IOL VIP lens for Dry Age Related Macular Degeneration
Age Related Macular Degeneration (ARMD) can be divided into 2 types commonly called wet and dry. Wet ARMD now has new treatments including Avastin and Lucentis which are 90 to 95% successful at stabilising vision.
Ninety percent (90%) of patients however have Dry ARMD which has not previously been treatable, although deterioration can be slowed by the use of multivitamins.
Vision can now be improved by a new telescope lens system called the Intraocular Lens for Visually Impaired People (IOL-VIP).
Who is suitable?
The IOL-VIP system is suitable for patients with dry ARMD or stable wet ARMD who have finished any treatment. It is also suitable for patients with myopic macular degeneration. Best results are achieved if vision is between 6/18 and 6/60 (the largest letter on a standard vision chart), but people with worse vision can also benefit.
An initial assessment is required to see if patients are suitable for the procedure. This includes the use of a simulator to show what sort of improvement patients can expect.
The procedure involves having standard phacoemulsification cataract surgery with insertion of 2 special implants, 1 in the anterior chamber of the eye and 1 in the posterior chamber of the eye. The anterior chamber implant is a high plus lens and the posterior chamber lens is a high minus lens. The 2 lenses work together to create a telescope.
The procedure is usually carried out under local anaesthetic as a day case, without the need to stay in hospital overnight.
If you have already had cataract surgery it may still be possible to carry out the procedure.
How it works
The IOL-VIP system was developed in Milan by Ophthalmologists and low vision specialists.
The implant has 2 main effects.
1. It magnifies the image by a small degree (1.3 times).
2. It moves the image through a prism effect away from the scarred retina to healthy retina.
The Milan team have carried out the procedure on hundreds of patients with great benefits. They have published their initial results in Ophthalmology, an international peer reviewed journal.
(Orzalesi N, Pierrottet CO, Zenoni S, Savaresi C,The IOL-VIP System. A Double Intraocular Lens Implant for Visual Rehabilitation of Patients with Macular Disease. Ophthalmology 2007;114: 860-865)
This showed that all 35 patients improved their visual acuity and 60% of patients gained more than 2 lines of visual acuity. 87.5% doubled their reading distance. Patients were followed for an average of 2 years.
Many patients were able to return to normal daily activities such as reading, watching TV, recognizing money and sewing. Patients are likely to still need their glasses after the surgery.
The IOL-VIP system combines established phacoemulsification cataract surgery with new technology. Implants into the anterior chamber and the posterior chamber have been used for many years in standard cataract surgery and have an established track record. The 2 implants are made of PMMA. This is standard material similar to Perspex that has been used for cataract implants for over 50 years and has been shown to be extremely safe.
The risks of the procedure are the same as for standard cataract surgery, with the worst one being infection (about 1in 1500 cases).
The field of view is slightly reduced (by 10%), and corneal endothelial cell loss is about 10%. This is slightly higher than with standard cataract surgery but is unlikely to cause problems in patients with healthy corneas.
Previous attempts at similar visual rehabilitation have included the implantable miniature telescope (IMT). However this severely restricted the field of view to 20 degrees (from about 120 degrees). The complication rate was high with a corneal endothelial loss of 20 to 25%. This can result in the cornea becoming waterlogged. The IMT was refused approval by the American Food and Drug Administration (FDA)
For appointments for an assessment at the Bath Clinic or for further information contact Mr Antcliff's secretary, Helen Barnes on 01225 838831
Richard Antcliff MD FRCOphth
Consultant Ophthalmic Surgeon
BMI Bath Clinic
Claverton Down Road