Eyeworld

EW CATARACT 30 November 2018 Presentation spotlight by Stefanie Petrou Binder, MD, EyeWorld Contributing Writer scatter (cataract) affected the visual acuity in the periphery of eyes with AMD from 0.8 to 0.95 logMAR. Experimenting with a wide-angle IOL option According to the research team's recent study using wide-angle IOLs in AMD patients, visual acuity was better than that achieved using standard implants. 1 "This IOL may be the next viable approach to help AMD patients magnify objects to improve visual acuity," Dr. Artal said. "You need to target your pa- tients for hyperopia using a novel, wide-angle IOL. Then, using exter- nal spectacles, a telescopic effect is achieved together with the internal lens implant. You get a modest type of magnification. The +3 D implant gives a magnification of 1.11 times, with spectacles, and a +6 D implant gives a magnification of 1.19 times. Unlike healthy patients, AMD patients have no problem with spec- tacles. They are used to them. This approach may be a good option in some patients with AMD," he said. The study included 244 eyes with dry/stable wet AMD with >0.3 logMAR visual acuity that were implanted with the iolAMD Eye- max mono (London Eye Hospital Pharma, London, U.K.). The iolAMD is a single-piece, injectable, hydro- phobic acrylic IOL for implantation in the capsular bag that offers an optimized retinal image to all macu- lar areas within 10 degrees of retinal eccentricity. The microincision telescopic lens maintains the safety profile of routine cataract surgery, as opposed to previous, much larger telescopic lenses. The mean patient age in the study was 80 years and the mean follow-up time was 3 months (range: 1–16 months). No eye had worse corrected dis- tance visual acuity (CDVA), and the frequency of perioperative compli- cations was equivalent to that seen with standard IOL implantation. The postop refractive outcomes were within ±1 D of the target refraction in 88% of cases. The mean preop- erative CDVA for 4 meters distance improved from 1.06 logMAR to 0.71 logMAR postoperatively (p<.0001), which was the equivalent of an 18-letter improvement, according retina that give lower image reso- lution. Dr. Artal explained that the central fovea provides visual acuity of 1 logMAR (20/20), while the ret- inal areas that are 5 degrees outside of the fovea give a visual acuity of 0.3 logMAR, and the retinal areas 10 degrees outside of the fovea give a visual acuity of 0.15 logMAR. He elucidated, "Five degrees is not much. Holding your thumb up with your arm stretched out in front of your face represents about 1.5 de- grees beyond the central fovea, and 5 degrees is represented by about three finger widths. This roughly allows you to understand how much vision you lose within just a few small degrees beyond the fovea." Dr. Artal and his team at LOUM constructed a cataract simulator in their laboratory with which they could realistically induce cataract in a subject. By creating scenarios with different types of cataract and different degrees of scatter, they were able to better understand how scatter affected visual acuity in the retinal periphery in eyes with different types of cataract. They saw that scatter (i.e., cataracts) in non-AMD affected eyes could reduce visual acuity in the fovea from –0.1 to 0.4 logMAR. The same amount of Not only is cataract surgery beneficial for vision in patients with macular diseases, but the choice of the right implant can provide an added visual advantage I mproving vision in patients with age-related macular degen- eration is an arduous, often dis- appointing task. The irreparable damage to the retina caused by AMD precludes the restoration of the sharp visual acuity provided by the central fovea and calls for inventive solutions that implement the still healthy yet more peripher- al retinal tissues. A novel IOL idea seems to be offering encouraging vi- sual outcomes in AMD patients with concomitant cataract, according to a presentation on this topic at the 22nd ESCRS Winter Meeting. A Spanish research team has investigated a new approach to improving vision in patients with macular diseases. According to a presentation given by Pablo Artal, PhD, Laboratorio de Optica, Uni- versidad de Murcia (LOUM), Spain, implanting standard lenses after cataract surgery offers these patients very limited visual benefits. "When you are doing standard cataract surgery in AMD patients, the benefit achieved is modest with standard lenses. There are some reports in the literature that show no more than a six-letter improvement," Dr. Artal said. "Cataracts diffuse the light entering the eye and increase ocular scatter severely, which reduces con- trast of the retinal image. The degree of contrast sensitivity that is lost largely depends on the type of cata- ract. If you look at the central foveal visual acuity in eyes with different degrees of cataract and a healthy macula, you see a good recovery of visual acuity after surgery. In an AMD patient, however, cataract sur- gery does not improve visual acuity the same way. Since AMD impacts the central fovea, the effect of cata- ract and consequently the effect of scatter on vision is much higher." Cataract investigations at LOUM AMD is a progressive disease that damages the central fovea, the area with the highest density of photo- receptors. Individuals affected by AMD become reliant on the use of the peripheral, healthy areas of the Wide-angle IOL: an option for AMD patients with cataract Intraocular telescopes for AMD patients with description of the working principle and examples of the typical magnification achieved Source: Pablo Artal, PhD

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