|WikiProject Medicine / Ophthalmology||(Rated C-class, Low-importance)|
|This is the talk page for discussing improvements to the Intraocular lens article.|
- 1 Article title
- 2 Materials Confusion
- 3 Article Improvement Drive
- 4 Verisyse versus Artisan
- 5 Corneal Incision, etc
- 6 Structure of Intro
- 7 URGENT: Vandalism
- 8 Material removed from another article
- 9 Accuracy of Ages
- 10 Clearer Hierarchy
- 11 Desire Information on IOL the healing process
- 12 multifocal and accommodative IOLS
- 13 NuLens Ltd. comment - no source and not NPV?
- 14 Lack of sources, etc
- 15 Phakic, aphakic and pseudophakic IOLs
- 16 Addition to the present article on: IOL History
- 17 Replacement of Intraocular Lens
- 18 Remove or Clarify Confusing or Misleading Text
- Why? "Intraocular lens implant" returns 6430 hits on Google , while "intraocular lens" (without implant afterwards) returns 77100 hits . I don't think your proposed move is a good idea, to my humble opinion. --Edcolins 21:30, Dec 10, 2004 (UTC)
- Although IOL is indeed the jargon, to the uninitiated that could be confusing, since the natural lens is logically also intraocular, so I could see why someone would propose such a move. Also, since intraocular lens implant contains "intraocular lens", searching for the latter would find the former (though I guess the ranking might be different). A-giau 07:25, 13 July 2005 (UTC)
- Revised Google search results: "intraocular lens": 533,000; "intraocular lens implant": 35,600; "intraocular lens" -"intraocular lens implant": 484,000; and of course "intraocular lens implant" -"intraocular lens": 0. User:Ceyockey (talk to me) 02:46, 22 May 2006 (UTC)
- I typed "intraocular lens" to get here. Adding "implant" to the title would have only redirected me. I like that intraocular lens implant redirects here because the later article title is redundant: if it's intraocular, I don't know how it would get there if it was not implanted. (lens (anatomy) talks about the crystalline lens. I think this whole section should be removed (or hidden or something) from the discussion. (That's why I moved it to the bottom.) If someone agrees, knock this section out completely. Garvin (talk) 06:44, 13 January 2008 (UTC)
- Garvin, thanks for alerting me that you were removing this discussion. I've restored it because I still think the title is misleading, for exactly the reason A-giau explains. As a non-clinical vision scientist, I find "intraocular lens" a terrible term for an implanted lens replacement; to me the obvious meaning of "intraocular lens" is the natural, anatomical lens. I know Google results are typically used to resolve titling issues, but in this case they're not relevant. The important question is not how many people will have trouble finding this article; it's the number of people who want the article on the natural lens who will end up here instead and be confused. --Chinasaur (talk) 23:05, 27 August 2008 (UTC)
This article commonly makes notations about PMMA and acrylic lenses, describing the two as entirely different materials. In fact, these 'two' materials are both the same thing - PMMA stands for polymethyl methacrylate, most commonly known as plexiglas, perspex, acrylic glass, or acrylic. Any other materials considered as 'acrylic' are unsuitable for the task - acrylic fiber appears white due to its highly refractive nature as a fiber and its impurities, whereas pure acryls by themselves are too reactive to be included as an implant material (They contain two double bonds, which are subject to easily being broken by free radicals and various components of one's body.). It is strongly suggested that the corrections be made. See the Acrylic glass article and the Acrylic disambiguation for more detailed information. Xander T. 03:08, 11 March 2007 (UTC)
- I agree with the above post completely. The section is very confusing and poorly organized. I have added the expand section tag to the article and moved this section of the discussion to the top of this discussion page. Garvin (talk) 01:57, 22 February 2008 (UTC)
- Yeah, apparently we replaced PMMA with acrylic at some point, despite these being the same material. Still needs fixing.22.214.171.124 (talk) 08:39, 8 November 2012 (UTC)
Article Improvement Drive
Verisyse versus Artisan
The "Artisan lens" has been renamed to 'Verisyse' and has been FDA approved http://www.fda.gov/cdrh/mda/docs/p030028.html I'm also considering a cleanup with a clear distinction between the Phakic version (normally used as a replacement for contact lenses) and the ... uh... non-phakic version, where the natural lens is replaced -- to treat clouding of the lens. --Mdwyer 21:48, 4 April 2006 (UTC)
- The commonly used phrase for "non-phakic" is aphakic, as in "aphakic IOL" or "aphakic intraocular lens" :-) Don't know if there is a commonly used abbrevation for aphakic IOLs, though? When you say IOL, you normally mean aphakic IOLs, because the number of cataract surgeries are currently much higher than surgeries for correcting refractive errors. Though this might change in the future (10 years?)...
