual symptoms when asked not
  intolerable
• None of the symptoms were severe enough to
  explant IOL
• All of pts would recommend IOL

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ACRYSOF ReSTOR

• Astigmatism- less then 0.50D
• Incision lt2.2 only 0.1 D of induced astig
• Eliminate PCO- vigorous polishing.,IOL design
• Centration of IOL
• CME use of drops 3 days pre op
• Recognise neural adaption
• Increased chair time.

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ReSTOR Not For Everyone

• Patients who are satisfied with wearing glasses
• Patients who want guarantees on surgical outcomes
  
• Patients that are hypercritical with unrealistic
  expectations
• Patients with excessive complaints about their
  prescription
• Patients who drive at night for a living, or
  whose occupation or hobbies depend on good night
  vision
• Patients who are amateur or commercial airline
  pilots ,truck drivers
• Patients who have lifelong complaints about glare
  and halos or are bothered by glare at night
• Patients with ocular disease may not be good
  candidates for this implant

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ACRYSOF TORIC IOL

• Design
• AcrySof Single-Piece
• Posterior toricity
• Toric axis marks
• Spherical dioptre range
• 6.0D to 30.0D
• Cylinder Power
• T30.75-1.5D
• T41.50-2.0D
• T52.00D
• T6-T9up to 6D
• Toric ReSTOR

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IOL Design Rotational Stability

• Lens stability is important
• Off-axis rotation reduces the corrective cylinder
  power
• For every 1 of rotation, 3.3 of the lens
  cylinder power is lost
• For 30 of rotation there is a complete loss of
  astigmatic correction
• Additional astigmatism or visual problems with
  greater than 30 of rotation

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Patient selection criteria

• gt50 cataract pts have more then 1D astig
• Only regular astig
• K readings IOL master,Manual
• Use Toric calculator
• Use only K readings
• Astigmatic neutral incision 2.2mm or less

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Toric IOLS

• Stable IOL in the bag
• After 1yr.- 98 within 10
• 92 within 5
• Markings can be 5 off
• gt 10 from axis reduces effect by 1/3
• gt 30 from axis causes increased astig

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ACRYSOF TORIC32 pts 3 month follow uprange
0.75DC to 3.50DC

• 74 6/6 or better
• 94 6/9 or better
• 76 within 0.50 DC
• 98 within 1.00 DC
• STABLE IN THE BAG IOL
• 98 within 10 92 within 5
• 98 WITH Bilat.IOL glasses free for distance.

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TORIC IOL
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ACRYSOF TORIC
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Microcoaxial Phacoemulsification

• 2.2 mm incision (sub 2mm soon)-astigmatic neutral
• Multifocal for distance,near vision
• Toric IOL-Correction of pre-existing astigmatism
• Rapid visual recovery
• Rapid life style recovery
• Safer for patient and surgeon(ltcoronary art
  spasm)

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One Day Post Op
VIDEO PLEASE