Initial Clinical Results With a Novel Monofocal-Type Intraocular Lens for Extended Macular Vision in Patients With Macular Degeneration

Long Term Visual Outcomes of an Extended Macular Vision IOL in Eyes with Macular Disease and Visually Insignificant Cataract

Purpose

To determine long-term efficacy and safety of an extended macular vision intraocular lens (IOL) implanted in patients with dry age-related macular degeneration (AMD) and visually insignificant cataracts.

Design

Retrospective observational case series.

Setting

MicroChirurgia Oculare, Italy.

Methods

A retrospective case series of patients with dry AMD and visually insignificant cataracts undergoing phacoemulsification and implantation of an extended macular vision IOL designed to optimize image quality up to 10° from the foveal center (EyeMax Mono, Sharpview Ophthalmology, London, UK). Criteria for implantation were visually insignificant cataract (NC1 according to LOCS III classification) with dry age-related macular degeneration. Hypermetropia was targeted in most eyes to provide magnification when corrected with spectacles. Primary outcome measures were changes in corrected distant and secondary outcome measures included near visual acuity (CDVA and CNVA, respectively) between baseline and latest follow-up and safety outcomes.

Results

113 eyes of 86 patients (mean age 70.3±7.9 years) were included (mean follow-up: 48.3±25.1 months). Mean CDVA improved by 0.22 logMAR (11 ETDRS letters), from 0.53±0.4 to 0.31±0.3 (n=113, p<0.001). Similarly, mean CNVA improved by 0.08 logMAR (4 ETDRS letters), from 0.45±0.2 to 0.37±0.2 (n=77, p<0.001). Eleven eyes had AMD with extensive atrophy, and their mean CDVA improved by 0.32 logMAR (16 ETDRS letters). Three eyes (2.7%) experienced loss of more than one line in logMAR CDVA and four eyes (5.2%) experienced loss of more than one line in logMAR CNVA. No complications or instances of IOL exchange were reported.

Conclusion

Visual improvement in eyes with visually insignificant cataract and AMD who underwent phacoemulsification and were implanted with EyeMax Mono IOL appears to be influenced by the IOL optical design. Vision enhancement in eyes with visually insignificant cataracts underscores the IOL's ability to optimize use of healthy retinal areas. Prospective studies with control groups are needed to confirm these findings.

Optimising image quality with EyeMax Mono lens in dry age-related macular degeneration

BACKGROUND

To investigate clinical outcomes in patients with dry age-related macular degeneration (AMD) after intracapsular implantation of a novel EyeMax Mono macular lens.

METHODS

In this study, 22 phakic eyes of 19 moderate to advanced dry AMD patients with macular disciform scar and/or macular atrophy who were followed up for ≥ 3 months after surgery were studied. A thorough pre-operative ophthalmological examination was performed, including measurement of corrected distance visual acuity in logMAR and ETDR. Following phacoemulsification, the EyeMax Mono lens was implanted intracapsularly via a 2.2-mm clear corneal incision to improve retinal image quality in all areas of the macula ≤ 10° from the central fovea. Main outcome measures included optimisation of corrected distance visual acuity and surgical safety.

RESULTS

Male-to-female ratio was 13:6. Mean age at surgery was 68.37 ± 10.23 years. The mean duration of post-operative follow-up was 7.91 ± 3.42 months. The mean post-operative refractive spherical equivalent improved to + 2.31 ± 1.56 D with significant visual improvement as early as 3 months post-operatively. Post-operative corrected distance visual acuity improved significantly from 1.05 ± 0.45 to 0.72 ± 0.43 logMAR (P < 0.001), equivalent to mean ETDRS of 49.55 ± 20.05 (P < 0.001). There were no major surgical complications, either intra- or post-operatively, except in two patients who experienced intra-operative haptic rupture.

CONCLUSIONS

Extended macular vision lenses appear to have a comparable safety profile as standard IOLs in the short to medium term. It could be the preferred lens for improving and preserving visual acuity in moderate to advanced dry AMD patients.

