The Artisan Lens

172 Pages·2009·3.19 MB·English

The Artisan Lens:
Effects on Vision Quality, the Corneal Endothelium and
Vision-Related Quality of Life
Ruchi Saxena
Financial support for the publication of this thesis was provided by the following:
Prof Dr Henkes Stichting
Stichting Leids Oogheelkundig Ondersteunings Fonds
Alcon Nederland B.V.
Allergan B.V.
Christelijke Stichting tot Praktisch Hulpbetoonaan Visueel Gehandicapten van
alle Gezindten
D.O.R.C. International
Ergra Low Vision
Laméris Ootech B.V.
Medical Workshop
Novartis Pharma B.V.
Oculenti Contactlenspraktijken
Ophtec B.V.
Pfizer B.V.
Stichting tot Verbetering van het Lot der Blinden in Nederland
Théa Pharma
URSAPHARM Benelux B.V.
 R. Saxena, 2009
No part of this thesis may be reproduced or transmitted in any form or by any
means without the permission of the author.
Layout and print by Ridderprint, Ridderkerk
ISBN/EAN: 978-90-5335-186-4
The Artisan Lens:
Effects on vision quality, the corneal endothelium and
vision-related quality of life
De Artisan lens:
Effect op de kwaliteit van de visus, het corneale endotheel
en de visus-gerelateerde kwaliteit van leven
Proefschrift
ter verkrijging van doctor aan de
Erasmus Universiteit Rotterdam
op gezag van de
rector magnificus
Prof.dr. S.W.J. Lamberts
en volgens besluit van het College voor Promoties
De openbare verdediging zal plaatsvinden op
woensdag 13 mei 2009 om 11.45 uur
door
Ruchi Saxena
geboren te Lucknow, India
PROMOTIECOMMISSIE
Promotoren Prof.dr. G. van Rij
Prof.dr. G.P.M. Luyten
Overige leden Prof.dr. J.C. van Meurs
Prof.dr. L. Feenstra
Prof.dr. P.J. Ringens
The Artisan Lens:
Effects on Vision Quality, the Corneal Endothelium and
Vision-Related Quality of Life
Ruchi Saxena
Contents
Chapter 1 General Introduction 7
Part 1: Objective Results: Clinical Analysis of the Artisan Lens
Chapter 2 The Influence of Incision-Induced Astigmatism and Axial 43
Lens Position on the Correction of Myopic Astigmatism
with the Artisan Toric Phakic Intraocular Lens
Chapter 3 Three-year Follow-up of the Artisan Phakic Intraocular 61
Lens for Hypermetropia
Chapter 4 Long-Term Follow-up of Endothelial Cell Change After 77
Artisan Phakic Intraocular Lens Implantation
Part 2: Subjective Results: The Quality of Life of Myopic Patients
Chapter 5 Vision-Related Quality of Life of Myopic Patients 95
Chapter 6 Quality of Life Before and After Refractive Surgery 109
Part 3: Special Applications of the Artisan Lens
Chapter 7 The Use of an Anterior Chamber Phakic Intraocular 129
Lens in the Treatment of Anisometropic Amblyopia
Chapter 8 Iris-fixated Phakic IOLs to Correct Postoperative 137
Anisometropia in Unilateral Cataract Patients with
Bilateral High Myopia

Chapter 9 Discussion 149
Chapter 10 Summary / Samenvatting 155
Appendix
National Eye Institute Visual Functioning Questionnaire-25 (NEI-VFQ-25) 165
Refractive Status and Vision Profile (RSVP) 181
Dankwoord 189
Curriculum Vitae 195
Chapter 1
1
General Introduction
1.1 Refractive Errors 9
1.2 A Brief History of Correcting Refractive Error
1.2.1 Glasses and Contact Lenses 13
1.2.2 Refractive Surgery 14
1.2.2.1 Radial Keratotomy 15
1.2.2.2 Excimer Laser Procedures 15
1.2.2.3 Phakic Intraocular Lens Implantations and the 16
Artisan Lens
1.3 Quality of Life 22
1.3.1 Choice Based Evaluation Methods 23
1.3.2 Standardized Questionnaires 23
1.4 Goals of this Thesis 25
General Introduction 9
1.1 Refractive Errors
Refractive errors are the most frequent disorders of the eye1. In the ideal refractive
state, emmetropia, an image is focused directly on the retina, resulting in the
perception of a sharp image in a healthy visual system (Figure 1.1.1). Such eyes
do not require glasses or contact lenses to see sharply. Most eyes, however,
have some degree of refractive error, although correction is not always required.

Figure 1.1.1 The Emmetropic Eye
(Courtesy of Ophtec BV)
In myopia (nearsightedness), the image appears focused anterior to the retina,
producing a sharp image at near and a blurred image at distance (Figure 1.1.2).
A concave lens (minus Diopter) is required to sharpen the image. The reverse
is true in hypermetropia (also known as hyperopia or farsightedness), where
the image is projected posterior to the retina, producing a blurred image at near
and a sharper image at distance (Figure 1.1.3). A convex lens (plus Diopter)
is required to produce a clear image. Astigmatism (cylindrical error) is the
result of two different refractive powers between two perpendicular meridians
(Figure 1.1.4). A cylindrical correction can correct this problem. Extreme cases
of all these refractive errors can cause severe visual loss. Anisometropia is the
presence of two significantly different refractive errors. In these situations, simple
spectacle correction is not always suitable due to aniseikonia (different sized
images) resulting from the different powers in the lenses; other options such
as contact lenses or surgery can then be considered. When refractive errors
and anisometropia are not corrected aptly, diminished binocular vision and/or
amblyopia could result.
Refractive error is not static. Newborns are normally born hypermetropic
(approximately +2.0 D) and emmetropise quickly to plano between 4 and 6
years of age. Lack of emmetropisation can lead to hypermetropia2.
1 0 Chapter 1
Figure 1.1.2 The Myopic Eye
(Courtesy of Ophtec BV)
Figure 1.1.3 The Hypermetropic Eye
(Courtesy of Ophtec BV)
Figure 1.1.4 The Astigmatic Eye
(Courtesy of Ophtec BV)
Myopia generally has its onset around puberty, although in pathologic myopia,
negative refractive error is found earlier. Myopization can continue slowly until
about the age of 30. The development of cataract in older individuals can cause
rapid myopization, however some patients become more hypermetropic.