1. National Survey on the Choice of Secondary Intraocular Lens Implantation in the UK James Tildsley Sathish Srinivasan Alan Gaskell [All authors have no financial interest] Ayr Hospital, Ayr, Scotland, UK

2. Introduction 270,000 cataract procedures were performed in UK National health service in 2008. 1 270,000 cataract procedures were performed in UK National health service in 2008. 1 The reported incidence of PC rupture and zonular dehiscience is 1.92% and 0.46% respectively. 2 The reported incidence of PC rupture and zonular dehiscience is 1.92% and 0.46% respectively. 2 Both of these complications have the potential to prevent primary lens insertion and aphakia Both of these complications have the potential to prevent primary lens insertion and aphakia

3. Introduction Secondary lens implant is now the standard for managing aphakia. 3 However there is a wide variation in the choice of lenses for secondary lens implant. Secondary lens implant is now the standard for managing aphakia. 3 However there is a wide variation in the choice of lenses for secondary lens implant. Given how common a secondary IOL may be required we conducted this national survey with the aim to collect data on current practice of UK Ophthalmology consultants on secondary IOL choice Given how common a secondary IOL may be required we conducted this national survey with the aim to collect data on current practice of UK Ophthalmology consultants on secondary IOL choice

4. Method An anonymous questionnaire was mailed to all 896 NHS ophthalmology consultants currently practicing in the UK. An anonymous questionnaire was mailed to all 896 NHS ophthalmology consultants currently practicing in the UK. Data on surgical experience, number of secondary IOLs performed, preferred choice of secondary IOL with no capsular support +/- associated open angle glaucoma (POAG) and closed angle glaucoma (CAG) / peripheral anterior synechiae (PAS), and personal experience of using the lenses were collected. Data on surgical experience, number of secondary IOLs performed, preferred choice of secondary IOL with no capsular support +/- associated open angle glaucoma (POAG) and closed angle glaucoma (CAG) / peripheral anterior synechiae (PAS), and personal experience of using the lenses were collected.

5. Questionnaire

6. Results - Surgical experience A total of 420 questionnaires were received, with a response rate of 47%. A total of 420 questionnaires were received, with a response rate of 47%. 50% perform 5-10 cataract procedures a week, 30% over 10 and 20% less than 5. 50% perform 5-10 cataract procedures a week, 30% over 10 and 20% less than 5. 75% had less than 2 complications leading to aphakia, 16% had 2 - 5 and 7% had over 5 75% had less than 2 complications leading to aphakia, 16% had 2 - 5 and 7% had over 5

7. Results - choice of lens

9. Results - experience with other lens types 19% familiarized themselves with Artisan iris clip lens, mainly by wet lab. 12% have used the Artisan lens in 18 months. 21% say it has changed their practice 19% familiarized themselves with Artisan iris clip lens, mainly by wet lab. 12% have used the Artisan lens in 18 months. 21% say it has changed their practice 23% have used an iris suture lens 23% have used an iris suture lens 92% personally undertake open loop ACIOL insertion. For scleral sutured PCIOL, Artisan iris clip lens and iris sutured PCIOL the results were 43%, 27% and 22% respectively 92% personally undertake open loop ACIOL insertion. For scleral sutured PCIOL, Artisan iris clip lens and iris sutured PCIOL the results were 43%, 27% and 22% respectively 20 to 25% would prefer to refer to the appropriate sub- specialty for insertion of a secondary IOL other than open loop ACIOL 20 to 25% would prefer to refer to the appropriate sub- specialty for insertion of a secondary IOL other than open loop ACIOL

10. Conclusion NHS Ophthalmology consultants currently working in the UK are using secondary IOLs for management of aphakia as recommended. 3,4,5,6 NHS Ophthalmology consultants currently working in the UK are using secondary IOLs for management of aphakia as recommended. 3,4,5,6 Overall the open loop ACIOL was the most popular secondary IOL. However this changed with associated POAG and CAG/PAS suggesting there are limitations of the open loop ACIOL and advantages using an Artisan iris clip lens, iris sutured PCIOL and particularly the scleral sutured PCIOL. This result was supported by other studies. 3-6, 8,10-13 Overall the open loop ACIOL was the most popular secondary IOL. However this changed with associated POAG and CAG/PAS suggesting there are limitations of the open loop ACIOL and advantages using an Artisan iris clip lens, iris sutured PCIOL and particularly the scleral sutured PCIOL. This result was supported by other studies. 3-6, 8,10-13

11. Conclusion Previous studies so far conclude that the outcomes of all the different secondary IOLs are comparable to each other but further research is required, and the choice of lens is based mainly on personal experience of using a lens. 3, 7,9,12,13 Previous studies so far conclude that the outcomes of all the different secondary IOLs are comparable to each other but further research is required, and the choice of lens is based mainly on personal experience of using a lens. 3, 7,9,12,13 Our study found the same result, but due to the fact that the different lens techniques investigated have been available for at least 28 years it suggests that different lens techniques are not being attempted. 13,14 Our study found the same result, but due to the fact that the different lens techniques investigated have been available for at least 28 years it suggests that different lens techniques are not being attempted. 13,14

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