We're excited to be able to offer the latest Avedro Mosaic custom corneal collagen crosslinking using precise eye tracking to deliver treatment to the weakest part of the keratoconic cornea. This technology can significantly improve the overall shape of the cornea and improve vision. Moorfields Private is the first clinic in the UK to offer this state of the art technology to patients.
Reis-Buckler Corneal Dystrophy
This is a relative rare corneal dystrophy where a material is deposited under the surface of the cornea. As this material collects the persons cornea becomes frosty and hazy resulting in reduced vision.
This 21 year old patient had PTK excimer laser treatment to clear a central window in the corneal deposits to allow her to see. The results were almost instantaneous.
Dont believe the hype - Symfony lens has the same rates of haloes and glare as other multifocal lenses
Medscape Coverage from the
Symfony Intraocular Lens Haloes Similar to Multifocals
May 09, 2017
LOS ANGELES — Patients implanted with the Tecnis Symfony extended depth of focus intraocular lens (IOL) (Abbott Medical Optics) may see haloes as troubling as those seen with multifocal IOLs, researchers say.
The new findings suggest the Symfony's advantages over older IOLs are less decisive than hoped.
Approved by the US Food and Drug Administration in July 2015, the Symfony had reached the market earlier in many other countries. Researchers from around the world presented their research on the lens here at the American Society of Cataract and Refractive Surgery (ASCRS) 2017 Annual Congress.
"One of the problems is that we've been anticipating the Symfony for so long in the [United States], that it's going to be a cure-all, and it's not," said Steve J. Dell, MD, medical director at Dell Laser Consultants in Austin, Texas.
However, experts agreed that the Symfony adds to the options for patients with presbyopia, particularly those for whom intermediate-range vision is paramount.
Standard monofocal IOLs provide clear vision only at one range. Multifocal IOLs are divided into sections that simultaneously focus light differently for different ranges. The sections that are out of focus sometimes cause haloes.
The Symfony instead uses echelettes, a type of diffraction grating, to extend the IOL's focus range. At the same time, it corrects chromatic aberration to enhance contrast. Previous studies had suggested that its halo and glare profile are comparable to those of a monofocal IOL.
That has raised the possibility that the Symfony could offer the best of both worlds: good vision at multiple ranges without haloes or glare.
But how does it compare to multifocal lenses in similar patients? Unable to find any head-to-head studies, Mary Attia, MD, from the Heidelberg University Hospital in Germany, and colleagues analyzed three groups of patients: two using multifocal lenses and one using the Symfony.
They implanted the bifocal AcrySof IQ ReStor SN6AD1 (Alcon) with a near addition of +3.0D in 40 eyes of 20 patients, the trifocal FineVision (PhysIOL) with an intermediate addition of +1.75D and a near addition of +3.5D in 21 eyes of 11 patients, and the Symfony ZXR00 and toric ZXT models in 31 eyes of 16 patients.
All three IOLs are available in Europe. The Symfony was approved for sale there in June 2014. The ReStor +2.5 is available in the United States, but the FineVision is not.
The patients receiving the FineVision had a median age of 66 years, those receiving the ReStor had a median age of 55.5 years, and those receiving the Symfony had a median age of 70 years.
All three performed well at long distances. The Symfony also excelled at a distance of 80 cm. But at 40 cm, the ReStor SN6AD1 was the winner, with the Symfony a distant third.
On average, the recipients of the three types of lens gave them similar ratings for haloes, about in the middle of a 0 to 10 scale, where 10 is so bad patients would not consider driving. The differences among the three lenses for this measure were not statistically significant (P > .05).
Table. Visual Acuity Compared
IOLMedian uncorrected distance visual acuity (logMAR)Median uncorrected intermediate visual acuity at 80 cm (logMAR)Median uncorrected near visual acuity at 40 cm (logMAR)Haloes (0 - 10 scale of increasing severity)
ReStor SN6AD1 (Bifocal)−0.060.01−0.035.00
Symfony (Extended Depth of Focus)−0.04−0.080.146.35
There was a trend toward better glare ratings for the Symfony, but Dr Attia did not present calculations on statistical significance for this measure.
Patients implanted with the Symfony were more likely to report needing glasses for seeing at far distance than patients implanted with either of the other types of lens, and more likely to report needing glasses for reading than the patients implanted with the ReStor SN6AD1. Dr Attia did not provide statistical significance for this comparison, either.
Clinicians should talk to their patients about the pros and cons of each lens before implanting them, Dr Attia said. "It's really according to the patients' lifestyle."
The Symfony might work best "for patients who care a lot about computer work, more than reading," she told Medscape Medical News. "Patients who read a lot would need reading glasses anyway."
For occasional, brief reading tasks, all the IOLs in the study might work without reading glasses, she said. In contrast, "a golf player would not be a good candidate for any of these lenses."
Patients may also benefit from combinations of multifocal IOLs, said Dr Dell, who reported favorable results in a study in which 100 patients received the +2.75 D (ZKB00) Tecnis Multifocal 1-piece in their dominant eye and 75 patients received the +3.25 D (ZLB00) and 25 received the +4.00 D (ZMB00) in the nondominant eye.
