™ PHILOSOPHY

A NEW STANDARD FOR OPHTHALMIC SURGERY

IN ORDER TO OBTAIN THE MOST CORRECT POST-SURGERY VISION, IT IS NECESSARY TO CHANGE THE NORMAL DIAGNOSTIC EVALUATIONS AND PRE-SURGERY PROTOCOLS. ONLY IN THIS WAY IT WILL BE POSSIBLE TO PROVIDE A PERFECT VISION FOR EVERYONE WHY WE DON’T HAVE A PERFECT VISION FOR EVERYONE?

«Unresolved ocular surface « ./. In people with unstable tear « ./.more than half of patients disease (OSD) represents a film, there may be variation undergoing cataract surgery major risk factor for suboptimal of more than 1.0D, which have dry eye symptoms¹, and outcomes in refractive surgery¹. can correspond to an error meibomian gland dysfunction Untreated preoperative dry eye of the same magnitude in lens (MGD) is diagnosed in the disease (DED) and meibomian power calculation and thus majority of patients with dry gland dysfunction (MGD) can significantly impact vision¹. eye disease (DED), and more impact the accuracy of refractive Dry eye symptoms also affect than half of refractive surgery calculation and contribute to the repeatability and accuracy of candidates²,³.» poor vision outcomes¹. keratometry and topography.²» Existing DED, both asymptomatic and symptomatic, can be exacerbated during surgery and References: lead to postoperative patient 1. Stapleton F et al. TFOS DEWS II dissatisfaction with their cataract Epidemiology Report. procedure¹.» Ocul.Surf.2017; 15:334-65 2. Lemp M, et al. Distribution of References: aqueous-deficient and evaporative dry 1. Cochener B et al. Prevalence of eye in a clinic-based patient cohort: meibomian gland dysfunction at the time a retrospective study. References: of cataract surgery. Cornea. 2012; 31(5):472-78 1. Labetoulle M et al. Management of dry Cataract Refract Surg. 2018; 44:144-8 eye disease to optimize cataract surgery 3. Cochener B et al. Prevalence of outcomes: two tables for a daily clinical 2. Filomena Ribeiro MD, The importance of meibomian gland dysfunction at the time practice. treating OSD in cataract refractive practice. of cataract surgery. J Fr Ophthalmol. 2019; 42:907-12 EUROTIMES, Dec.2019/Jan.2020 J Cataract Refract Surg. 2018; 44:144-8

« ./. The 2018 ESCRS Clinical Trends Survey revealed the vast majority of respondents agree that mild-to-moderate dry eye significantly impacts keratometry and intraocular lens (IOL) calculations. However, routine examination of the ocular surface is inconsistent. Eighty-four percent of respondents routinely check the ocular surface in all or most of their preoperative laser vision correction (LVC) examinations, but only 76% perform an ocular surface check during preoperative cataract surgery examinations. This suggests that cataract surgeons will deal with significant ocular problems in aproximately 40% of their preoperatively or both preoperatively and postoperatively¹.» …we must change

References: 1. José Güell, MD, PhD - Trends in OSD this unsatisfactory status! Treatment: 2018 ESCRS Clinical Survey Data WHAT SHOULD BE DONE?

« ./. It is therefore important « ./. All patients can benefit « ./. There is a clear need to detect, diagnose and treat OSD from preoperative ocular surface to encourage preoperative prior to surgery. The benefits of preparation, and there is a clear assessment of the risk of DED pretreating MGD on keratometry, case for surface optimisation development or worsening in all prior to cataract surgery, have in people with DED, MGD and patients as a routine approach to been demostrated: 88% of conjunctival inflammation.» cataract surgery. In the majority patients with well-managed MGD of cases (80%+) presenting were within 0.25D of refractive for refractive surgery, only an target and 92% were within estimated two minutes is required 0.5D¹» to assess the ocular surface, and only five minutes in patients who are at greater risk of DED or who have existing symptoms.¹ ./. an unstable tear film leads to inaccurate or non-repeatable preoperative measurements, robust assessment is recommended in all patients who are candidates for cataract surgery¹»

1. Labetoulle M et al. Management of dry 1. Cochener-Lamard. Optimisation of eye disease to optimize cataract surgery the ocular surface for accurate biometric 1. Baudin C. Ocular surface and external outcome:Two tables for a daily clinical measurements. filtration surgery: mutual relationships. practice. Presented at ESCRS 2019, Paris, France. Dev. Ophthalmol. 2012;50:64-78 J Fr Ophthalmol. 2019; 42:907-12

