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Modified cataract surgery with telescopic magnification for patients with age-related macular degeneration.
Can J Ophthalmol. 2007 Dec; 42(6):854-9.CJ

Abstract

BACKGROUND

The most desirable effect following cataract surgery in the presence of age-related macular degeneration (AMD) is to obtain an improvement in distance resolution acuity, and the only optical solution to this is the use of telescopic magnification. The purpose of the study was to develop and verify the clinical utility of inducing low-grade telescopic magnification (<33%) at the time of cataract surgery by the choice of an appropriate intraocular lens power and spectacle glasses in patients with AMD and cataract.

METHODS

The design was a prospective, nonrandomized, interventional case series involving 6 patients aged 74-86 (mean 80; SD 4) years with AMD and cataract. Participants were males and females, equal in number, who had visual acuity of less than 20/400 in the weaker eye. Standard cataract surgery was performed in the weaker eye. The power of the intraocular lens was derived from the reduced Gullstrand model of the eye in such a way that at the intraocular lens plane a minus lens was created, which, together with a plus lens in matching glasses, formed a Galilean telescopic system with magnification of up to 33%. Outcome measures were visual acuity, contrast sensitivity, and activities of daily living (ADL) scores.

RESULTS

The mean power of the implanted intraocular lenses was 6.31 (SD 2.42) diopters and, according to the theoretical derivations, achieved magnification between 20% and 30% (mean 26%; SD 4.92%). Visual acuity improved for the group from a mean of 20/525 (logMAR 1.48; SD 0.13) to a mean of 20/290 (logMAR 1.20; SD 0.21). Contrast sensitivity improved significantly (p < 0.001) only in the lower spatial frequencies. Postoperatively, ADL scores improved significantly in all patients except one. At the end of the follow-up period, 3 patients reported that they would like to proceed with similar surgery for the other eye.

INTERPRETATION

An optimal surgical telescopic device based on low-grade telescopic magnification may improve functional vision for usage in all tasks in AMD patients. All patients from this study were satisfied following surgery and viewed study outcomes as positive and beneficial, and some patients responded with enthusiasm. Surgeons are encouraged to use this modified technique of cataract surgery in low-vision patients with AMD and cataract.

Authors+Show Affiliations

Low Vision Service, University Health Network Hospitals, Department of Ophthalmology and Vision Sciences, University of Toronto, Toronto, ON.No affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Journal Article

Language

eng

PubMed ID

17965754

Citation

Iizuka, Megumi, et al. "Modified Cataract Surgery With Telescopic Magnification for Patients With Age-related Macular Degeneration." Canadian Journal of Ophthalmology. Journal Canadien D'ophtalmologie, vol. 42, no. 6, 2007, pp. 854-9.
Iizuka M, Gorfinkel J, Mandelcorn M, et al. Modified cataract surgery with telescopic magnification for patients with age-related macular degeneration. Can J Ophthalmol. 2007;42(6):854-9.
Iizuka, M., Gorfinkel, J., Mandelcorn, M., Lam, W. C., Devenyi, R., & Markowitz, S. N. (2007). Modified cataract surgery with telescopic magnification for patients with age-related macular degeneration. Canadian Journal of Ophthalmology. Journal Canadien D'ophtalmologie, 42(6), 854-9.
Iizuka M, et al. Modified Cataract Surgery With Telescopic Magnification for Patients With Age-related Macular Degeneration. Can J Ophthalmol. 2007;42(6):854-9. PubMed PMID: 17965754.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Modified cataract surgery with telescopic magnification for patients with age-related macular degeneration. AU - Iizuka,Megumi, AU - Gorfinkel,John, AU - Mandelcorn,Mark, AU - Lam,Wai-Ching, AU - Devenyi,Robert, AU - Markowitz,Samuel N, PY - 2007/10/30/pubmed PY - 2008/2/22/medline PY - 2007/10/30/entrez SP - 854 EP - 9 JF - Canadian journal of ophthalmology. Journal canadien d'ophtalmologie JO - Can J Ophthalmol VL - 42 IS - 6 N2 - BACKGROUND: The most desirable effect following cataract surgery in the presence of age-related macular degeneration (AMD) is to obtain an improvement in distance resolution acuity, and the only optical solution to this is the use of telescopic magnification. The purpose of the study was to develop and verify the clinical utility of inducing low-grade telescopic magnification (<33%) at the time of cataract surgery by the choice of an appropriate intraocular lens power and spectacle glasses in patients with AMD and cataract. METHODS: The design was a prospective, nonrandomized, interventional case series involving 6 patients aged 74-86 (mean 80; SD 4) years with AMD and cataract. Participants were males and females, equal in number, who had visual acuity of less than 20/400 in the weaker eye. Standard cataract surgery was performed in the weaker eye. The power of the intraocular lens was derived from the reduced Gullstrand model of the eye in such a way that at the intraocular lens plane a minus lens was created, which, together with a plus lens in matching glasses, formed a Galilean telescopic system with magnification of up to 33%. Outcome measures were visual acuity, contrast sensitivity, and activities of daily living (ADL) scores. RESULTS: The mean power of the implanted intraocular lenses was 6.31 (SD 2.42) diopters and, according to the theoretical derivations, achieved magnification between 20% and 30% (mean 26%; SD 4.92%). Visual acuity improved for the group from a mean of 20/525 (logMAR 1.48; SD 0.13) to a mean of 20/290 (logMAR 1.20; SD 0.21). Contrast sensitivity improved significantly (p < 0.001) only in the lower spatial frequencies. Postoperatively, ADL scores improved significantly in all patients except one. At the end of the follow-up period, 3 patients reported that they would like to proceed with similar surgery for the other eye. INTERPRETATION: An optimal surgical telescopic device based on low-grade telescopic magnification may improve functional vision for usage in all tasks in AMD patients. All patients from this study were satisfied following surgery and viewed study outcomes as positive and beneficial, and some patients responded with enthusiasm. Surgeons are encouraged to use this modified technique of cataract surgery in low-vision patients with AMD and cataract. SN - 0008-4182 UR - https://www.unboundmedicine.com/medline/citation/17965754/Modified_cataract_surgery_with_telescopic_magnification_for_patients_with_age_related_macular_degeneration_ L2 - https://linkinghub.elsevier.com/retrieve/pii/S0008-4182(07)80052-4 DB - PRIME DP - Unbound Medicine ER -