mr a nylander. clinical experience with the accommodative wiol-cf acrylic iol. zby arthur nylander,...

Mr A Nylander.

Clinical Experience with the Accommodative WIOL-CF acrylic IOL.

By Arthur Nylander, FRCS, FRCOphth, D.O.

Consultant ophthalmologistEast Lancashire hospitals,

Lancashire, U.K.

The author as no financial interest in these products

Mr A Nylander.

East Lancahire Hospitals

Serves a population of 500000 people Burnley General Hospital

Blackburn Royal Infirmary

Rossendale General Hospaital

Seven Consultant Ophthalmologist

Five Middle Grade Doctors

Nine Trainee Doctors

Mr A Nylander.

WIOL-CF

Accommodative Full-Optics acrylic IOL

Mr A Nylander.

WIOL-CFMain Features and Benefits

Accommodation capability > 2.25 Dioptres Low incidence of PCO (< 1%/year)Resistance to deposits Large glare-free

opticsVery good centration and position stabilityPotential for full reversibility -

reimplantableAllows vitreo-retinal surgery

Mr A Nylander.

WIOL-CF Posterior Chamber foldable acrylic IOL

• MAIN FEATURES:

Accommodating Large continuous aspheric opticsFills the posterior capsule Highly biocompatible materialLarge lens implantable through a

small incision

Mr A Nylander.

WIOL-CF design

Full disc plano-convex lens up to 9 mm O.D. Posterior polyfocal hyperbolic optics

Optics continuous up to the rim

Implantation: Preformed through < 3mm incision using

a 3.0mm cartridge and titanium injector.

Mr A Nylander.

WIOL-CF acrylic IOL

Mr A Nylander.

O.D. – 8.6 – 9.0 mm

HYPERBOLOID SURFACE CONTACTING POSTERIOR CAPSULE

MENISCOID ANTERIOR SURFACE

WIOL-CF “Full Optics” acrylic IOL

C.T. =

1.1-1.4 mm

Mr A Nylander.

SHARP EDGE

MENISCOID ANTERIOR SURFACE

CONICAL FASETTE

WIOL-CF edge profile

HYPERBOLOID SURFACE CONTACTING POSTERIOR CAPSULE

OPTICAL TRANSITION ZONE

Mr A Nylander.

WIOL-CF Features Benefits

High water content

( 42%, higher than any other IOL on the market today )

High carboxylate content

( only on the current market )

Low refractive index

Superior biocompabilityHigh permeabilityHydrated surface with low friction vs. tissue (e.g., capsule, iris, cornea )

Resistance to calcification

Minimized surface reflections and glare at night

Mr A Nylander.

WIOL-CF Features Benefits

Negatively charged surface

(only one on the market )

Partly dehydrated for insertion

Resistance to protein depositsResistance to cell attachmentResistance to opacification of posterior capsuleNo adhesion to tissues ( capsule, iris, cornea )

Increased strength for safer foldingNon-slippery for safer gripSmaller size for implantation

Mr A Nylander.

WIOL-CF Features Benefits

Full-disc configuration

Self-centeringExcellent position stabilityMaintenance of posterior capsular wallReplaceability of WIOL-CFVery large optical zoneEnables vitreo-retinal surgery

Mr A Nylander.

WIOL-CF Features Benefits

Continuous transition between optics and rim

Sharp-edged continuous rim

Aspherics hyperboloid optics

No edge effects ( no glare, improved night vision )

Resistance to PCO

Improved depth of focusPseudo-accommodationImproved resistance to astigmation

Mr A Nylander.

Power Calculation Chart

Calculated Select Calculated Select Calculated Select Calculated Select Calculated Select Calculated Select Calculated Selectdioptric dioptric dioptric dioptric dioptric dioptric dioptric dioptric dioptric dioptric dioptric dioptric dioptric dioptricpower power power power power power power power power power power power power power