« ./. Awarness of OSD in cataract « ./. Patient expectations « ./. Preoperative examination surgery candidates is critical from cataract surgery are and assessment of tear to optimising postoperative higher than ever and most osmolarity is a key step in outcomes, because the tear film physicians should resolve DED to understanding the risk of DED is an important component of contribute to patient satisfaction and the severity of disease in ocular power. after a refractive procedure¹. symptomatic patients¹» Effective, early management Unresolved OSD is likely to lead of OSD will improve pre-surgery to suboptimal postoperative assessments, increase accuracy vision quality, because of IOL power calculations and preoperative calculations will be help reduce complications inaccurate²» associated with surgery. Management of OSD in the pre-, peri- and postoperative phases of cataract surgery will contribute to more stable vision and greater patient satisfaction.¹»

1. ESCRS. Clinical Survey Data: ocular surface. 2018 2. Cochener-Lamard. Optimisation of 1. Filomena Ribeiro MD, The importance of the ocular surface for accurate biometric 1. Sullivan BD et al. An objective approach treating OSD in cataract refractive practice. measurements. to dry eye disease severity. EUROTIMES, Dec.2019/Jan.2020 Presented at ESCRS 2019, Paris, France. Invest Ophthalmol Vis Sci. 2010;51:6125-30 HOW TO OBTAIN A PERFECT VISION

1 DED SCREENING: AUTOMATIC OSDI-6 MGD SCREENING: 2D MEIBOGRAPHY 3D MEIBOGRAPHY

EVALUATION OF AUTOMATIC PULT PATHOLOGY LEVEL: MEIBOSCALE PLUS 12 SUBLEVELS

OVERALL TIME REQUIRED: 3 MINUTES

• THE PATHOLOGY LEVEL OBTAINED IS ENTERED 2 INTO THE SOFTWARE OF TREATMENT DEVICE.

• THE SOFTWARE AUTOMATICALLY SETS TREATMENT PARAMETERS.

• THE LLLT® MASK IS APPLIED ON PATIENT FOR 15 MINUTES

3 SURGERY • REFRACTIVE

• CATARACT

• ETC. WE HAVE TO GO FURTHER: ™ PHILOSOPHY

SCREEN TOWARDS A PERFECT VISION FOR EVERYONE THANKS TO AI ARTIFICIAL INTELLIGENCE AND 3D IMAGING

IN 3 MINUTES DRY EYE: NO

DRY EYE: YES

3D WE HAVE TO GO FURTHER: ™ PHILOSOPHY

INNOVATIVE INSTRUMENTS TO SOLVE AT 100% - AUTOMATICALLY AND PAINLESS - MGD AND OTHER OCULAR SURFACE PATHOLOGIES

UPPER AND LOWER EYELIDS TREATMENT IN 15 MINUTES

MATCH BETWEEN DEGREES OF PATHOLOGY SEVERITY AND TREATMENT LEVELS ™

™ OPE® / IPL Optimal Power Energy TWO TECHNOLOGIES IN SYNERGY POLYCHROMATIC light FOR TREATMENTS 100% THERMIC pulses Stimulation of NEUROTRANSMITTERS INCREASED contraction and SECRETION of Meibomian Glands

LIGHT MODULATION® / LLLT Low Level Light Therapy

Endogenous heat on UPPER and LOWER EYELIDS STIMULATION of cellular metabolism (ATP) Facilitates FLOW and SECRETION of Meibomian Glands

™ FIRST APPROVED TREATMENT FOR DRY EYE/ MGD USING PHOTOBIOMODULATION 100% AUTOMATED TREATMENT

LIGHT MODULATION® triggers biochemical and biophysical reactions that stimulate cells to make a better protein synthesis

PHOTOBIOMODULATION is an innovative technology that solicits mitochondria contained in cells. Thanks to different wavelengths it is possible to stimulate more specific objectives getting a better energy production within the mitochondria.

CE0476 medical certification ™

™

AUTOMATED AI EVALUATION 2D and 3D Images of Meibomian Glands

AND 3D MEIBOGRAPHY AUTOMATIC detection of Meibomian Glands and AUTOMATIC calculation of loss percentage

Evaluation of 4 LEVELS by Dr. Pult Meiboscale plus 12 SUBLEVELS

QUALITATIVE analysis of Meibomian Glands in the upper and lower eyelids

AUTOMATIC OSDI-6 questionnaire

INFRARED - HQ image of the ducts

DEMODEX Screening

MAGNIFICATION from 50 to 1000 times of ocular surface with white light

™

LLLT TO TREAT ACCORDING TO PATHOLOGY’S SEVERENESS An INNOVATIVE SYSTEM to solve most important pathologies of the eye surface: DRY EYE/MGD, CHALAZION, BLEPHARITIS, SJOGREN SYNDROME, POST-BLEPHAROPLASTY using LIGHT MODULATION®/ LLLT technology.

™ provides customized treatments based on MGD severity level detected with Me-Check™ screening instrument.

According to Meibomian Glands loss, ™ releases the correct amount of energy and treatment duration for that specific patient.