- Hmmm... Apparently "pseudophakic" is used for IOLs when you replace the natural crystalline lens with an artificial one. If you want to be precise, "aphakic" means the absence of a lens in the eye, and "phakic" means that there is a lens present. Don't know if this should be part of the article? Guess it should...
The FDA documents suggest that Artisan and Verisyse are the same thing "Verisyse (Model VRSM5US and VRSM6US) also known as ARTISAN (Model 206 and 204) Phakic Intraocular Lens (IOL)", but the artical lists one as silicone and the other as acrylic. PMMA is the same as Acrylic. --Mdwyer 21:54, 4 April 2006 (UTC)
- Ophtec produced the Artisan® lensacrylic IOLs.
- AMO (Advanced Medical Optics) produces the Verisyse™ lens.
Corneal Incision, etc
-- User:Steve McGrew I deleted the word "corneal", as the incision isn't made in the cornea, but in the white of the eye above the cornea. I also broke the paragraph before the Crystalens into two paragraphs, as the addition of the crystalens data made reading it clumsy.
I didn't change the statement that it requires a larger incision than traditional implants, but considered it as I've been researching this (I had the multifocal lens implanted in my left eye) and Wikipedia is the only place I've seen this. I'll ask my eye surgeon when I see her in September for the checkup. If she says the incisions are the same time I'll do a further edit. If any of you are eye surgeons have experience implanting these things, please clear the matter up. A citation would be helpful.
- The number of incisions change depending on what the doctor foresees is needed. Sometimes, the number of incisions are greater than actually needed - the surgeon makes the incisions "just in case", because it is more difficult to make incisions in the eye after a while, when the eye is softer because fluids has leaked out. Also, the locations - for example in the cornea or the sclera (the white of the eye) - and their locations depends on the lens type; is the lens inplanted in front of the iris, or behind it? Is the lens aphakic or phakic? Is the lens foldable or not? Please note that I'm not an eye surgeon, just very interested... --User:Di92jn
Structure of Intro
The current intro has a short para on was an IOL is and what it is used for. It then moves onto a para on the procedure for insertion, before returning to three short and confusing paragraphs on the different types. I have restructured this into two paragraphs by moving and reflowing paras 3-5 into para 1m so that para talks about the IOL and its use, Para 2 talks about the procedure, and Para 3 the risks.
Also the intro should be crisp and avoid drilling into detail that is covered later.
More improvements to readability than a material content change,
However the statement "Newer bifocal intraocular lenses give distance vision in one area and near vision in another area of the vision field" is just wrong. You do not have different fields as with bifocal glasses, so the new wording avoids this misleading statement. TerryE 23:39, 21 July 2007 (UTC)
[Note will be removed.] Is the article vandalised?
- "most patents still rely on glasses for driving "
- "during Nd:YAG capsulotomy. "
- "Deducing that the transparent material was inert and useful for implantation in the eye, Ridley designed and implanted the first intraocular lens in a human eye."
- "...use of silicone acrylate which is a soft material. This allows the lens to be folded and inserted into the eye through a smaller incision. Acrylic lenses can also be used with small incisions and are ... ...Acrylic is not always an ideal choice due to its added expense.[repeated]"
- I agree that the the whole "glasses for driving and reading" sentence was very misleading. I reworded that sentence to be more accurate. Please clarify your concerns about the 2nd and 3rd items.Kevinbsmith (talk) 13:54, 20 December 2008 (UTC)
Material removed from another article
I removed the following from Toric lens. It's too detailed and unbalanced for that article. It needs to be gone over, cleaned up and de-POVed. Perhaps there is detail that can be used in this article, however.--Srleffler (talk) 19:19, 15 June 2008 (UTC)
TICL Toric Implantable Contact Lens
is a phakic lens and an alternative for laser vision correction. The TICL is distributed by Staar Surgical, Switzerland. 1999 first successful implantations were performed by Neuhann, Munich Germany. The TICL function similar to a contact lens, except the lens is implanted into the eye, not placed over it. Because of the similarities between the phakic intraocular lens and contact lenses, many replace the word "Collamer" in the ICL acronym and call the lenses "implantable contact lenses." (This term is widely accepted in international markets.)The TICL is an intraocular implant manufactured from a proprietary, hydroxyethyl methacrylate (HEMA)/porcine-collagen based biocompatible polymer material. The TICL contains a UV absorber made from a UV absorbing material. The Visian TICL features a plate-haptic design with a central convex/concave optical zone and incorporates a forward vault to minimize contact of the Visian TICL with the central anterior capsule. The TICL features an optic diameter with an overall diameter that varies with the dioptric power: the smallest optic/overall diameter being 5 mm/12.1 mmn and the largest 5.8 mm/13.7 mmn. All descriptions of optic diameter-, overall diameter or TICL power refer measuremrents in BSS unless otherwise noted. The lenses are capable of being, folded and inserted into the posterior chamber through an incision of 2.5 mm or less. The Visian TICL is intended to be placed entirely within the posterior chamber.
