Cataract Surgery with Standard Lens Implants
Traditionally, after the cataract is removed, the natural lens is replaced by a standard or single focus intraocular lens implant (standard IOL). This lens improves the patient’s DISTANCE VISION, but reading glasses or bifocals may still be required to view things closer than arm’s length. Alternatively, the patient may choose a single focus lens implant (standard IOL) that provides focus at NEAR VISION, and will therefore still require glasses to see distance. Newer lens implant options, however, can offer much greater freedom from glasses.
Cataract Surgery With Advanced Technology Lens Implants
One of the most exciting changes in cataract surgery in the last 10 years has been the introduction of a variety of special lenses called “Advanced Technology “ lens implants (also referred to as “Premium” lens implants). These lenses include the Alcon Toric lenses for astigmatism correction, the PanOptix® Trifocal lens, the Tecnis Synergy Multifocal lens, the Alcon ReSTOR® Multifocal lens, the TECNIS® Multifocal lens, the TECNIS® Symfony Extended Range lens, TECNIS® Symfony Toric Extended Range lens , Vivity Extended Depth of Focus lens, Vivity Toric Extended Depth of Focus lens,and the Crystalens® accommodating lenses. These more advanced lenses are designed to allow patients to be more independent of glasses. These lenses are not appropriate for all eyes. A full eye exam in combination with measurements of the eye, scanning of the macula, and mapping of the cornea help to determine if the patient is likely to benefit from one or more of these advanced technology options. Just as important, consideration of patient lifestyle, occupation, hobbies, and goals with cataract surgery is taken into account. The role of our doctors is to narrow down the options to lenses appropriate for the patient and then educate the patient about these options so that the doctor and patient together can choose the best option for that individual.
Advanced Technology Lens Implant Options
How do I choose a lens implant type?
Your doctor will perform a complete eye exam to assess the overall health of your eye. Noninvasive, painless measurements of the eye are then performed using state of the art technology. Your doctor will then narrow down the lens implant options that are appropriate for your eye based on the exam and the measurements. You will be asked about the visual needs of your lifestyle and daily activities, as well as your wishes regarding independence from glasses or contacts. Your doctor will use all of this information to help guide you in making the best choice of IOL for your eyes.
Monofocal Toric IOLs
These lens implants correct astigmatism in the patient’s eye. Many people have a cornea that is not perfectly spherical in shape. This asymmetric curvature is called astigmatism. Astigmatism can be corrected in glasses, contact lenses, or in the eye itself with a Monofocal Toric IOL. When cataract surgery is performed, measurements before surgery will determine how much astigmatism is in the surface of your eye (the cornea). This may not be at all the same as what is in your pre-surgical glasses or contact lenses. If you have significant astigmatism, and you prefer not to be dependent on glasses/contacts, a Monofocal Toric IOL will correct the astigmatism and provide clear vision at either distance or near. Monofocal Toric IOLs are not multifocal, so they have to be set for a particular type of vision without glasses (near vision or distance vision clear without glasses, but glasses for focal length not corrected by the IOL).
Sometimes a patient chooses to have Monofocal Toric IOLs with one eye set for near and the other set for distance. This is called Monovision. Monovision can provide independence from glasses for many activities. While not the best choice for all patients, it can be an excellent choice for patients who have liked monovision in contact lenses in the past.
Toric Multifocal IOLs are another option for patients with astigmatism. These IOLs provide better vision without glasses for both near and far, and also correct astigmatism. These IOL types are listed below.
Trifocal IOLs (PanOptix®)
The PanOptix® Trifocal Lens is the first and only trifocal IOL available in the United States. It is a type of multifocal IOL, but generally provides a broader range of vision without glasses than previous multifocals. It is designed to provide distance, intermediate (computer), and near (reading) vision. Like other multifocal IOLs, it is designed with multiple rings of different power (unlike trifocal glasses). This IOL is available with astigmatism correction as well (Toric PanOptix® Trifocal Lens). The full benefit of this IOL is seen when it is placed in both eyes. All multifocals can cause some glare, halos, or a mild decrease in contrast sensitivity, but these are generally mild and overall patient satisfaction with this lens is excellent. While we can’t guarantee independence from glasses with any IOL, most of our patients do not need glasses most of the time with these IOLs.
Multifocal IOLs with continuous range of vision (Tecnis Synergy Multifocal and Tecnis Synergy Multifocal Toric IOL)
These IOL types are similar functionally to the Trifocal IOL (PanOptix) listed above. This type of multifocal IOL generally provides a broader range of vision without glasses than previous multifocals. It is designed to provide distance, intermediate (computer), and near (reading) vision. Like other multifocal IOLs, it is designed with multiple rings of different power (unlike trifocal glasses). The full benefit of this IOL is seen when it is placed in both eyes. All multifocals can cause some glare, halos, or a mild decrease in contrast sensitivity, but these are generally mild and overall patient satisfaction with this lens is excellent. While we can’t guarantee independence from glasses with any IOL, most of our patients do not need glasses most of the time with these IOLs.