Improving Outcomes for Patients with Age-Related Macular Degeneration and Cataracts: The Importance of Including an Assessment of Activities of Daily Life (ADL)

Age-related macular degeneration (AMD) is the leading cause of blindness in the developing world. AMD causes a substantial burden on patients, reducing independence, their ability to conduct daily activities, and increasing rates of cognitive decline and depression. There is a significant unmet need for patients with AMD, which will grow as the population ages and rates of disease increase. In the past, many studies have demonstrated a benefit when coexisting cataract formation is treated by removing the cloudy lens. AMD-lenses are intraocular implants designed to improve visual acuity in patients with AMD, avoiding the need for cumbersome manual vision aids and magnifiers. Many IOLs have been investigated in AMD, with differing mechanisms aimed at overcoming visual impairment. Most AMD studies use Early Treatment Diabetic Retinopathy Study (ETDRS) chart-based assessments of vision, but BCVA does not correlate with lesion size or pattern, especially in geographic atrophy, and may not be the most appropriate measure to effectively assess vision defects in AMD before or after a cataract surgery. One option is a simple functional assessment of vision related to activities of daily living (ADL), based on a reproducible, task-based questionnaire. The test consists of 6 assessments of ADL to be completed by patients before and after cataract surgery. Experiences highlight the importance of including an assessment of ADL in patients receiving an implant, which gives an effective measure of patient satisfaction. We would welcome the use of similar questionnaires in larger studies of patients, to validate its utility in a broader patient population. In this review article, we (Scandinavian-Austrian-cooperation) summarize lenses designed for implantation in patients with AMD, and how best to improve outcomes through proper patient selection, appropriate vision evaluation using quality-of-life related assessment, and pre- and post-operative care.

Intraocular vision-improving devices in age-related macular degeneration

Age-related macular degeneration (AMD) is a leading cause of blindness, especially in western countries, and will substantially burden society and the world’s health care system. Patients with late AMD often accompany a progressive loss of central vision, which will heavily influence the quality of life and associated with increased risk of functional disability. The principal visual rehabilitation methods with low-vision magnifiers, such as hand or stand magnifiers, spectacles, and closed-circuit television, were cumbersome to use and cosmetically burdensome. Therefore, the development of intraocular vision-improving devices has become an attractive alternative to extraocular visual aids, and better life quality improvement has been reached among AMD patients. To evaluate each device’s safety and efficacy based on current research, we searched the Cochrane Library, PubMed using pre-reported search terms and keywords combined with both Mesh term and text words. We explored randomized clinical controlled trials, cohort studies, and case serial reports and summarizes three aspects: visual outcomes, safety outcome, and quality of life outcomes. There are four types of devices recommended for AMD patients illustrating in this article: an implantable miniature telescope (IMT), IOL-VIP System, EyeMax Mono, and Scharioth macula lens (SML). There is no doubt that these technological advancements would bring new hope for AMD patients. However, the lack of randomized controls, limited follow-up duration, and various visual acuity (VA) measurements in different studies would be difficult than IOL devices.

A case report detailing use of a new intraocular lens with advanced technology, designed specifically for patients with center-involving macular disorders

RATIONALE

Many studies have shown that cataract surgery can be performed safely and improve visual acuity, without increasing the risk of progression of existing age-related macular degeneration (AMD). Data are emerging for an intraocular lens (IOL) that utilizes an advanced optical design to optimize the image supplied to all areas of the macula and not just the foveal center, which may benefit patients with center-involving macular disorders.

PATIENT CONCERNS

An 83-year-old Caucasian female presented with poor contrast sensitivity and color perception with increasing glare over the preceding year.

DIAGNOSIS

She had a progressive cortical cataract and stable dry AMD in the left eye, and wet AMD in the right eye. In the left eye, preoperative best-corrected distance visual acuity (BCDVA) was 0.2 (decimal) and best-corrected near visual acuity (BCNVA) was 0.05 (decimal).

INTERVENTIONS

Standard small-incision phacoemulsification was performed in the left eye, with capsular bag implantation of EyeMax Mono (LEH Pharma, London, UK), a single-piece, soft, hydrophobic, acrylic IOL designed to optimize image quality across the macula, rather than a standard monofocal lens.

OUTCOMES

At 6 months postoperation, visual acuity in the left eye had markedly improved, with a BCDVA of 0.5 (decimal) and a BCNVA of 0.2 (decimal).

CONCLUSION

In this first case undertaken at our center (and the first in Austria), cataract extraction and EyeMax Mono implantation were performed safely, with good subjective and objective outcome measures consistent with the effects of image optimization across the macula. Further studies of this IOL in patients with center-involving macular disorders, such as AMD, are warranted.