Accuracy of Ages
Just wondering about the accuracy of the statement about 'Before 1993, implantation was not allowed in people under the age of 19.' I received my Interocular Lens Implants following cataract surgery at the age of 17 in the summer of 1992. At the time I was one of the younger people to have this performed, with Victoria's surgery occurring the following year. What is the source of this information?Phalcomb (talk) 02:44, 21 July 2008 (UTC)
In 1952 in Johannesburg, South African eye surgeon Edward "Teddie" Epstein successfully implanted a 12 year girl with a Ridley-Rayner lens. This patient was examined in 2009 and the eye is in good health and the lens is clear and fully functional. There is a longer experience of IOL implantation in children than is suggested here. I recommend the statement is deleted. Raynerhistorian (talk) 17:16, 6 December 2009 (UTC)
Seems to me that this article would be much improved by first clearly distinguishing between phakic and (psuedo)aphakic lenses. For anyone wanting to learn about these lenses (as opposed to a lens expert), these two are almost unrelated, and probably even belong in separate articles. For example, a phakic lens won't help a cataract, which isn't clear from the introductory paragraph.
Within aphakic lenses, the next important distinction is monofocal vs. multifocal/accommodating. Each of those should be discussed, along with links to monovision and mini-monovision. Type of material is a very minor point, I think. Kevinbsmith (talk) 13:39, 20 December 2008 (UTC)
Desire Information on IOL the healing process
I would like more information on: How the eye heals in the sac created when the lens is removed. Are the 2 "wings" on the lens only for initial positioning or are they needed afterwards. The lens area after implantation is apparently filled by a saline solution. Does the eye replace this with something more structural. What are it's optics properties.? What function do the zonules have on the new area for fixed focus lenses. For the cases when the area around the lens becomes cloudy, is it in front or behind the lens? Why does it occur.
multifocal and accommodative IOLS
Need info on these lenses and cost. I have been diagnosis w/catharacts and doctor suggested the above lenses which my insurance does not cover. I am an avid reader and enjoy driving so I need help in making the correct decision. —Preceding unsigned comment added by 126.96.36.199 (talk) 18:18, 5 October 2009 (UTC)
- The article says they're actually hinged... There's a number of reasons that's a stupid idea, but why can't they just be literally made of a flexible material like our natural lenses? — Preceding unsigned comment added by 188.8.131.52 (talk) 16:25, 20 July 2011 (UTC)
NuLens Ltd. comment - no source and not NPV?
Currently reads: "NuLens Ltd. is currently in patient trials with a new Accommodative Intraocular Lens (IOL) technology with the potential to provide over 10 diopters of accommodative power. With an IOL that sits on top of the collapsed capsular bag, the NuLens Accommodative IOL may be the first intraocular lens to provide real, comfortable, and lasting accommodation for near, intermediate and far distances."
Lack of sources, etc
I have come back to this article out of interest (as a patient who received multi-focal IOLs a couple of years ago), but now also as someone who is a lot more familiar with Wikipedia editorial processes. This article read like a student's essay on the subject. The first 5 sections do not contain a single reference so it entirely unclear what the source for this content is. I have therefore added a "Primary sources" tag.
What I'll also try to do if I have time is to convert the current references into more standard form. In the meantime if an Ophthalmic professionals care to provide the WP:RS, I'll happily assist in the editorial process. --TerryE (talk) 18:41, 2 February 2010 (UTC)
Phakic, aphakic and pseudophakic IOLs
The section with this title says:
The "aphakia" case seems weird. "Aphakia" implies that there is no lens. "Aphakic IOL" in the section title therefore suggests both "no lens" and "intraocular lens", which is a contradiction.
