1. Clinical Experience with the Accommodative WIOL-CF acrylic IOL.
3/25/2017
Clinical Experience with the Accommodative WIOL-CF acrylic IOL.
By Arthur Nylander,
FRCS, FRCOphth, D.O.
Consultant ophthalmologist
East Lancashire hospitals, Lancashire, U.K.
The author as no financial interest in these products
Mr A Nylander.

2. East Lancahire Hospitals
3/25/2017
East Lancahire Hospitals
Serves a population of people
Burnley General Hospital
Blackburn Royal Infirmary
Rossendale General Hospaital
Seven Consultant Ophthalmologist
Five Middle Grade Doctors
Nine Trainee Doctors
Mr A Nylander.

3. WIOL-CF Accommodative Full-Optics acrylic IOL
3/25/2017
WIOL-CF
Accommodative Full-Optics
acrylic IOL
Mr A Nylander.

4. WIOL-CF Main Features and Benefits
3/25/2017
WIOL-CF Main Features and Benefits
Accommodation capability > 2.25 Dioptres
Low incidence of PCO (< 1%/year)
Resistance to deposits Large glare-free optics
Very good centration and position stability
Potential for full reversibility - reimplantable
Allows vitreo-retinal surgery
Some clinical results will be presented in the second part. Let me summarize the main reasons why we are interested in this lens:
Mr A Nylander.

5. WIOL-CF Posterior Chamber foldable acrylic IOL
3/25/2017
WIOL-CF Posterior Chamber foldable acrylic IOL
MAIN FEATURES:
Accommodating
Large continuous aspheric optics
Fills the posterior capsule
Highly biocompatible material
Large lens implantable through a small incision
This lens has the following main features:
Mr A Nylander.

6. WIOL-CF design Full disc plano-convex lens up to 9 mm O.D.
3/25/2017
WIOL-CF design
Full disc plano-convex lens up to 9 mm O.D.
Posterior polyfocal hyperbolic optics
Optics continuous up to the rim
Implantation:
Preformed through < 3mm incision using a 3.0mm cartridge and titanium injector.
Mr A Nylander.

7. 3/25/2017
WIOL-CF acrylic IOL
Mr A Nylander.

8. WIOL-CF “Full Optics” acrylic IOL
3/25/2017
WIOL-CF “Full Optics” acrylic IOL
MENISCOID ANTERIOR SURFACE
C.T. = mm
The profile shows the posterior surface which a hyperboloid and anterior is a modified spheric surface, or meniscoid.
HYPERBOLOID SURFACE CONTACTING POSTERIOR CAPSULE
O.D. – 8.6 – 9.0 mm
Mr A Nylander.

9. WIOL-CF edge profile MENISCOID ANTERIOR SURFACE
3/25/2017
WIOL-CF edge profile
MENISCOID ANTERIOR SURFACE
OPTICAL TRANSITION ZONE
CONICAL FASETTE
The lens has a sharp rim which then blends into the optical part via a narrow conical fasette. This rim may be one of the reasons why the lens is very resistant to posterior capsule opacification.
SHARP EDGE
HYPERBOLOID SURFACE CONTACTING POSTERIOR CAPSULE
Mr A Nylander.

10. WIOL-CF Features Benefits
3/25/2017
WIOL-CF Features Benefits
High water content
( 42%, higher than any other IOL on the market today )
High carboxylate content
( only on the current market )
Low refractive index
Superior biocompability
High permeability
Hydrated surface with low friction vs. tissue (e.g., capsule, iris, cornea )
Resistance to calcification
Minimized surface reflections and glare at night
Mr A Nylander.

11. WIOL-CF Features Benefits
3/25/2017
WIOL-CF Features Benefits
Negatively charged surface
(only one on the market )
Partly dehydrated for insertion
Resistance to protein deposits
Resistance to cell attachment
Resistance to opacification of posterior capsule
No adhesion to tissues ( capsule, iris, cornea )
Increased strength for safer folding
Non-slippery for safer grip
Smaller size for implantation
Mr A Nylander.

12. WIOL-CF Features Benefits
3/25/2017
WIOL-CF Features Benefits
Full-disc configuration
Self-centering
Excellent position stability
Maintenance of posterior capsular wall
Replaceability of WIOL-CF
Very large optical zone
Enables vitreo-retinal surgery
Mr A Nylander.

13. WIOL-CF Features Benefits
3/25/2017
WIOL-CF Features Benefits
Continuous transition between optics and rim
Sharp-edged continuous rim
Aspherics hyperboloid optics
No edge effects ( no glare, improved night vision )
Resistance to PCO
Improved depth of focus
Pseudo-accommodation
Improved resistance to astigmation
Mr A Nylander.

14. Power Calculation Chart
3/25/2017
Power Calculation Chart
Mr A Nylander.

15. Power Calculation For the WIOL-CF Lens
3/25/2017
Power Calculation For the WIOL-CF Lens
1.The surgeon calculates the lens power based on the A-constant for SRK-T. Lets’s assume that the calculated value is 21.5d.
2.Surgeon corrects the calculated value using the correction chart. The value of 22.5d (right red column) relates to the value 21.5d (left blue column).
3.Finally, the value of +0.5d is added to the corrected value. Therefore surgeon implants WIOL-CF of the dioptric power of 22.8 (23.0)d.
4.Anterior surface is the flat (plano) surface of the lens, posterior surface is the convex surface of the lens, it is easy to recognise from the side view.
5.Lens has to be rinsed by isotonic saline solution and positioned posterior (convex) side down into the cartridge. Procedure of folding is shown in the following video.
Mr A Nylander.

