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The SML Experience

01

Pre-Operative

Patient selection

    Suitable patients:

    • With dry AMD and near vision difficulties.
    • With other stable retinal conditions
    • Diabetic retinopathy, myopic retinopathy
    • Other hereditary retinal diseases proved by OCT
      *Please contact us for further information
    • Pseudophakic or candidates for cataract surgery.
    • Who show sufficient near vision improvement on near vision tests performed with +2.5D at 40cm and with +6.0D at 15 cm.
    • CDVA
      - equivalent to 0.50 logMAR or 20/60 Snellen
      - equivalent to 1.00 logMAR or 20/200 Snellen
      *Please note that the patient may still benefit from the SML if outside of the above

Preoperative CNVA needs to be examined as follows:

    • Patients read at a distance of 40 cm with an addition of +2.5D placed over their distance prescription eyeglasses (examination A) and then at a distance of 15 cm with an addition of +6.0D placed over their distance prescription eyeglasses (examination b).
    • The patient is a good candidate for the SML implantation if there is 3 or more lines of improvement between examination A and B.
    • The patient may still benefit from SML implantation in case of 1 or 2 lines of improvement (please consult Medicontur or your local provider)
    Contraindications
    • Active neovascular AMD/maculopathy
    • Active iris neovascularisation
    • Zonulopathy
    • Subluxation of the primary IOL
    • Shallow pseudophakic ACD (< 2.8 mm measured from the endothelium)
    • Narrow angle, i.e. < Schaefer grade 2
    • Pigment dispersion syndrome
    • Uveitis
    • Pupillary abnormalities (e.g. photopic pupil less than 2.5 mm)
    • Aphakia
    • Progressive glaucoma
    • Corneal diseases involving central cornea

IMPORTANT:

    • Based on these near vision tests, we can estimate the likely near visual acuity of the patients after implantation of the SML.
    • It is important to communicate this with the patients and to set realistic expectations for them.
    • Each eye should be tested monocularly for distance (UCDVA & BCDVA) and near visual acuity.
    • The implanted eye should be the better seeing one
    • SML DOES NOT cure maculopathy.
    • SML is a magnifier. It is like a low vision aid inside the eye.
    • Exacerbation of maculopathy might occur any time after the implantation of the SML.
    • The SML does not affect /limit any diagnostic or treatment procedures of exacerbated maculopathy

THE SML ADVISOR

This tool has been designed for your convenience and support.
The SML Advisor is your personal consultant which helps you select the optimal patients who will most likely benefit from the implantation of the SML.
  • 01
    Determine if your patient is suitable for SML implantation.
  • 02
    Determine the more suitable eye for implantation.
  • 03
    Estimate the extent of visual acuity improvement.
  • 04
    Generate a pdf and/or print-out including detailed patient data and the results of your evaluation, which you can then add to the patients’ records.
  • 05
    If your patient is evaluated suitable for the implantation, conveniently send the order form directly to our scientific team and your local provider.
Caution: Even the best online tools cannot substitute accurate measurements and the opinion of a specialist ophthalmologist. If you have any further questions please contact us at scientific@medicontur.hu
SML Advisor
02

Implantation

Implantation in the ciliary sulcus is performed following cataract surgery.
Monocular implantation in the better-seeing eye.
Easy implantation using 
a standard IOL injector through a 2.2 mm incision.
No extensive training is required – minimal learning curve.
MEDICONTUR SCHARIOTH MACULA LENS

IMPLANTATION

Additional points to remember:
  • Interval between OCT & surgery should not exceed 10 days
  • Interval between cataract surgery and the SML implantation should be at least one month
  • Clear lens extraction and intracapsular IOL and SML implantation in one session is possible, though currently not recommended by Medicontur
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03

Post-Operative

KEY: POST-SURGICAL TRAINING IS PARAMOUNT FOR PATIENT SATISFACTION

TRAINING AFTER SURGERY

Patients need to practice performing near-vision reading tasks without the use of magnifying aids. This should be performed 2-3 times a day for at least 20 minutes at a time during the first 4-8 weeks following SML implantation.
  • The eye without the SML implantation may need to be covered during the first few days after SML implantation when reading.
  • The reading material needs to be held at approximately 15–18 cm from the patients’ eye. Good lighting conditions and high contrast reading materials are recommended.
  • A dedicated and experienced low vision expert is necessary for achieving optimal results after surgery.
  • The adaptation is quick: it usually takes 2-5 weeks after surgery.
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w-100 mt-4

POSSIBLE COMPLICATIONS AND RECOMMENDATIONS

Complications are not common but may occur
  • WET AMD development: So far there is NO clear evidence that intravitreal injection of anti-VGEF may prevent decompensation/development of wet AMD after the implantation of SML under dry and stable AMD conditions. For this reason the preventive use of anti-VGEF is currently not recommended by Medicontur.
  • SD-OCT macula is recommended to be performed before surgery, ideally no more than 10 days before surgery to avoid hidden / developing wet AMD.
  • Inflammatory reaction in the anterior chamber. Anti-inflammatory drugs like corticosteroids (for up to 3 weeks after surgery) and NSAIDs (for up to 2 months after surgery) are recommended.
  • Far vision disturbances (halos, glares). We recommend sunglasses and if these are not effective, we recommend so called neutral Density Filter glasses. Pilocarpine can also be considered if sunglasses are not effective in reducing these symptoms.
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