More recently, he has successfully tried blending the Symfony with other IOLs as well. "The dysphotopsias are different and smaller, but they're not zero," he said.
In the discussion that followed these presentations, some experts said they preferred to aim for emmetropia with the Symfony, and others for a slight plus correction.
"The main news is that there are a lot of excellent options," session panelist Phillip C. Hoopes Jr, MD, from Intermountain Healthcare in Draper, Utah, told Medscape Medical News.
He agreed with Dr Attia that the Symfony adds to the options for patients who need good intermediate vision for computer work.
Dr Dell reported financial interests in Abbott, Advanced Tear Diagnostics, Allergan, Bausch + Lomb, Lumenis, Optical Express, Presbyopia Therapies, and Tracey Technologies. Dr Attia reported financial relationships through her institution with Alcon, Alimera, AMO, Carl Zeiss Meditec, CIMA, Contamac, Hoya, HumanOptics, Kowa, Mediphacos, Novartis, Oculentis, Ophtec, PowerVision, Rayner, and SIFI. Dr Hoopes reported relationships with AcuFocus, and SUN.
American Society of Cataract and Refractive Surgery (ASCRS) 2017 Annual Congress. Presented May 8, 2017.
Xtrafocus implant offers non-multifocal cataract surgery patients the option to improve reading vision after monnofocal lens implants
A new product from Morcher takes advantage of the pinhole effect to enhance depth of focus and will allow patients who have previously had cataract surgery with a monofocal lens a second chance to improve unaided reading vision if they missed out on the opportunity to have a multifocal lens at the time of their primary surgery.
The new implant has a 1.30mm central pinhole and is placed in front of the previously implanted monofocal lens. The pinhole aperture achieves 3D of near focus in the non-dominant eye and aids reading vision. The surgery is performed through a tiny 2.4 mm incision under local anaesthetic and would take less than 10 minutes to perform. It has the added benefit of being reversible with easy removal of the implant leaving behind the underlying intraocular lens in case of dissatisfaction.
Some patients may require additional YAG laser or laser eye surgery to achieve optimal vision.
Why its important your eye surgeon also does laser eye surgery if you're having a multifocal or #trifocal lens implant
I am about to perform laser surgery on a patient of mine who had uncomplicated refractive lens exchange surgery with trifocal lens implants. The patient feels that her vision is blurred for distance and is much clearer when the small residual prescription in each eye (-0.5 dioptre) is corrected. To give her the best possible result and clearest vision from her expensive new lenses she needs correction of this small prescription which would probably go unnoticed in an eye without a multifocal lens.
During cataract or lens replacement surgery the lens implant power is based on a predictive formula. This is accurate in most cases, but in roughly 1 in 100 patients the predicted prescription may be different to the end result. The commonest cause of unsatisfactory or blurred vision in patients with multifocal or trifocal lenses is due to residual uncorrected prescription. This is even more so if there is a high level of residual astigmatism.
If your surgeon is unable to correct this by laser eye surgery you may be referred to another surgeon to have your prescription corrected. Worse still, nothing further may be done and the patient may simply be asked to accept their visual outcome. There may be further costs if another surgeon is required and patients should clarify from the outset what actions will be taken in the event of blurred vision after multifocal or trifocal lens implants. Residual prescriptions only require correction if it leads to unsatisfactory results. There may be other causes of reduced vision such as cystoid macular edema or early posterior capsular opacification which your surgeon should exclude.
I see and treat a lot of patients with blepharitis and meibomian gland dysfunction. Blepharitis is an inflammatory condition of the lid margin where there is typically a sensitivity to normal skin bacteria such as Staphylococcus Aureus. Due to it's close contact with the eye's surface blepharitis typically causes dry eye, irritation and redness of the eye. Part of the treatment regime for blepharitis includes regular lid cleaning to remove build up of oil and skin flakes from the lid margin and to reduce bacterial load. One recent useful tip from a female patient who wanted to wear occasional mascara was to use disposable mascara brushes to avoid harbouring staphylococcus and other bugs in the make brush. These are available through amazon and are very reasonably priced for hundreds of brushes. Great idea!
Left to right switch over corneal auto-transplant
How do you restore sight in a patient who is blind in one eye due to end stage glaucoma (this eye has a healthy cornea) and is almost blind in the fellow eye due to a dense corneal scar after infection? The fellow eye has less advanced glaucoma and some macular degeneration but was the only eye with visual potential. The patient has not been able to see for 6 years and is dependent on others and needs to be led. The patient also comes from a country with standards of healthcare that are variable and hence long term survival of any treatment was another concern.
My approach to this case was to swap the healthy cornea from the right eye with the scarred cornea in the left eye. At the end of the surgery the patient had their own clear cornea and new lens implant on the left and their own scarred cornea on the right.
At the next day review both eyes were healing well with minimal inflammation. The patient was for the first time able to read letters from the vision chart and could walk unaided. He was incredibly emotional that after 6 years some sight had been restored. Vision wont be perfect due to glaucoma and macular degeneration, but some vision will improve his quality of life and help him regain his confidence and independence. An added bonus is the fact that he cannot reject his own tissue and hence rejection in the long term wont be an issue once things have healed. A rewarding case for me and him.