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In the decades since intraocular lenses (IOLs) were first introduced, the primary focus has been on optimizing visual outcomes in normally sighted individuals undergoing clear lens extraction and cataract surgery. This has led to the development of injectable soft acrylic IOLs, designed to minimize surgically induced astigmatism, and aspherical lens optics to counter the age-related positive spherical aberration of the cornea.1 Standard soft acrylic IOLs are now capable of delivering a tightly focused image at the fovea and consistent, high-quality visual outcomes in patients with otherwise healthy eyes. However, the quality of the image supplied by such lenses drops off significantly only a few degrees outside of the center of the fovea, and this may have significant implications for visual outcomes in patients with macular disease.2 Patients with macular disease can expect to have a degraded quality of vision with standard IOLs that compounds the poor contrast sensitivity and patchy photo-receptor loss associated with conditions such as age-related macular degeneration (AMD). Furthermore, as conditions such as AMD progress, patients can expect the quality of the images supplied to preferred retinal loci to worsen as more of the macula becomes affected.
Surgical options for patients with macular pathology undergoing cataract extraction and IOL implantation are extremely limited. Intraocular telescopes have been devised, some of which incorporate prismatic mechanisms to improve image quality at the patient's preferred retinal locus.3–7 However, patients with AMD frequently depend on the use of multiple preferred retinal loci to complete activities of daily living or may rely on different areas as the AMD progresses, so that targeting a specific preferred retinal locus has the disadvantage of compromising image quality at other retinal loci. In addition, many intraocular telescopes must overcome issues related to aniseikonia and reductions in contrast sensitivity while also requiring large corneal wounds for implantation, with consequent safety implications and effects on visual outcomes.6,7
This study was designed to assess safety and initial outcomes following implantation of a novel, single-piece, injectable, soft acrylic IOL for implantation in the capsular bag (Eyemax mono; LEH Pharma, London, United Kingdom). The optics of the Eyemax mono IOL are uniquely configured to supply a focused image to all areas of the macula extending up to 10° from the foveal center in patients with bilateral...