A groundbreaking new type of lens, implanted after cataract
surgery has been developed that can be adjusted to give a patient perfect
vision after it has been inserted into the eye.
How the made-to-measure lens works
1. The
15-minute procedure is carried out under local anaesthetic. A 2mm incision is
made in the eye. Through this, the cloudy lens is fragmented using
high-frequency ultrasound. This is then removed through a fine tube.
2. The
light-adjustable lens (LAL) is rolled up and inserted through the same
incision. It unfolds once inside the eye.
The first artificial
lens implant to treat cataracts was carried out in London just over 60 years
ago. Pioneered by ophthalmic surgeon Sir Harold Ridley, it was a concept that
would go on to save the sight of millions.
Now, a groundbreaking new type of lens has been developed that can be adjusted
to give a patient perfect vision after it has been inserted into the eye.
Made from a unique material, the lens has the ability to change shape when a
certain strength of laser light is shone on to it, meaning it can be tailored
to an individual patient's needs - whether they have cataracts or are long or
short-sighted, or have astigmatism, for example. This is a condition that
causes blurred vision due to the front of the eye not being a regular shape.
Surgery using the innovative light-adjustable lens (LAL), developed by a US
company and a Nobel prize-winning scientist, has been carried out on the first
patients in the UK in the past few weeks by consultant ophthalmic surgeon Mr
Bobby Qureshi.
'You can virtually promise people who have cataract surgery that they will have
perfect vision, whereas before that hasn't been possible,' says Mr Qureshi.
'What's more exciting is that some people may even achieve "super
vision", which is better than 20/20 (normal vision).
'Every eye has microscopic imperfections that can limit vision. With this lens,
we can correct these and potentially give people high-definition vision.'
He says: 'This is an incredible operation. It is probably the biggest
breakthrough in cataract surgery for decades. I feel so fortunate to be
pioneering it in the UK. This has raised the bar of cataract surgery to a whole
new level.'
A cataract is the clouding of the lens, the part of the eye that helps focus
light on to the retina to form an image. As the lens ages, it starts to turn
yellow and cloudy. Light is unable to pass through to the retina and vision
becomes blurred. Left untreated, cataracts can lead to blindness.
About a third of people in the UK over 65 have cataracts in one or both eyes.
Typically, treatment is a replacement lens implant but perfect vision could not
be guaranteed - until now.
Mr Qureshi, who specialises in cataract surgery and lens implants, explains:
'Cataract surgery is one of the most common surgeries performed worldwide. We
do around 300,000 in Britain each year on the NHS alone.
'Traditionally, it involves the insertion of monofocal lenses - these improve
distance vision but have only a single focus, so patients will still need
glasses for reading and the majority have some residual long sight, short sight
or astigmatism, which means glasses are required
'Ten years ago, multifocal implants came along, offering patients better vision
for both near and distance. But many are still left with residual astigmatism
and require laser eye surgery, or still need to use glasses.
'Part of the reason for this is that due to their design multifocal lenses can
cause lights to glare at night. They also don't correct intermediate vision
very well. The difference with the LAL is that for the first time we can put a
lens into the eye and change the strength of it from outside the eye via a computer.'
Mr Qureshi says the LAL will also help anyone with presbyopia (age-related
long-sightedness) - something that begins around the age of 40 and affects
everyone at some point. The procedure can remove the need for glasses
altogether.
'Potentially, anyone over 40 who wears glasses could have total freedom from
them with this operation and possibly sharper vision than could ever have been
achieved before,' says Mr Qureshi.
The key with the LAL is the unique materials called 'macromers' embedded in the
make-up of the lens. When UV light of a specific wavelength is shone into the
eye, they group together, producing a swelling that changes the lens curvature.
In other words, the lens can be reshaped precisely for each patient's needs.
So far, 1,000 patients have been operated on worldwide and the first cases in
the UK were done three weeks ago by Mr Qureshi, who works at the private London
Eye Hospital.
He performs the procedure - which is carried out under local anaesthetic and
takes ten to 15 minutes - by making a 2mm incision in the eye. Through this,
the cloudy lens is fragmented using high-frequency ultrasound and is removed
through a fine tube.
The LAL is rolled up and inserted through the same incision. It unfolds once
inside the eye.
Mr Qureshi says: 'In just a couple of hours, patients should notice an
improvement in their vision - often even better than it was before their eye
problems.
'But certainly by the
time I see patients a few days later, their vision is already at 90 per cent.'
The next step is the
adjustment, which is done ten days to a fortnight after the lens implant. Once
Mr Qureshi has evaluated the patient's vision, he or she will be seated with
their chin resting on a support, much like during a normal eye test.
A sophisticated computer then shines beams of UV light into the eye and on to
the lens for about 90 seconds, changing its shape. A few days later, the
patient returns for any finetuning, after which, using further beams of light,
the LAL is 'locked in' to position.
Mr Qureshi says the procedure does not carry significantly more risks than
traditional cataract surgery. But because the light can make a patient's eyes
susceptible to UV light until the LAL is locked in, they must wear protective
glasses.
They must also use anti-inflammatory and antibiotic eye drops for four to six
weeks.
The hope is that the operation will eventually be available on the NHS. In the
meantime, it costs about £3,000 privately.
Part-time nurse Gill Balfour, 61, from Epsom, Surrey, was one of the first in
the UK to have the LAL. For the past ten years she has been wearing glasses or
contact lenses to correct presbyopia.
'Mr Qureshi explained all about the LAL and I did my own research. I was really
excited about having it done,' she says.
Gill opted for blended vision rather than a multifocal lens and had a
predominantly distance lens implanted in her left eye about three weeks ago. It
has now been locked in. Next week, she will have a predominantly near lens
inserted into her right eye.
Gill says the vision in her left eye improved dramatically as soon as the lens
was inserted.
'I had to wear a protective patch overnight. But as soon as I removed it the
following day, I could tell immediately that the vision in that eye was better.
Everything was brighter. I suddenly saw the world in a different light.
'Through the new lens, I realised that white looked really white, whereas
through my right eye it was slightly yellow.
'Through my left eye, I can
now read the smallest line of letters on an eye chart, which is two lines
better than normal vision. Before, without glasses or contacts, it would have
been a complete blur.
'The amazing thing is that these lenses will last for the rest of my life.'