Prof.Dr Tansu Erakgün Telescopic Intraocular Lenses

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    Telescopic Intraocular Lenses in Macular Macular Disease

    Macular degeneration disease, commonly known as ‘macular degeneration’, has two types: dry (non-exudative) and wet (exudative).

    Although approximately 90% of macular degeneration patients are dry type, advanced vision loss usually occurs in wet type patients.

    In dry type macular degeneration, vision loss occurs as a result of the atrophy (drying) of the layers in the visual center, while in the wet type, bleeding occurs in the visual center, and then vision is lost due to the scar tissue that develops.

    Wet-type vision loss is a faster and more advanced vision loss.

    In both types, the patient loses central vision. It becomes difficult to read a book, distinguish phone numbers or money in their hands, recognize the person they are looking at, or watch television.

    Macular degeneration usually occurs after the age of 50, but vision loss often occurs over the age of 60-65. The disorder makes the patient’s daily life very difficult.

    Advanced age, hypertension, genetic factors, smoking, a diet poor in antioxidants, and exposure to sunlight for a long time can lead to this disease. Among these reasons, genetic factors have an important place.

    Treatment Options

    There are several treatment options for wet macular degeneration, which causes sudden vision loss.

    Intraocular injections, that is, needle therapy, developed especially in recent years, are an extremely effective treatment method to eliminate bleeding.

    However, loss of central vision is inevitable in delayed cases, treatment-resistant cases and some dry type macular degeneration. Unfortunately, there is no other treatment option for patients in this situation.

    This is a condition that usually affects both eyes. In a situation where the vision in both eyes is greatly reduced, it becomes very difficult for the patient to continue his daily life.

    Binoculars/magnifying glasses

    A magnifying glass effect can be created with special glasses, known as assistive vision devices, which can increase vision, albeit to a limited extent.

    These glasses are called telescopic glasses. It functions as a kind of binoculars.

    With telescopic glasses, it is partially possible for the patient to see near and far. However, it is very difficult for patients to adapt to these glasses. The visual field of these glasses is very narrow and the patient sees as if looking through a keyhole.

    The adaptation rate of patients to these glasses is 10 percent. Although his central vision is getting stronger, it is not possible to move and walk with glasses because his peripheral vision is lost.

    However, in macular degeneration, the patient can see the surroundings even though he cannot see where he is looking. But when binocular glasses are worn, the peripheral vision that makes daily life easier is eliminated.

    Telescopic Intraocular Lenses

    Instead of binocular glasses, which are difficult to use, telescopic intraocular lenses have been developed in recent years with a similar logic. These are also called miniature telescopic lenses.

    It is a version of the telescopes used as glasses adapted to the eye. The advantage of the patient is that he or she does not experience the deprivation of peripheral vision that occurs with telescopic glasses.

    The patient can see both central and peripheral vision. In this system, first of all, the patient must not have had cataract surgery. Because telescopic intraocular lenses are placed into the eye by performing cataract surgery.

    After the patient’s lens is removed with the phacoemulsification method, two lenses, one with a high positive value and one with a high negative value, are placed into the eye.

    These lenses both enlarge the existing image and move the image from the diseased visual center to a healthier retinal area with a prismatic effect. In other words, a new yellow spot is created for the patient.

    Before deciding on this surgery, a prismatic telescopic simulation examination is performed to determine whether the patient will benefit from this surgery.

    If the patient’s current vision improves, it is expected that he will benefit from this surgery. After the surgery, rehabilitation can be performed so that the patient can benefit from these lenses to the maximum extent.

    Apart from macular degeneration, successful results can also be obtained in some diseases that cause irreversible damage to the visual center, such as some congenital macular diseases and visual center damage due to high myopia.

    References:

    https://entokey.com/telescopic-intraocular-lenses/

    Agarwal, A., Lipshitz, I., Jacob, S., Lamba, M., Tiwari, R., Kumar, D. A., & Agarwal, A. (2008). Mirror telescopic intraocular lens for age-related macular degeneration: design and preliminary clinical results of the Lipshitz macular implant. Journal of Cataract & Refractive Surgery, 34(1), 87-94.