The
use of intravitreal antigrowth factor agents has greatly increased the
chance of retaining reasonably good vision following the development
of wet ARMD. However, there remains a significant number of patients
with poor vision due to macular scars in both eyes secondary to ARMD.
These patients include those who only had a partial response to Lucentis
treatment, those with dry age related macular degeneration and a very
large group of patients who developed ARMD prior to the development of
Lucentis treatment. In these patients visual function is sometimes improved
by the use of low vision aids. These have traditionally been provided
in the form of high power spectacles or magnifying glasses which are
useful for reading but inconvenient for prolonged work, and not of great
help for distance vision.
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Traditional magnifying spectacles
/ low vision aids |
Diagram of Gallilean telescope system |
A new type of intraocular lens inserted
in place of the natural lens has recently been developed which offers
the opportunity to provide a magnified image on the retina (1.3 X ) while
at the same time providing a reasonable field of view for distance vision.
The lens system works on the principle of a Gallilean telescope and has
the additional benefit of displacing the image away from the damaged
retina onto a healthier area with further improvement in vision
Initial results with this system have been very encouraging
with a significant percentage of patients gaining visual improvement
and some being able to read again. Surgery is usually carried out as
a day case under local anaesthetic and consists of several steps:
- Out patient consultation to determine suitability for
IOL-VIP system using a simulator which is placed in a spectacle frame
and mimics the potential visual improvement possible following surgery.
- Laser
treatment to the iris one week prior to lens insertion. This is a
simple out-patient procedure designed to prevent glaucoma following
lens implantation.
- Removal of cataract using routine cataract
surgery techniques.
- Implantation of 2 lenses to create
the IOL-VIP system.
- In patients who have already undergone
cataract surgery a version of the IOL-VIP is available which
can be used in addition to the normal replacement lens already in the
eye.
Patients normally notice improvement within a few days although some
may require additional help to use the magnified, eccentric image.
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Post operative picture of the
IOL - VIP in position. |
Diagram of the two intraocular lenses
used to create the IOL - VIP system |
|
Initial studies suggest that duration of symptoms is not important.
Those who potentially do best have some useful vision of 6/60 or better
in one eye with a relatively small macular scar.
One lens is behind and one lens is in front of the iris. A small stitch
is inserted which is removed at the first post-operative visit.
All intraocular surgery carries some risk and in the worst case scenario
vision can be lost. However, studies so far indicate that the IOL-VIP
implantation carries only slightly more chance of problems than routine
cataract surgery.
If you would like further information
or to make an appointment please contact my personal assistant:
Jacquie
Maclaren
Tel: 01189 553457
E
-mail: secretary@tanner-eyes.co.uk
