Intraocular vision-improving devices in age-related macular degeneration

Abstract

Age-related macular degeneration (AMD) is a leading cause of blindness, especially in western countries, and will substantially burden society and the world's health care system. Patients with late AMD often accompany a progressive loss of central vision, which will heavily influence the quality of life and associated with increased risk of functional disability. The principal visual rehabilitation methods with low-vision magnifiers, such as hand or stand magnifiers, spectacles, and closed-circuit television, were cumbersome to use and cosmetically burdensome. Therefore, the development of intraocular visionimproving devices has become an attractive alternative to extraocular visual aids, and better life quality improvement has been reached among AMD patients. To evaluate each device's safety and efficacy based on current research, we searched the Cochrane Library, PubMed using pre-reported search terms and keywords combined with both Mesh term and text words. We explored randomized clinical controlled trials, cohort studies, and case serial reports and summarizes three aspects: visual outcomes, safety outcome, and quality of life outcomes. There are four types of devices recommended for AMD patients illustrating in this article: an implantable miniature telescope (IMT), IOL-VIP System, EyeMax Mono, and Scharioth macula lens (SML). There is no doubt that these technological advancements would bring new hope for AMD patients.However, the lack of randomized controls, limited follow-up duration, and various visual acuity (VA) measurements in different studies would be difficult than IOL devices.

High-addition segmented refractive bifocal intraocular lens in inactive age-related macular degeneration: A multicenter pilot study

“…However, external magnifying lenses and other reading aids are sometimes difficult to handle. In order to achieve freedom from external aids, IOL implants have been developed based on different optical principles to improve functional vision in AMD patients [ 6 – 13 ]. Some of such IOLs, like the IMT or the IOL-VIP, are quite large multipiece devices associated with a high rate of complications [ 7 , 11 ].…”

“…Today, the main approach to help patients cope with their reduced vision and enable them to handle everyday tasks is visual rehabilitation with external low-vision aids like spectacles, hand-held telescopes or magnifiers. However, such aids have several drawbacks, reducing the visual field, restricting movement and the necessity of extensive training in the use of the aids [ 6 ].…”

“…There have been specialized intraocular lens (IOL) implants developed to improve AMD patients’ vision and act as alternatives to external aids. These IOLs either magnify or eccentrically dislocate the image projected on the retina or attempt to combine both magnification and image-displacement [ 6 – 14 ]. Earlier devices were rigid and bulky and implanted through a large incision of 5 to 12 mm.…”

“…Earlier devices were rigid and bulky and implanted through a large incision of 5 to 12 mm. More modern IOLs are made from foldable acrylic allowing implantation through much smaller incisions of 2.2 to 3 mm [ 6 ].…”

Management of Cataract in Patients with Age-Related Macular Degeneration

“…Another approach to magnification is the Lipshitz macular implant, based on a Cassegrain configuration, which uses mirrors instead of lenses [36]. A description of all the available magnifying intraocular lens devices is outside the scope of this review but is well covered elsewhere [10,36,37]. There is an inherent compromise between improved magnification and loss of field of view.…”