In my humble opinion, this entire section is redundant. The relevant info (i.e. on phakic and psuedophakic IOLs) can be integrated into other relevant sections. (That is what I did when I used this article as a basis for the corresponding Dutch article).
Addition to the present article on: IOL History
In my opinion this article can be much improved if a section is introduced after the "History" section, to describe what happened after the 1950's. However I do not wish to study how I can become an expert Wikipedia editor and would be grateful if anyone who agrees with me that it would be a useful addition, can take over that task from me. At this point in time I even have not yet created a Wikipedia account, but will do so if I receive any response. Then I would also be prepared to do some extra work on it for further improvement.
Discussion on Wikipedia's article on IntraOcular Lens (IOL); its History.
It is proposed to introduce the following section after the “History”section. The long road to general acceptance.
The 1950’s. The introduction of a foreign body in the human eye, was a paradigm shift in ophthalmological practice. It was therefore not unexpected that, when Harold Ridley first reported on his implantations of the lens (fabricated by Rayner), it met with criticism. The severeness of this criticism by several prominent ophthalmologist of the day was however very disappointing, since it sometimes developed into hostility where words as “malpractice”, “recklessness” and “criminal conduct” were used. Proponents sometimes saw the advancement of their careers obstructed ,.
A major reason for the criticism was that initially some 15% of the implants had to be removed again, because of dislocations or infections. But then there were also 85% of the patients, who were overjoyed for having near perfect vision again after a long period of blindness.
Of course such an entirely new practice needs to go through a period of improvement in the design and in the search for the optimal location and fixation of the implants. Luckily there were many, who continued their efforts. Names that stand out are Ridley’s young colleague Peter Choyce (UK), Edward Epstein (South Africa), Joaquin Barraquer (Spain) and Benedetto Strampelli (Italy). In the USA Warren Reese implanted many lenses in Wills Eye Institute in Philadelphia as from 1952. But nevertheless the rather poor success ratio and the fear for litigation and conviction caused many initial proponents to abandon their efforts and progress was slow. This delayed introduction many years, thus depriving patients of having their eyesight restored. It was also a major reason why Sir Ridley only very belatedly (as from 1985) received his much deserved prestigeous awards .
The 1960’s. Around 1960 the future for IOL’s looked rather bleak. But new ophthalmologists joined the ones who had persisted and international cooperation started to flourish. Svyatoslav Fyodorov in Russia, started implantations around 1960 and joined his contemporary Binkhorst of the Netherlands who had designed his iris clip lens, which he had implanted for the first time in 1958. Some modifications resulted in the Fyodorov-Binkhorst lens and after the 2-loop lens, the 4-loop Binkhorst lens was designed  fabricated by Morcher in Germany. Without belittleing the considerable contributions of many others, it was according to Steinert  (on page 379) quote: ”the perseverance and intellectual and surgical acumen of one man that kept this subject alive to herald in the modern era. Cornelius Binkhorst” unquote..”Kees” Binkhorst operated in Sluiskil and Terneuzen in the south of the Netherlands. Around the mid 1960’s when progress in the USA had practically come to a halt, he cooperated with several USA surgeons when they started implanting his lenses in their country .
In 1966 some 16 pioneers of IOL’s formed the International Intraocular Implant Club (IIIC), with Peter Choyce as their secretary and Ridley as president.
Still in the 1960’s Binkhorst began his cooperation with a young Dutch colleague, Jan Worst, who had his practice in the Northern Dutch city of Groningen. Worst designed around 1968 the Medallion lens and used perlon thread and later ultrathin stainless steel wire to suture the lens to the iris which obviated the daily application of eyedrops, as needed by Binkhorst’s lenses. Later he attached haptics to the lenses for fixation to the iris.
The 1970’s When IOL’s started loosing their bad image, Binkhorst was honoured by the American Society of Cataract and Refractive Surgery (ASCRS), with the introduction in 1975 of the yearly Binkhorst Award.
