The IOL=

The IOL-VIP System

Dominic McHughRoyal Society of Medicine

2010

ARMDLeading cause of blindness (“SVL”) in the

Western World2.7 million in the UK have some loss.54% increase in >75s over the next 25

yrs.

ARMD Quality of Life

With ARMD Without ARMD

Home Care 23% 5%Falls 16% 8.3%Falls With Fractures 3.5% 1.5%Healthcare Costs €12,579 €1,300(£8,521) (£885)

LVA Possibilities

• Intraocular Miniature Telescope Galileian telescope 2.2- 3.5x intra (Lipshitz)

•

• Hanita Ben-Sira implant Galileian telescope 2x IOL+spectacle

Surgical Rehabilitation for ARMD

Difficulty maintaining coaxial alignment

Monovision

VF 20°

11 mm incision

IOL-VIP SystemBCC IOL in the capsular bag = telescope ocular

BCX IOL in AC= telescope objective

IOL-VIP System

PC IOL AC IOL-66D +55D

IOL CHARACTERISTICSANTERIOR CHAMBER IOL

(BCX) 

Optic

Material PMMA with UV filter

Diameter 5.0Thickness 1.5mm

Haptics Loop shape Z Material PMMA-1PAngle 10° 

IOL power +55.00 D

PC IOL (BCC) 

Optic Material PMMA with UV

filterDiameter 5.0Thickness 1.5mm

Haptics

Loop shape C Material PMMA-1P Angle 7°

IOL power -66.00 D

Inclusion criteria for IOL-VIP surgery

•Bilateral stable macular degeneration/macular hole

•VA 6/18-6/60

•Good peripheral field

•Adequate AC depth

•Adequate endothelial cell count

•Predicted benefit by IOL-VIP simulator

Exclusion criteria for IOL-VIP Surgery

•Active exudative macular degeneration •Glaucoma

•Cornea guttata

•PAS

•Endothelial cell count < 1600 cell/mm2

•Shallow anterior chamber with depth < 3 mm

•Corneal diameter < 11 mm

no visual acuity improvement using the IOL-Vip simulator

IOL-VIPProposed

mechanism of action

Prismatic deviation of Image to PRL.Image magnificiation~1.3

Image shift to PRL (MP)Image shift to PRL (MP)

Post-op

Pre-op

RE preop BCVA : 0.25postop BCVA: 0.5

LE preop BCVA : 0.3 postop BCVA: 0.7

(Fasciani et al, 2008)

IOL-VIP Simulator Prism

IOL-VIPPreoperative assessment

Best VA without and with simulator prism, rotated to achieve PRL

12

39

6

12

39

6

Left EyeRight Eye

12

6

9 3

12

6

9 3

IOL-VIP SystemOptimal simulator orientation

determines relative IOL position

12

39

6

12

39

6

Left EyeRight Eye

9 3

1-2

1-2

8-7

8-7

1-2

8-7

12

6

1-2

8-7

IOL-VIP SystemOptimal simulator orientation

determines relative IOL position

IOL-VIP Surgery

Phakic/Pseudophakic eyes• Corneal tunnel (superior/temporal depending on IOL orientation•Large (6-7 mm) CCC•Phacoemulsification if phakic•Enlarge corneal incision to 7 mm•PC IOL: bag if phakic, sulcus if pseudophakic•PI+miochol•A/C IOL•Corneal sutures

IOL-VIP Surgery

IOL-VIPVisual Outcome

Orzalesi et al 2007

IOL-VIPPostoperative findings

•Low surgical complication rate•Endothelial cell loss 7%•PCO 18%•High hyperopia in emmetropes; better if myopic•Recent availability of “bespoke” implants

IOL-VIPConclusions

Advantages• Improves reading/distance vision in suitable cases (6/18-6/60 pre op; small-moderate central scotoma)•Patients comment favourably on scotoma shifting away from centre

Disadvantages•Careful selection required: pathology; psychology; costs•Lengthy (6 week) postoperative rehabilitation training•Suture removal•Refractive error : hyperopia and astigmatism (reduced with new implants