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Advanced Intraocular Lenses

Advanced Intraocular Lenses

Intraocular lenses are implanted routinely during modern cataract surgery. Eye has a natural lens inside that helps us focus. When the lens comes discolored or cloudy, it is called a cataract. After the cataract is removed during surgery, an artificial lens or implant is placed in the eye to give patient clear vision.

The intraocular implants can be grouped into two categories. The first is the standard lens implant, which only corrects for eye’s pre-existing far-sightedness or near-sightedness. With the standard lens implants, most patients after surgery would need to wear glasses to read, while in others, bifocal glasses are needed for both close and far if residual refractive errors (farsightedness, nearsightedness, and astigmatism) remain.

The second category of the lens implants is the advanced intraocular lens implants, which can give patients a greater range vision for far and near without the aid of glasses. The advanced intraocular implants come in two different types: accommodating and multi-focal:

  • Accommodating intraocular lens (such as Crystalens) provides patient with unaided near vision by moving slightly as patient focus at near. The movement originates from the muscles in the eye.
  • Multi-focal intraocular lens (such as Restor +3, Restor +4 and Tecnis Multifocal) provides full range of vision for far and near by having multiple focal points ground in the lens. Some of focus points are far, some for near, and some for intermediate)

Though, generally speaking, advanced intraocular lens iimplants perform well, they all have certain limitations, which have to be carefully explained to patient prior to surgery. Each advanced intraocular lens has its advantages and disadvantages:

  • The accommodating intraocular lenses give sharp visual images both in light and dark but may not provide enough power for reading. Accommodating implants are best suited for patients who drives at night or patients, whose most working distances are in distant to intermediate range.
  • The multi-focal intraocular lenses provide good distant and excellent reading vision in light. In dark, however, multi-focal intraocular lenses can cause halos around lights and they are not recommended in patients who pilot airplanes, drive or work at night. For most patients, the halos become much less noticeable few months after surgery.

Presbyopia correction is a staged or multi-step process. In about 10 to 25% of cases, more than one surgery is needed to achieve the optimal result. Presbyopia-correcting intraocular lens implants do not work well if there is excessive astigmatism. Correction of the astigmatism (with LASIK or limbal relaxing incisions) may be necessary to attain optimal vision. LASIK is also needed if there is significant residual farsightedness and nearsightedness after the initial surgery.

To be successful with presbyopia correction, the patient has to be motivated with reasonable expectations. Before undergoing presbyopia correction, patient has to understand that presbyopia correction reduces the need for glasses but does not necessarily eliminate the need for glasses completely. It is not uncommon that after successful surgery, in some patients, glasses are needed for driving or reading in the dark. Furthermore, the costs of advanced intraocular lens implants and LASIK are not customarily covered by health or medical insurances. Patient must be willing and be able to cover the extra cost involved.

At DuPage Ophthalmology, we put every patient interested in presbypia correction through a thorough examination prior to surgery, combining the testing performed prior to cataract surgery and laser vision correction. We use the best and most up-to-date technology to measure the dimensions of the eye and to assess the health status of the eye. Our preoperative workup is extensive and we reserve special time slots to give extra time for performing preoperative evaluation and surgical counseling to our patients prior to undergoing presbyopia correction.

Monovison presbyopic vision correction (an alternative to advanced intraocular lenses)

For patients who wear monovision contact lenses and are interested in prebyopia correction, another option is to implant standard or toric intraocular lens implants, one for distance vision in the dominant eye and one for near in the non-dominant eye. Toric intraocular lenses are necessary in eyes with mild to moderate astigmatism. Limbal relaxing incisions can also be performed if the astigmatism is mild.

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