16. Surgical Implantation
3/25/2017
Surgical Implantation
Video clip
Mr A Nylander.

17. WIOL-CF accommodation
3/25/2017
WIOL-CF accommodation
Implanted in 51 eyes :
Up to this date results in summary:
WIOL-CF allows a comfortable everyday life and work or sports activities without use of spectacles or contacts
Good patient preference and satisfaction.
Objective examination shows 20/20 uncorrected acuity for both near and far vision
Now some personal experience. My right eye was implanted more than 4 yeas ago and my left eye 2 years ago. In summary, this lens allow me a normal active life without spectacles – reading, night driving, sports, etc.
Objective examination shows 20/20 vision both for near and far vision.
Mr A Nylander.

18. WIOL-CF ACCOMMODATIVE IOL
3/25/2017
WIOL-CF ACCOMMODATIVE IOL
Implantation history
First implanted in January 2004.
Implanted 3 in 2004
Implanted 27 in 2005
Implanted 21 so far in 2006
Mr A Nylander.

19. WIOL-CF ACCOMMODATIVE IOL
3/25/2017
WIOL-CF ACCOMMODATIVE IOL
Implanted 51 lens in 38 patients
11 of these patients have had the lens implanted in both eyes
29 patients have had unilateral implantation.
19 males
21 females
Mr A Nylander.

20. WIOL-CF ACCOMMODATIVE IOL
3/25/2017
WIOL-CF ACCOMMODATIVE IOL
Age Distribution
Youngest Patient 43 years old
Oldest Patient 87 years old
Mr A Nylander.

21. WIOL-CF ACCOMMODATIVE IOL
3/25/2017
WIOL-CF ACCOMMODATIVE IOL
Mr A Nylander.

22. WIOL-CF ACCOMMODATIVE IOL
3/25/2017
WIOL-CF ACCOMMODATIVE IOL
Lens Diopters
Lens come in Diopters powers from 15.0 to 30 Diopters
Implanted from 19.0 Diopters to 29.0 Diopters
NO difference in folding pattern
All powers injected with the same behaviour
Lens must unfold inside the capsular bag
Mr A Nylander.

23. WIOL-CF Accomadative iol
3/25/2017
WIOL-CF Accomadative iol
Mr A Nylander.

24. Case Study 1 CASE 1 - Mr. S.H Aged 55 Hospital Administrator
3/25/2017
Case Study 1
CASE 1 - Mr. S.H Aged 55 Hospital Administrator
pre op: OD OS
Add for N5
Right Phacoemulsification Wiol-CF IOL 5/5/05
Left Phacoemulsification Wiol -CF IOL 16/5/05
Unaided V.A. June 05 OD 6/4 OS 6/4-2 N8 N8
Patient very happy
Unaided V.A. November 05 OD 6/9 OS 6/4-2 N8 N8
Right YAG capsulotomy
Mr A Nylander.

25. Case Study 2 CASE 2 - Mr. M. H. Aged 52 Taxi Driver
3/25/2017
Case Study 2
CASE 2 - Mr. M. H. Aged 52 Taxi Driver
pre op: OD OS
Add for N5
Right Phacoemulsification Wiol-CF IOL 5/5/05
Left Phacomulsification Wiol -CF IOL 24/11/05
Unaided V.A. December 05 OD 6/9-1 OS 6/6 N5 N5
Patient say can read without glasses. Very happy.
Mr A Nylander.

26. Case Study 3 CASE 3 - Mrs. S.A. Aged 71 Retired Horse Trainer
3/25/2017
Case Study 3
CASE 3 - Mrs. S.A. Aged 71 Retired Horse Trainer
pre op: OD OS
Add for N5
Right Phacoemulsification +19 Wiol-CF IOL 11/01/04
Unaided V.A. 6/6 N8.
Very Happy.
Mr A Nylander.

27. Case Study 4 Brought Husband of patient case 3.
3/25/2017
Case Study 4
Brought Husband of patient case 3.
Mr. T.A. Aged 86 for Bilateral Cataract
Right Phacoemulsification Wiol -CF IOL 23/2/06
Left Phacoemulsification Wiol -CF IOL 2/3/06
Unaided V.A. April 06 OD 6/9-1 OS 6/9 N12 N10
Patient happy.
Mr A Nylander.

28. WIOL-CF accommodation: subjective patient's observations
3/25/2017
WIOL-CF accommodation: subjective patient's observations
Good focus requires some effort and training
Acuity degrades by fatigue, (e.g.after long work on poor computer screens or reading of low-quality print in poor light conditions)
Far focus improves and double vision disappears by widely opening eyes
Near focus improves by narrowing eyes and good illumination
In addition to the objective results presented by Professor Pasta later, I have made some subjective observations:
Mr A Nylander.

29. WIOL-CF accommodation: subjective patient's observations
3/25/2017
WIOL-CF accommodation: subjective patient's observations
Very near focusing requires conscious effort and time (1 to 2 seconds lag)
Using both eyes improves significantly both near and far focus
No glare or other vision problems while driving at night
No degradation of peripheral vision at driving, tennis, etc.
No acuity deterioration after 4 years (subjectively improved)
Mr A Nylander.

30. Conclusion All patients obtained some accommodation.
3/25/2017
Conclusion
All patients obtained some accommodation.
Accommodation range from N12 to N5 Mostly N8.
Better accommodation with 6/9 or 6/6 vision than 6/4 or 6/5.
Encourage patients to use their accommodation.
Mr A Nylander.

31. 3/25/2017
Conclusion
Older patients need more encouragement than younger patients.
Correction factor appears to be accurate.
PCO in 2 out of 51 cases.
1 YAG Capsulotomy at 18 months
No problems with YAG Capsulotomy
Overall results with the WIOL-CF lens are very promising.
Mr A Nylander.