1. Poster Nr.
Novel bifocal macular lens may restore reading vision in eyes with maculopathies Nicole Horchi, Hermann Anhalm, Martin Lörtscher, Carsten H. Meyer Department of Ophthalmology, Pallas Clinics, Aarau, Switzerland
Background: Loss of reading vision remains the most prominent burdon for elderly patients with a variety of progressive maculopathies. With chronic progression of the disease, patients may face scar formation with secondary loss of photoreceptors and consecutive impaired central vision. At this stage - when the restoration of the photoreceptor function is limited – the patient may partially gain central vision from complementary cataract surgery.
Methods: Novel bifocal macular intraocular lenses (mIOL) became recently available in order to magnify the central vision in addition to the preserved distance vision after surgery. The optical part for close distance reading contains a magnifying lens of +8 diopters (Oculentis M plus 8 IOL), thus handicapped patients with maculopathies may recognize smaller print again. In addition pseudophacic eyes with progressed maculopathy, may also be treated by a secondary mIOL implantation in an AddOn lens design of plus 10 diopters by 1stQ achieving the same results in a two-step approach.
Results: Conventional diffractive bifocal IOLs by Oculentis, GmbH (Berlin, Germany) have been approved for clinical application for more than 10 years. The here presented novel mIOL system has the same established lens design. The implantation of both mIOLs is equal to standardized IOL or AddOn lens implantation (1stQ, GmbH, Mannheim, Germany) and may be performed through small gauge tunneled incisions of 2.2 mm. Selected patients should present preoperatively with stabile retinal situation and visual function of unilateral low vision of <20/400 and 20/60 – 20/100 in the better eye. The mIOL is only implanted unilateral in the better eye. Our preliminary results confirm easy implantation and safe centration of both mIOL systems. Patients gained additional reading function making them more independent at home and for e.g. reading labels during shopping.
Conclusion: These latest developments may offer phacic or pseudophacic patients with maculopathies improved reading function. Current investigations determine which preoperative visual functions parameters are the best predictive factors for a successful application.
A 74 years old Swiss lady complained about loss of central vision due to advance AMD in both eyes. Her BCVA was 20/200 OD and 20/400 OS, her near vision obtained with Snellen cards was 20/400 OD and 20/800 OS. She was not able to read any newspaper, documents or labels at the supermarket without using handheld magnifying glass.
On slid-lamp examination she presented moderate cataract formation. Funduscopy revealed bilateral signs of advanced AMD with GA OD and disciform scar formation OS. On OCT and FAF there was a significant GA OD with loss of the retinal pigment epithelium (RPE)-layer in her central and paracentral fovea.
We discusses with the patient in detail the specific IOL selection for each eyes and offered her the option implant the novel LENTIS Mplus High Add IOL (Oculentis GmbH, Berlin, Germany) in her better eye eventually to achieve some additional near vision (figure 1). Cataract surgery was unremarkable with a tunneled microincisions of 1.8 mm, ultrasound time of 2.4 seconds OD. The mIOL was easily implanted using an injector und just under a water filled anterior chamber as for routinely performed at our institution.
BCVA for distance was 20/40 OD and 20/200 OS, her reading vision improved to 20/64 OD and remained stable at 20/400 OS. The patient did not complain about glare or blurry vision in nether eye. There was no complain about double vision or photopic phenomena including halos, no compromised distance VA, and the patient adapted quickly to her gained near vision.
The patient presented with decent VA OD, but poor VA even corrected OS. Her distance UCVA in OD was 20/100, with a refraction of X180 and distance BCVA of 20/200. With a near addition of 6.00D, the patient could achieve a near BCVA of 20/50 (15 cm); however she required 10 to 15 times magnification. In her left eye the eye presented a wet AMD with central scan formation. Her distance UCVA was 20/800 with refraction of ,25X180. In this eye her near BCVA was only 20/800.
The implantation the acrylic Add-on IOL is performed in the pseudophacic eyes through a 2.8 mm corneal incision (figure 2). No complication occurred during the implantation of the Add-on IOL in the ciliary sulcus. The special design of the 1stQ A4SW00 prevents complication such as decentration posterior synechiae, interlenticular secondary capsule formation, or iris capture.
Four days later, her distance UCVA improved to 20/80. For her near vision, her UCVA was 20/50 at 13 cm, and she only required 2.5 magnification power for reading newspaper size print at a distance of 13 cm. We also had the patient use the Salzburg Reading Desk, which can automatically measure the distance that the patient is reading at. At a distance of 10 cm, she was able to read 43 words per minute which is remarkable for AMD patients. She had no problems with near and distance vision or photopic phenomena including glare. She feels comfortable performing her daily life and duties.