Meanwhile Worst continued his work. He had a very inventive mind and was a real “handyman”; an Artisan. With every implantation he was looking for improvements in his method and instruments. He often made instruments himself, which were later perfected with the help of his expert instrument maker Klaas Otter in his “Medical Workshop”; later named “Ophtec”. They also fabricated their own IOL’s. Worst believed in using simple instruments, which he carried with him in a small toolbox, when he was invited worldwide to give lectures and perform guest implantations. Nearly every year he went to Pakistan, Nepal or India , to teach and perform implants of IOL’s, often for free. Here he showed how to make surgical knives out of normal razorblades, rather than using the in those countries prohibitively expensive surgical scalpels .
In India (Amritsar) he had close relations with Daljit Singh, who with his help introduced IOL implantations there. Singh restored the eyesight to many people, also amongst his poor rural patients. He started this work in 1976, using Worst’s Medallion lens and from 1979 onward used Worst’s Iris Claw lens. Several 100.000’s of such implantations were performed in India in the following years...
As from 1975 Worst gave weekly courses and demonstrations to numerous -also international- ophtalmologists. He was a teacher by nature. After conferences in Europe frequently many attendees e.g. from the USA and South Korea would flock to Groningen. After the course they would go home with lenses to apply at home what they had learned. Robert Drews -who befriended Worst in 1968- later saw this as an important contribution to what he called the explosion of .IOL implants in the 1970’s and 1980’s.. At the end of the decade IOL’s started to be manufactured in the US. It had up to then mainly been an European affair.
In 1976 Worst was the first one to be awarded the Brinkhorst Award by the ASCRS.
The 1980’s and onward. In 1986 Worst designed the Myopia P(hakic)IOL with Iris Claw fixation, later named the Artisan lens which found universal acceptance. It was first implanted by Paul Fechner in Germany in the same since Worst did initially not want to operate on a healthy eye. Phakic meaning that the original natural lens is still in place, as opposed to aphakic, when it has been extracted by a cataract operation. It is sometimes called an Intraocular Contact Lens (ICL) and is an alternative to using spectacles. The process is reversable; if the natural lens changes its optical power, the PIOL can be removed and replaced.
Gradually lens design changed into the hands of manufacturers who employed ophthalmologists. Multifocal and Accommodating lenses were fabricated and toric lenses to correct astigmatism as described in following sections of this IOL article.
At present. Some 60 years after the invention by Sir Harold Ridley, there are several 100’s of different IOL designs and worldwide probably more than 200 million of lenses have been implanted, making it the most commonly performed eye surgery.
\ References Ref. 1. Transactions of the American Academy of Ophtalmology and Otolaryngology. January/February 1953 Ref. 2. Harold Ridley and the Invention of the Intraocular Lens by David Apple and John Sims. Survey of ophtalmology, volume 40 number 4 Jan-Febr. 1996. See also: www.rayner.com/history/Invention_of_IOL.pdf Ref.3. Sir Harold Ridley cover story by David Apple. Cataract & Refractive Surgery Today (CRSToday), issue March 2004. Ref.4. www.rayner.com/history Ref.5. Cataract Surgery. Techniques, Complicated cases and Management by R.F. Steinert et al.ISBN –13: 978-0-7216-9057-5 Ref. 6. The Intraocular Implant Lens. Development and Results with Special Reference to the Binkhorst Lens. 1975 by Marcel Nordlohne. ISBN 9061931762 and Zubal books catalogue number 527793 Ref. 7.Recollections from 1967 and beyond by Chandrappa Resmi. Cataract & Refractive Surgery Today (CRSToday), issue October 2006. Ref. 8. My Awakening to IOL’s by Robert Drews.Cataract & Refractive Surgery Today (CRSToday), issue April 2006. Ref. 9. www.janworst.com . Ref. 10 Ocular Surgery News Europe/Asis-Pacific edition July 1, 2002. Ref. 11. Emedicine.medscape.com. May 16, 2008. Arun Verna, Myopia, phakic IOL.
Pioneers of IntraOcular Lens implantations. From left: John Alpar, Norman Jaffe, Cornelius Binkhorst, Jan Worst, Sir Harold Ridley, Peter Choyce, Svyatoslav Fyodorov and Michael Roper Hall
Replacement of Intraocular Lens
Remove or Clarify Confusing or Misleading Text
Under the section "Materials used for intraocular lenses" there is text that states " This break through material provides the exact chromophore the human retina has already specified for light protection."
I'm not aware that the human retina, clever as it seems in operation, is a self-aware entity that can specify anything. Remove this anthropomorphic expression. — Preceding unsigned comment added by 184.108.40.206 (talk) 06:06, 26 February 2013 (UTC)