Mr. Peter G. LaHaye IOLAB Corporation 560 West Terrace Way San Dimas, California 91773

Dear Mr. LaHaye:

We have recently received a large shipment of your Choyce style intraocular lenses.

On Friday, January 20, 1978, I opened one of your Choyce style lenses - 12.5 mm. +19.00 diopter, Control #101477-91P-475 - to examine the lens carefully with the slit lamp biomicroscope. Much to my disappointment, upon inspecting the posterior lateral edges of the lens, it could be easily seen that the edge, especially the posterior edge of the lens, was not p<:lished. On the one side of the Choyce lens the postenor edge was a sharp right angle with no evidence, whatsoever, of the edge having been pol­ished. The other side of the Choyce lens revealed an unpolished bevel at the posterior edge of the lens. I compared this lens with a SurgiDev lens, which I had recently removed from a patient with a "sputtering hyphema syndrome," the third such lens which I have removed in the recent past. The SurgiDev lens also revealed that the posterior edges of the lens were not polished.

It is our feeling, as it is the feeling of Dr. Robert Drews, President of The American Intra-Ocular Im­pla~t Society, that in addition to warping, one of the mam reasons for the sputtering hyphema syndrome in Choyce style intraocular lenses is poor polishing of the posterior edge of the lens.

It is, therefore, with disappointment that we are returning our entire supply of Choyce style intra­ocular lenses which we have obtained from you.

John W. Beam, M.D. Edward Joseph Zobian, M.D. West Reading, Pennsylvania

Editor: This letter was sent to AIOIS as well as the addressee.

Dear Editor:

I might be wrong, as my children tell me I often am, although I never realize it, but I am greatly troubled by the term which is becoming more and more popular in lectures and lately, in publications. The term is "implant years, " which, as you know, is the number of lenses inserted times the numbers of the years inserted.

Choyce Mark VIII lenses made by Rayner and he observes each of them for ten years, he will have one hundred implant years for each of the three different lenses made by reliable manufacturers. If another doctor puts in one hundred medallion two-loop lenses with some heavy metal loops and one hundred Binkhorst four-loop lenses with heavy platinum iridium loops and one hundred injection molded Choyce lenses in one year, at the end of the year he also will have one hundred implant years for each lens. But, whereas the first surgeon's lenses withstood the test of time and very likely ten years after the implantation, the eyes are still good, the lenses are still in place, the second surgeon's eyes will show deterioration and if not during the first year, by the second year surely, the heavy lenses will create sphincter problems, chronic uveitis, perhaps even c.orneal-endothelial dystrophy and many of the injec­tlOn molded lenses will warp inside of the eye.

I have attended meetings where speakers spoke about their last two-three-four-five hundred lenses all performed within the last few months. As a matte~ of fact, one of the speakers even apologized for the slides because he said, "The following thirty-odd lenses were put in last week and I have just received the slides this morning, I didn't even have time to edit them." With his enormous volume, his "implant years" are high up but his results are highly question­able. So is followup.

I believe, when we are talking about devices which have a late potential risk, the term "implant year" is misleading. The term is purely a statistical one and I am sure, in many instances within the industry, is highly informative. The fact, for instance, that last year the commercial air lines flew 10,500,000 passenger miles without any major accident certainly indicates the safety of such way of traveling but one does not stay in the airplane for ten years and certainly the airplane doesn't stay in us for ten years.

I wonder whether our Society shouldn't make an effort to call the fallacy of the use of such a term to the attention of the Membership and to urge the speakers to refrain from using this term as an evidence of anything. Perhaps implant years does indicate the efficacy of the lens but certainly, it has nothing to do with lens safety, and we have to be concerned with both.

John J. Alpar, M.D. Amarillo, Texas

Dear Editor:

If you take a surgeon who puts in ten medallion How should we assess the experience of implant two-loop lenses made by Medical Workshop and ten surgeons? Numbers of implant procedures alone are Binkhorst two-loop lenses made by Morcher and ten clearly not sufficient; we must find a way of taking

AMERICAN INTRA-OCULAR IMPLANT SOc. JOURNAL - VOL. IV, APRIL 1978. 68