Multifocal (bifocal) IOLs (TECNIS® multifocal and ReStor® multifocal)
These particular IOLs have largely been replaced by the newer Trifocal PanOptix IOL and the Tecnis Synergy Multifocal IOL because of the broader range of uncorrected vision they deliver. Both the original TECNIS® Multifocal and the original ReStor® Multifocal IOLs have been widely used for many years with excellent results. The intermediate range vision (computer range) is generally better with the newer IOLs. For that reason, with the launch of the newer Trifocal PanOptix IOL and the Tecnis Synergy Multifocal IOL in 2021, these newer IOLs are used more commonly.
Extended Range IOLs (Tecnis Symfony and Vivity IOLs)
The TECNIS® Symfony IOL and the Vivity IOL are a type of lens implant called Extended Range IOLs or Extended Depth of Focus IOLs (EDOF). These lenses are designed to have some of the advantages of multifocal IOLs without all of the disadvantages of a multifocal. These IOLs provide good distance and intermediate vision without glasses, but patients may still need glasses for reading. These lenses can cause some glare and halos with night driving, but usually less so than with a multifocal IOL, and generally this is very mild. While multifocal IOLs can create a slight loss of contrast acuity, the TECNIS® Symfony and Vivity IOLs are similar to the standard monofocal IOL in contrast sensitivity. In addition, both of these IOLs are available in astigmatism correcting forms (Toric) to correct mild to moderate amounts of astigmatism. The TECNIS® Symfony is an excellent choice for a patient wishing to be more independent of glasses, especially if the patient has some astigmatism or concerns about glare.
Both the Symfony and the Vivity IOLs are available with built-in astigmatism correction (the Symfony Toric and Vivity Toric) to correct mild to moderate amounts of astigmatism. These extended range IOLs are an excellent choice for a patient wishing to be more independent of glasses, especially if the patient has some astigmatism or concerns about glare.
These lenses are also a good option in patients who are not ideal candidates for a multifocal IOL, but who still desire more range of vision without glasses than a monofocal IOL can provide. In patients with very mild macular issues, such as mild macular aging changes or a mild macular epiretinal membrane, multifocal IOLs do not work as well. If the macular issues are mild, an extended range IOL is often a very good option.
Accommodating IOLs (Crystalens® IOL)
These lenses also provide near and far vision by flexing and slightly shifting in the eye when you shift from near to far viewing or visa versa. We find these lenses give a better range of focus than a standard IOL, but readers may still be needed for intermediate and near vision. We use this type of IOL for patients who want to have a range of focus but are not good candidates for a multifocal IOL (we don’t recommend the multifocal IOLs in patients with macular disease such as macular degeneration, macular pucker, etc.). This IOL does not provide as much range in vision as do the multifocal IOLs.
WHAT IS THE TECNIS® MULTIFOCAL LENS IMPLANT?
The TECNIS® multifocal IOL is one of several different multifocal lens implants available. When cataract surgery is performed, the natural lens of the eye is removed and replaced with a clear, man-made lens implant (IOL). There are many different IOL types available. The term “multifocal” means that it is designed to provide clear vision without glasses for distance and near vision. This is in contrast to a “monofocal” IOL that is set for a specific vision (distance, intermediate, or near) without a range of focus. The goal of the TECNIS® IOL is to allow patients to be independent of glasses most, if not all, of the time.
How is the TECNIS® Multifocal Lens Implant Different from other Multifocal IOLs?
The TECNIS® multifocal IOL was designed using wavefront technology. This technology is used to correct optical aberrations (visual distortion) that can cause glare, halos, and a lesser visual quality. The TECNIS® is a diffractive lens with concentric rings of different power that provide vision at near and distance. Because the lens is designed to be independent of pupil size, reading vision in low light conditions is better than with some of the other multifocal lens implants.
Who would Benefit from the TECNIS® Multifocal Lens?
When choosing an IOL type for a cataract patient, we take into account the overall health of the eye and the desires of the patient. A multifocal lens implant does not work well in an eye with significant macular disease (macular degeneration, macular pucker, macular scar or hole) or severe glaucoma. If, however, the general health of the eye is fairly good and there is little astigmatism, this IOL is an excellent option. This is a good choice for a patient who wishes to be independent of glasses at all distances. While no lens can guarantee a patient will not need glasses, studies done with the TECNIS® Multifocal showed that about 90% of patients who had this lens implanted in both eyes were independent of glasses a year after surgery.
Can the TECNIS® Multifocal Lens be Implanted in Only One Eye?
