Multifocal optics for age-related macular degeneration

Asymmetric high-add lens improves near vision

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Gerd U Auffarth MD
Multifocal optics with a high rotationally asymmetric near add can be used as implantable low-vision aids in patients with age-related macular degeneration (AMD), according to Gerd U Auffarth. In patients with cataract and central vision loss from AMD, the bifocal Oculentis Lentis Mplus MF80 intraocular lens (IOL) with a +8.0D near add achieved a magnification equivalent to about 1.5 times for a 30cm reading distance, reported Dr Auffarth, of the University of Heidelberg, Germany. The IOL’s near add zone covers about half the optic on one side laterally, providing distance correction on the other side. “In selected AMD cases we can achieve excellent visual rehabilitation. Even a slight vision increase result in improvement of quality of life,” Dr Auffarth said. WET OR DRY The study involved 14 eyes in 12 patients, of whom 11, or 92%, were female. Mean age was 81 years, and five patients had dry AMD and six wet AMD, Dr Auffarth said. Central vision lesions and geographic atrophy were typical. Mean monocular pre-op distance uncorrected visual acuity was logMAR 1.00 ±0.32, or about 20/200, and 0.78, or about 20/120, corrected. Mean distance power of the implanted IOLs was 19.1 ±4.0D. Outcomes varied by patient condition, Dr Auffarth said. In one 76-year-old female patient with wet AMD treated for five years with 25 intravitreal injections of ranibizumab, bevacizumab and aflibercept, implanting an MF80 in her better-seeing left eye with a cortico-nuclear cataract, paracentral macular scar and macular oedema improved vision from about 0.6 logMAR, or about 20/80, distance corrected before surgery to 0.20 logMAR, or about 20/32, distance corrected, and 0.18 logMAR, or about 20/30, uncorrected near, and 0.1, or about 20/25, distance corrected near at 15cm distance. In contrast, an 81-year-old female patient with wet AMD and macular oedema implanted with an MF80 in her better-seeing left eye saw vision improve from 0.82 logMAR, or about 20/130 distance corrected vision to 0.56 logMAR, or about 20/70, uncorrected near vision at 15cm. Nonetheless, she was able to read newspaper print with 2.5x magnification and reported cooking without visual aids and writing with large letters without visual aids, Dr Auffarth said. Patients with a predicted uncorrected distance visual acuity of 20/100 to 20/63 will likely achieve excellent uncorrected near vision, those expected to achieve 20/500 to 20/125 distance will likely see good near vision, while those expected distance vision of less than 20/400 will likely see no benefit from the MF80 IOL, Dr Auffarth said. Gerd U Auffarth: gerd.auffarth@med.uni-heidelberg.de; auffarthg@aol.com