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P. G. Limoli, E. Vingolo, L. D'Amato, R. Solari, E. Giacomotti, R. Di Corato, R. Carpi, F. Tassi; ReSTOR, Virtual Rehabilitation and Maculopathy. Can We Talk About a Surgical Way for Visual Rehabilitation? Case Report and Considerations. Invest. Ophthalmol. Vis. Sci. 2009;50(13):5608.
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In patients with cataract and maculopathy , the ability to provide, through a virtual rehabilitation software (VirtualIPO ©), the magnification needed to read can be applied in choosing the IOL by which cataract surgery could become a rehabilitation opportunity. In our experience, the magnification provided by diffractive IOL and the enlargement obtained with a surgical myopization allows the reduction of the power of the proper magnifying optical system which can be virtually decided before the operation.
We have chosen 5 maculopathic patients (8 eyes) aged between 61 and 79 year. We evaluated the residual visual acuity by near with the proper magnifying device in pts, the real and the virtual magnification, and the dioptric power of the magnifying system. Then we made a phacoemulsification with apodized diffractive IOL RESTORETM implant.
The case reports presented show that the virtual magnification (2.86 X) coincided with the real one after surgery (2.75 X). This magnification has been kept unchanged, the power of magnifying system from 10.67 diopters becomes 6.91 diopters after surgery; in this way we have reduced the global power of the magnifying system without altering the magnification required for reading. Part of the reduction (3.2 D) was achieved by using a IOL RESTORE TM, thanks to diffractive characteristics of the lens. A further part of the reduction (average 1.19 D) was obtained with a surgery myopization calculated at the discretion of the surgeon. A further part of the reduction (average 1.19 D) was obtained with a surgery myopization calculated at the discretion of the surgeon. Magnifying power system is:Virtual X * 4 - 3,2 D - surgery myopization(2.86 * 4) - 3.2 - 1.19 = 11.44 - 3.2 - 1.19 = 7.04 DThe far distance visus remains basically unchanged. The reduction of magnifying power system determines a proportional increase in working distance and field offered by the system.
Lowering the system power below 10 diopters makes the surgery option suitable for the creation of binocular systems which are more useful to the process of rehabilitation and more aesthetically accepted. We believe that the surgical way for visual rehabilitation, below a visus remaining 30 cp, and only in selected cases from virtual analysis, can be a less discriminatory way to rehabilitate low vision patients with maculopathy.In a more ethical approach to visual rehabilitation, we believe it is important to deepen the benefits and limits of this approach, further widening the case studies.
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