(D) (D) (D) (D) (D) (D) (D) (D) (D) (D) (D) (D) (D) (D)15.0 15.4 17.0 17.6 19.0 19.7 21.0 21.8 23.0 23.9 25.0 26.1 27.0 28.215.1 15.6 17.1 17.7 19.1 19.8 21.1 21.9 23.1 24.0 25.1 26.2 27.1 28.315.2 15.7 17.2 17.8 19.2 19.9 21.2 22.0 23.2 24.1 25.2 26.3 27.2 28.415.3 15.8 17.3 17.9 19.3 20.0 21.3 22.1 23.3 24.2 25.3 26.4 27.3 28.515.4 15.9 17.4 18.0 19.4 20.1 21.4 22.2 23.4 24.4 25.4 26.5 27.4 28.615.5 16.0 17.5 18.1 19.5 20.2 21.5 22.3 23.5 24.5 25.5 26.6 27.5 28.715.6 16.1 17.6 18.2 19.6 20.3 21.6 22.4 23.6 24.6 25.6 26.7 27.6 28.815.7 16.2 17.7 18.3 19.7 20.4 21.7 22.6 23.7 24.7 25.7 26.8 27.7 28.915.8 16.3 17.8 18.4 19.8 20.5 21.8 22.7 23.8 24.8 25.8 26.9 27.8 29.015.9 16.4 17.9 18.5 19.9 20.6 21.9 22.8 23.9 24.9 25.9 27.0 27.9 29.116.0 16.5 18.0 18.6 20.0 20.7 22.0 22.9 24.0 25.0 26.0 27.1 28.0 29.216.1 16.6 18.1 18.7 20.1 20.9 22.1 23.0 24.1 25.1 26.1 27.2 28.1 29.316.2 16.7 18.2 18.8 20.2 21.0 22.2 23.1 24.2 25.2 26.2 27.3 28.2 29.416.3 16.8 18.3 18.9 20.3 21.1 22.3 23.2 24.3 25.3 26.3 27.4 28.3 29.616.4 16.9 18.4 19.1 20.4 21.2 22.4 23.3 24.4 25.4 26.4 27.5 28.4 29.716.5 17.0 18.5 19.2 20.5 21.3 22.5 23.4 24.5 25.5 26.5 27.6 28.5 29.816.6 17.1 18.6 19.3 20.6 21.4 22.6 23.5 24.6 25.6 26.6 27.7 28.6 29.916.7 17.2 18.7 19.4 20.7 21.5 22.7 23.6 24.7 25.7 26.7 27.9 28.7 30.016.8 17.4 18.8 19.5 20.8 21.6 22.8 23.7 24.8 25.8 26.8 28.0 28.8 30.116.9 17.5 18.9 19.6 20.9 21.7 22.9 23.8 24.9 25.9 26.9 28.1 28.9 30.2

Correction of optical power of WIOL - CF10. 00

15. 00

10. 00 15. 00

O pt ická mohut nost WI O L - CF ( D)

Mini

mál ní

zao

stř

ení , Doln í rozli

šov

ací

me z (D)

Minimální zaostření Dolní rozlišovací mez

Mr A Nylander.

Power Calculation For the WIOL-CF Lens

• 1.The surgeon calculates the lens power based on the 119.5 A-constant for SRK-T. Lets’s assume that the calculated value is 21.5d.

•  • 2.Surgeon corrects the calculated value using the correction chart.

The value of 22.5d (right red column) relates to the value 21.5d (left blue column).

 • 3.Finally, the value of +0.5d is added to the corrected value.

Therefore surgeon implants WIOL-CF of the dioptric power of 22.8 (23.0)d.

•  • 4.Anterior surface is the flat (plano) surface of the lens, posterior

surface is the convex surface of the lens, it is easy to recognise from the side view.

•  5.Lens has to be rinsed by isotonic saline solution and positioned posterior (convex) side down into the cartridge. Procedure of folding is shown in the following video.

Mr A Nylander.

Surgical Implantation

Video clip

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WIOL-CF accommodation• Implanted in 51 eyes : • Up to this date results in summary:

WIOL-CF allows a comfortable everyday life and work or sports activities without use of spectacles or contacts

Good patient preference and satisfaction.

Objective examination shows 20/20 uncorrected acuity for both near and far vision

Mr A Nylander.

WIOL-CF ACCOMMODATIVE IOL

Implantation historyFirst implanted in January 2004.Implanted 3 in 2004Implanted 27 in 2005Implanted 21 so far in 2006

Mr A Nylander.

