The IOL-VIP System

The IOL-VIP System (Intra-ocular lens for Visually Impaired People) is a new surgical treatment available for Dry age related macular degeneration and some other types of macular degeneration. It was originally developed in Milan, Italy by a team of low vision aid specialists and eye surgeons. The system works by providing a magnifying and prismatic effect with an intra-ocular device (a double lens system that reproduces a "Galilean Telescope") that facilitates the improvement of central vision with only a limited effect on the peripheral field.

What is macular degeneration and what treatments are currently available ?

Age related macular degeneration (AMD) is the commonest cause of visual loss in the UK, particularly in patients over the age of 65 years. It is classified into either wet or dry types.

Wet AMD is caused by an ingrowth of abnormal blood vessels from the choroid, the layer under the retina, and these can rapidly bleed and cause leakage of fluid into the retina – hence it is called wet AMD. This type may respond to laser treatment or to injection with small doses of intraocular drugs called anti-VEGF agents, of which Lucentis and Avastin are examples.

Dry AMD is analogous to “wear and tear” changes at the back of the eye and as such is not generally treatable, although low vision assessment and the provision of optical aids can be very helpful.

The IOL-VIP system may be particularly helpful in those cases with dry AMD where there is no other treatment available. In addition it may also be helpful in patients with wet AMD that have been left with small, well defined central areas of scarring in the retina. This type of problem also can occur in some other conditions that affect younger patients, such as myopia, trauma or rare conditions such as PIC and POHS.

How does it work

During the procedure two intra-ocular lenses are placed inside the eye. One in front of the iris and one behind.

These lenses have two functions. Firstly, by working together they act like a telescope and produce a 1.3x magnification effect. Secondly by rotating the lenses a prismatic effect is induced that moves the image onto an area of healthier retina.

Who is suitable for this device?

Patients with dry age related macular degeneration with vision of 6/18 or worse in both eyes and at least 6/60 in one eye are the most suitable. Certain eye conditions such as glaucoma that affects the visual field, certain corneal problems and high refractive errors are not suitable for this procedure. All patients are fully assessed prior to surgery and we will be able to tell you if you are suitable at that stage.

As part of that assessment, a simulator is used that will demonstrate to the patient the potential improvement in vision prior to surgery and also provides information to the surgeon on who is suitable and which position of the lenses gives the best vision.

The procedure

Prior to the operation a small hole is placed in the iris using a laser (a Laser Iridotomy). The actual operation is similar to a cataract operation in that a small incision is made in the cornea and the natural lens is removed. The first Lens of the system is then placed in the capsular bag and the second Lens is placed in front of the iris. The procedure is performed under local anaesthetic as a day case. You will need to use eye drops for several weeks following the surgery.

As with any operation there are risks. With this procedure the risks are similar to those of a cataract operation including infection and haemorrhage, but fortunately these are not common. Corneal changes can occur if cells are lost from the back of the cornea. The laser iridotomy can cause temporary bleeding, inflammation and pressure rises, however, in most cases these can be dealt with using eye drops. The risks will be discussed with you prior to surgery.

Benefits of the procedure

An improvement in distance vision is the goal for patients, with an improvement of 2 lines on the chart being a good result. The improved distance vision reduces the amount of magnification needed for near vision tasks and reading. The reading distance is also improved.