Visual and Microperimetry Outcomes of an Extended Macular Vision Intraocular Lens in Macular Atrophy

This study aimed to evaluate visual acuity and microperimetry correlated with anatomical changes in eyes with macular diseases implanted with the EyeMax Mono intraocular lens (IOL) (SharpView Ophthalmology).

A single-center retrospective, real-world case series was set in Knappschaft Eye Hospital, Sulzbach, Germany. Patients with macular disease who underwent EyeMax Mono IOL implantation were included. The outcome measures were corrected distance visual acuity (CDVA) and microperimetry indices: fixation stability and bivariate contour ellipse areas (BCEAs) at 63% and 95%. The geographic atrophy (GA) monitor (RetInSight) was used to analyze changes in retinal integrity.

Twenty-one eyes (11 patients; mean age 72.8 ± 8.3 years, mean follow-up 7.4 ± 4.0 months) were included. Preoperative GA measured 4.7 ± 4.0 mm2 (n = 14), and EZ loss on SD-OCT was 2,433.1 ± 1,009.5 µm (n = 17). The CDVA improved by 0.2 logMAR (p = 0.007, n = 21), with 12 eyes gaining ≥1 line and seven eyes gaining ≥3 lines. Fixation stability improved in two eyes, stabilized in nine eyes, and worsened in four eyes. The changes in BCEA were not statistically significant. Higher preoperative BCEA correlated with greater postoperative improvement (p < 0.001). In the foveal fixation group (n = 4), 75% and 50% of patients showed improved BCEA and CDVA, respectively. In extrafoveal fixation (n = 11), BCEA improved in 50% of patients, while 64% showed CDVA improvement. The GA monitor showed worsening in 9/15 eyes, and 4 eyes showed worsening on microperimetry without a CDVA decline. Anatomical changes stabilized in six eyes; of these, two exhibited a decline in microperimetry without a CDVA decline.

EyeMax Mono IOL improved CDVA, although no significant changes were observed in the microperimetry indices. Better microperimetry outcomes were observed in extrafoveal fixation cases. While the optical design of the IOL likely contributes to visual improvement, the small sample size limited the statistical power to detect significant microperimetry changes.