Long Term Visual Outcomes of an Extended Macular Vision IOL in Eyes with Macular Disease and Visually Insignificant Cataract

Federico Badalà,1 Elena Bona,1 Giulia Devincenzi,1 Kouros Nouri-Mahdavi2 1Micro Chirurgia Oculare, Eye Clinic, Milan, Italy; 2Glaucoma Division, Stein Eye Institute, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, CA, USACorrespondence: Federico Badalà, Email [email protected]: To determine long-term efficacy and safety of an extended macular vision intraocular lens (IOL) implanted in patients with dry age-related macular degeneration (AMD) and visually insignificant cataracts.Design: Retrospective observational case series.Setting: MicroChirurgia Oculare, Italy.Methods: A retrospective case series of patients with dry AMD and visually insignificant cataracts undergoing phacoemulsification and implantation of an extended macular vision IOL designed to optimize image quality up to 10° from the foveal center (EyeMax Mono, Sharpview Ophthalmology, London, UK). Criteria for implantation were visually insignificant cataract (NC1 according to LOCS III classification) with dry age-related macular degeneration. Hypermetropia was targeted in most eyes to provide magnification when corrected with spectacles. Primary outcome measures were changes in corrected distant and secondary outcome measures included near visual acuity (CDVA and CNVA, respectively) between baseline and latest follow-up and safety outcomes.Results: 113 eyes of 86 patients (mean age 70.3± 7.9 years) were included (mean follow-up: 48.3± 25.1 months). Mean CDVA improved by 0.22 logMAR (11 ETDRS letters), from 0.53± 0.4 to 0.31± 0.3 (n=113, p< 0.001). Similarly, mean CNVA improved by 0.08 logMAR (4 ETDRS letters), from 0.45± 0.2 to 0.37± 0.2 (n=77, p< 0.001). Eleven eyes had AMD with extensive atrophy, and their mean CDVA improved by 0.32 logMAR (16 ETDRS letters). Three eyes (2.7%) experienced loss of more than one line in logMAR CDVA and four eyes (5.2%) experienced loss of more than one line in logMAR CNVA. No complications or instances of IOL exchange were reported.Conclusion: Visual improvement in eyes with visually insignificant cataract and AMD who underwent phacoemulsification and were implanted with EyeMax Mono IOL appears to be influenced by the IOL optical design. Vision enhancement in eyes with visually insignificant cataracts underscores the IOL’s ability to optimize use of healthy retinal areas. Prospective studies with control groups are needed to confirm these findings.Keywords: AMD, Age macular degeneration, extended macular vision IOL, IOL, preferred retinal locus, PRL