Restoring vision
Intraocular lenses (IOLs) are medical devices that are implanted inside the eye to replace the eye’s natural lens when it is removed during cataract surgery.
CATARACTS are often associated with old people. It is the most common cause of vision loss in people over 40 and the leading cause of blindness in the world.
According to the 2014 National Eye Survey II, more than 43,000 Malaysians have cataract blindness while 1.3 million more Malaysians over the age of 50 are expected to develop cataracts in the next five to 10 years.
Over 670,000 cataract surgeries will take place in the next four to five years in Malaysia.
A cataract is a clouding of the normally clear eye lens, which lie behind the iris and the pupil. Since the lens is mostly made of water and protein, as one grows older, the protein tends to clump together and cloud a small area of the lens. Over time, this “clouding” may grow larger and cloud more of the lens, thus making the vision blurry.
Many people consider poor vision an inevitable part of natural ageing, but cataracts are easily treatable.
A cataract surgery is a simple, relatively painless procedure to regain vision, usually lasting no more than 10-minutes for uncomplicated cases.
In most cases, the cataracts are removed and replaced with a clear intraocular lens (IOLs). These are usually made of a flexible plastic, with extensions called haptics that hold the lens in place once inserted into the eye.
The IOL is rolled up and placed in the eye. Once inside, the IOL unfolds.
With advances in technologies and proce- dures, new IOLs are being developed all the time, with unique features.
Abbott, a global healthcare company, has a number of IOLs which allow patients to customise their treatment based on their lifestyle.
With the opening of Abbott’s new manufacturing facility in Kulim, Kedah recently, millions of highly precise IOLs used in cataract surgery will be produced and exported worldwide, making Malaysia a key player in addressing the global impact of cataracts.
“The lenses we’re making here are identical to the ones we’re making in our two other manufacturing plants in Puerto Rico and Netherlands. The first lenses will be available for use by doctors and patients in the second half of the year. Our plant here will make a million lenses a year and we will grow over time,” says Aaron Kendrick, site director of Abbot facility in Malaysia.
Monofocal IOLs are used to restore vision for one area of focus only – usually distance. However, reading glasses may still be needed.
There are also other premium or multifocal IOLS available in the market.
“Multifocal IOLs allow a person to see near and intermediate distances, and may reduce the need for eye glasses. There is also the Toric lenses for astigmatism and distance vision so patients don’t have to wear glasses after surgery,” explains Leonard Borrman, Abbott Medical Optics divisional vice president of research and development.
A new innovation is the extended depth of focus IOLs.
“These lenses elongate the focus so that the person has more natural vision and can see near objects, intermediate or computer distance without eye glasses,” says Borrman.
For many cataract patients, multifocal IOLs have worked well and have afforded them a broader range of vision postoperatively.
For others, though, the possibility of glare, halo and other qualitative vision problems has led them to shy away from multifocal lenses and stick with monofocal options.
The new lens aims to bridge the gap between multifocals and monofocals and allow more vision at different distances while minimising visual side effects
It was launched in Europe in 2015 and has been available in Malaysia since last year.
Prior to the discovery of IOLs, cataracts were not removed but treated with a procedure called couching, whereby a sharp instrument was used to push the cloudy lens to the bottom of the eye. The technique is still being practised in remote areas in third world countries.
“The IOLs were developed in the United Kingdom in the 1950s by serendipity. They found that a piece of plastic in a cockpit of a jet that had ended up in a patient’s eye was actually safe and didn’t cause problems, so they decided to make lenses out of it,” says Borrman.
Kendrick adds, “But, the first lenses were hard and they still had to make a large incision in the eye.”
Abbott’s Malaysian facility will eventually make all types of IOLs.
“Restoring or improving sight can make a huge difference in how people live their lives. Today’s seniors don’t want vision or other health issues to slow them down from enjoying their favourite activities,” says Kendrick.
Borrman says, “You’ve got to catch the problem early to manage it. Smoking has been related to the development of cataracts. If you wear sunglasses, it helps protect the lens from UV radiation. Managing other health-related problems like obesity and diabetes also goes a long way.
“Realistically, cataracts can have a significant effect on a person’s quality of life. Sometimes, the cataract can be so dense you can’t see through at all. The lenses provide vision equivalent to their early years of life. The colours also appear more vibrant.”