Enhancing the quality of life in visually impaired AMD patients

For many years we have induced pseudophakic myopia of 5 dioptres in our age-related macular degeneration (AMD) patients. This helped aid in near vision recovery and allowed patients to resume some activities in their lives that they were unable to previously do as a result of poor vision. It also avoided spectacle induced loss of contrast sensitivity. While our patients were pleased with their near acuity, they were displeased with the high myopic correction for distance acuity.

Low vision aid

While the lens is not indicated for this use, I realized that I could use the lens as a low vision aid. Under photopic conditions, a -2.00 distance refraction provides a near equivalent of +5.20 D with a best focus of 20 cm. The AcrySof ReSTOR lens technique does not reduce uncorrected distance acuity nearly as much as a -5.0 D myopia inducing monofocal lens. The patients were much happier now that they only needed a -2.0 D distance correction.

Our first two AMD patients that were implanted with the ReSTOR lens were absolutely ecstatic, so we started a pilot study. The pilot study was a prospective series of cataract patients with vision loss from AMD, who received an offlabel AcrySof ReSTOR IOL following phacoemulsification. Surgery was planned for a desired postoperative refraction of -2.0 to -3.0 spherical equivalent. This pilot study also demonstrated that not only was the patients' uncorrected near acuity improved, but also that many aspects of their quality of life improved; therefore a formal, multicentre study was conducted.

The 6-month multicentre included 20 eyes of 13 patients that were more than 50 years of age with stable, dry macular degeneration or with macular degeneration associated with disciform scarring per the doctor's examination. Near and distance Snellen visual acuities with and without correction were collected, as well as subjective patient quality of life statements collected pre and postoperatively. The National Eye Institute Visual Function Questionnaire (VFQ-25 Version 2000) was also administered to the patient's pre- and postoperatively.³