2. PROBLEMS OF APHAKIA & IOL
Maj
M. Ahsan Mukhtar
FCPS, FRCS (Glasg)
CLASSIFIED EYE SPECIALIST
REGISTRAR VITREO-RETINAL SURGERY

3. OBJECTIVES Enlist common problems of aphkaia
Briefly describe the mechanism / physics of these problems
Know basics of intraocular lenses

7. PROBLEMS OF APHAKIA Relative spectacle magnification (RSM)
Anisometropia in unilateral aphakia
Aberrations
Heavy lenses (glasses)
Visual field limitation
Loss of ultra-violet protection
Other problems
Cystoid Macular edema
Retinal Detachment
Increase In Proliferative Diabetic Retinopathy
Amblyopia in children with unilateral aphakia

8. PROBLEMS OF APHAKIA Relative spectacle magnification (RSM)
Anisometropia in unilateral aphakia
Aberrations
Heavy lenses (glasses)
Visual field limitation
Loss of ultra-violet protection
Other problems
Cystoid Macular edema
Retinal Detachment
Increase In Proliferative Diabetic Retinopathy
Amblyopia in children with unilateral aphakia

9. RELATIVE SPECTACLE MAGNIFICATION
The ratio between the corrected and uncorrected image size
Image is 33% larger in corrected aphakia
Patient may misjudge distances
Actual VA of an Aphakic reading 6/9 is approx 6/12

10. RELATIVE MAGNIFICATION AND IMAGE SIZE
SOLUTION
Intra-ocular lens
Contact lens
Isiekonic lens
Corneal procedures

11. PROBLEMS OF APHAKIA Relative spectacle magnification (RSM)
Anisometropia in unilateral aphakia
Aberrations
Heavy lenses (glasses)
Visual field limitation
Loss of ultra-violet protection
Other problems
Cystoid Macular edema
Retinal Detachment
Increase In Proliferative Diabetic Retinopathy
Amblyopia in children with unilateral aphakia

12. ABERRATIONS IMAGE DISTORTION troublesome to the newly aphakic patients
Straight lines appears curved except when viewed through a very small axial zone of lens

13. ABERRATIONS RING SCOTOMA
The prismatic power of the more peripheral parts of a spherical lens

14. ABERRATIONS JACK-IN-THE-BOX
The direction of the scotoma changes as the patient moves his eyes, and objects may appear out of the scotoma or disappear into it.
SOLUTION
Tell the patient to move his head instead of moving eyes while wearing aphakic glasses

15. PROBLEMS OF APHAKIA Relative spectacle magnification (RSM)
Anisometropia in unilateral aphakia
Aberrations
Heavy lenses (glasses)
Visual field limitation
Loss of ultra-violet protection
Other problems
Cystoid Macular edema
Retinal Detachment
Increase In Proliferative Diabetic Retinopathy
Amblyopia in children with unilateral aphakia

16. HEAVY GLASS LENSES
Use plastic lenses

17. PROBLEMS OF APHAKIA Relative spectacle magnification (RSM)
Anisometropia in unilateral aphakia
Aberrations
Heavy lenses (glasses)
Visual field limitation
Loss of ultra-violet protection
Other problems
Cystoid Macular edema
Retinal Detachment
Increase In Proliferative Diabetic Retinopathy
Amblyopia in children with unilateral aphakia

18. VISUAL FIELD LIMITATION
SOLUTION
Ask Patient to move head instead of moving eyes while wearing aphakic glasses

19. PROBLEMS OF APHAKIA Relative spectacle magnification (RSM)
Anisometropia in unilateral aphakia
Aberrations
Heavy lenses (glasses)
Visual field limitation
Loss of ultra-violet protection
Other problems
Cystoid Macular edema
Retinal Detachment
Increase In Proliferative Diabetic Retinopathy
Amblyopia in children with unilateral aphakia

20. LOSS OF ULTRA-VIOLET PROTECTION
SOLUTION
Intra-ocular lens with UV protection
Glasses with UV protection

21. PROBLEMS OF APHAKIA Relative spectacle magnification (RSM)
Anisometropia in unilateral aphakia
Aberrations
Heavy lenses (glasses)
Visual field limitation
Loss of ultra-violet protection
Other problems
Cystoid Macular edema
Retinal Detachment
Increase In Proliferative Diabetic Retinopathy
Amblyopia in children with unilateral aphakia

22. OTHER PROBLEMS DUE TO APHAKIA
Cystoid Macular edema
Retinal Detachment
Increase In Proliferative Diabetic Retinopathy
Amblyopia in children with unilateral aphakia
Occlusion therapy
IOL
Contact lenses

24. INTRA OCULAR LENSES

26. INTRA OCULAR LENSES The optic (the central refracting element)
The heptics

27. IOL MATERIAL Optic Heptics Polymethylmethacrylate (PMMA) Silicon
Acrylic (hydrophillic and hydrophobic)
Hydrogel
Heptics
Polypropylene (3 piece)
Same material as optics (1 piece)

28. IOL DESIGN

29. TYPES OF IOL
AC IOL
Iris claw Lens
PC IOL

30. IOL TYPES
Monofocal IOL
Multifocal IOL
Toric
Accomodative

33. PLACEMENT OF IOL IN EYE The posterior chamber (PC IOL) capsular bag
Sulcus
The anterior chamber (AC IOL)
Iris / pupil supported
Angle supported

34. AC-IOL

35. PC IOL
PC IOL in Capsular bag
PC IOL

36. RIGID VS FOLDABLE IOL’S
PMMA
One piece to facilitate maximal stability and fixation
Foldable
Silicone IOLs: have lower rates of posterior capsular opacification than PMMA IOLs
Acrylic IOLs
Hydrogel IOLs: have higher water content
Collamer IOLs : are a mixture of collagen and hydrogel (newly developed)

37. ADVANTAGES OF IOLs All problems of aphakia ------ gone
Broader field of view
Lesser problem of image magnification
Binocularity is maintained

38. DISADVANTAGES OF IOLS Problems of accommodation
Chances of dislocation into the vitreous
UGH syndrome with AC-IOL
Endothelial decompensation

39. THANK YOU