WIOL-CF ACCOMMODATIVE IOL

Implanted 51 lens in 38 patients11 of these patients have had the

lens implanted in both eyes29 patients have had unilateral

implantation.19 males 21 females

Mr A Nylander.

WIOL-CF ACCOMMODATIVE IOL

Age DistributionYoungest Patient 43 years oldOldest Patient 87 years old

Mr A Nylander.

WIOL-CF ACCOMMODATIVE IOL

AGE DISTRIBUTION

0

10

20

30

40

50

60

70

80

90

100

Number of Patients

Mr A Nylander.

WIOL-CF ACCOMMODATIVE IOL

Lens DioptersLens come in Diopters powers from 15.0 to

30 Diopters Implanted from 19.0 Diopters to 29.0

DioptersNO difference in folding patternAll powers injected with the same

behaviourLens must unfold inside the capsular bag

Mr A Nylander.

WIOL-CF Accomadative iol

Diopter Powers used

0

5

10

15

20

25

30

35

Number of Patients

Series1

Mr A Nylander.

Case Study 1

CASE 1 - Mr. S.H Aged 55 Hospital Administrator pre op: OD -1.00/-0.75@25 OS -2.25/-1.00@135 Add +1.75 for N5 Right Phacoemulsification +21.5 Wiol-CF IOL 5/5/05 Left Phacoemulsification + 21.5 Wiol -CF IOL 16/5/05 Unaided V.A. June 05 OD 6/4 OS 6/4-2 N8 N8 Patient very happy Unaided V.A. November 05 OD 6/9 OS 6/4-2 N8 N8 Right YAG capsulotomy

Mr A Nylander.

Case Study 2

CASE 2 - Mr. M. H. Aged 52 Taxi Driver pre op: OD +0.50/-0.75@50 OS +0.75/-0.50@50 Add +2.25 for N5 Right Phacoemulsification +23.5 Wiol-CF IOL

5/5/05 Left Phacomulsification + 23.5 Wiol -CF IOL

24/11/05 Unaided V.A. December 05 OD 6/9-1 OS 6/6 N5

N5 Patient say can read without glasses. Very happy.

Mr A Nylander.

Case Study 3

CASE 3 - Mrs. S.A. Aged 71 Retired Horse Trainer pre op: OD +0.50/-0.75@50 OS +0.75/-0.50@50 Add +2.75 for N5 Right Phacoemulsification +19 Wiol-CF IOL

11/01/04 Unaided V.A. 6/6 N8. Very Happy.

Mr A Nylander.

Case Study 4

Brought Husband of patient case 3. Mr. T.A. Aged 86 for Bilateral Cataract Right Phacoemulsification + 26.5 Wiol -CF IOL

23/2/06 Left Phacoemulsification + 26.5 Wiol -CF IOL

2/3/06 Unaided V.A. April 06 OD 6/9-1 OS 6/9 N12 N10 Patient happy.

Mr A Nylander.

WIOL-CF accommodation: subjective patient's

observationsGood focus requires some effort and training

Acuity degrades by fatigue, (e.g.after long work on poor computer screens or reading of low-quality print in poor light conditions)

•Far focus improves and double vision disappears by widely opening eyes

•Near focus improves by narrowing eyes and good illumination

Mr A Nylander.

WIOL-CF accommodation: subjective patient's observations

• Very near focusing requires conscious effort and time (1 to 2 seconds lag)

• Using both eyes improves significantly both near and far focus

• No glare or other vision problems while driving at night

• No degradation of peripheral vision at driving, tennis, etc.

• No acuity deterioration after 4 years (subjectively improved)

Mr A Nylander.

Conclusion

• All patients obtained some accommodation.

• Accommodation range from N12 to N5 Mostly N8.

• Better accommodation with 6/9 or 6/6 vision than 6/4 or 6/5.

• Encourage patients to use their accommodation.

Mr A Nylander.

Conclusion

• Older patients need more encouragement than younger patients.

• Correction factor appears to be accurate.

• PCO in 2 out of 51 cases.

• 1 YAG Capsulotomy at 18 months

• No problems with YAG Capsulotomy

• Overall results with the WIOL-CF lens are very promising.