This question comes up a lot with patients who have already had cataract surgery on one eye several years ago before the advanced technology IOLs were available. The short answer is “yes.” Multifocal lenses work best when they are implanted in both eyes. This generally provides the best independence from glasses at all distances. If the TECNIS® is implanted in one eye, and the other eye either has a standard monofocal lens or does not have good vision, the patient is more likely to need glasses for some tasks. For example, long periods of reading may be more comfortable with glasses in this case. Nonetheless, the TECNIS® IOL provides much more spectacle independence than a standard monofocal lens does, even if only implanted in one eye. Many patients opt for this choice and thereby lessen their dependence on glasses considerably.
What are the Risks of the TECNIS® Multifocal Lens?
The lens is about the same size and shape as most other IOLs, so there is no added risk at the time of surgery. After surgery, multifocal lens implants can cause some glare and halos, particularly with night driving. This is not usually a big issue for patients, but if your job requires a lot of night driving, this lens might not be the best choice. With any multifocal IOL, there is a risk of slight blurring or ghosting, or “waxy” vision. Overall we find that our patients are really happy with this lens. Though it may not provide perfect vision all the time at all distances without glasses, most patients don’t wear glasses much or at all after placement of TECNIS® multifocal IOLs in both eyes.
RESTOR® MULTIFOCAL IOL
What is a Lens Implant?
A cataract is the clouding of the natural lens in the eye that occurs with age. During cataract surgery, the natural lens is removed and replaced with a man-made lens (an intraocular lens implant or IOL). There are now many different types of IOLs available.
What is a ReSTOR® Lens?
The ReSTOR® lens is a type of intraocular lens implant (IOL) that can be used in cataract surgery. The goal of this IOL is to allow patients to see at near and far distances without glasses. Rather than being a lens with a single power throughout, it has concentric rings of different lens power so that there is a full range of vision, near to far, that is in focus without the need for glasses. This lens has been used since 2005 and has an excellent track record. It is a great lens for people who want to be able to both drive and read without glasses. People who play sports such as golf or tennis can enjoy good distance and near vision without loss of depth perception.
Will I Still Need Glasses After a ReSTOR® Lens Implant?
About 80% of patients with this IOL implanted in both eyes report that they never need glasses. We tell our patients that this means they may need glasses for some activities, but should generally be fairly independent of glasses for most things. While some patients may wear glasses for night driving or reading in low light (a restaurant menu, for example), most patients do not end up wearing glasses much, if at all.
How do I know if I am a Candidate for the ReSTOR® IOL?
There are several factors that need to be taken into account. The main concerns are the overall health of the eye and the amount of astigmatism present in the eye.
First, we look at the overall health of the eye. If an eye has macular degeneration, severe glaucoma, corneal scarring, or other significant causes of vision loss apart from the cataract, the ReSTOR® lens is not likely to provide as good a result.
Second, we review data from a wide variety of computerized scans of the eye that are done in the office. These include a corneal map, ultrasound measurements of the shape and length of the eye, and a macular scan. None of these are invasive tests, and they are performed during your office visit. If the results indicate that the eye has significant astigmatism of the cornea (an irregular surface of the eye), a ReSTOR® Toric IOL can be used. This is a multifocal IOL that also corrects astigmatism.
What are the Side Effects of the ReSTOR® IOL?
Overall, cataract surgery is considered a very low-risk procedure. It is, nonetheless, a surgery, so there is a risk of complications. The size, shape, and acrylic material of the ReSTOR® lens are identical to a standard lens implant (monofocal or single vision IOL), so the placement of this lens does not pose an increased risk during the surgical procedure. The main downside to this IOL is that some patients will experience glare after surgery. This tends to be noted during night driving. In general, this complaint is usually mild and tends to dissipate with time. When we ask patients if they have glare in the first few months after surgery, some do, but it is rare for this to be a significant issue. This generally resolves gradually over 6 to 12 months without any intervention.
If you are interested in seeing your best without glasses, please call our office so we can schedule a time to evaluate the appropriateness of this technology for you. Together we will discuss the benefits, risks, and cost so you can make an informed decision.
TECNIS SYMFONY® EDOF
The TECNIS Symfony® and Symfony® Toric IOLs are both extended depth of focus (EDOF) IOLs. The Symfony® Toric corrects astigmatism as well. An EDOF IOL is designed to provide a continuous range of clear distance and intermediate vision without the need for glasses. Reading vision may require glasses. This IOL may be a good choice for the patient who is not an ideal candidate for a multifocal IOL (a lens that provides distance, intermediate and reading vision) due to minor macular aging changes or other eye exam findings. Some eyes are still candidates for an EDOF lens when a multifocal is not appropriate. For these patients, the EDOF lens provides more range of vision without glasses than a standard monofocal lens.
What are the risks with this lens?
The Symfony® and Symfony® Toric IOLs are the same shape and size as a standard IOL, so they do not increase the risk of surgery. Vision in dim lighting may be slightly reduced. Glare and halos can occur especially with night driving. These are usually not severe, and tend to dissipate somewhat with time.
How do I know if I am a good candidate for the Symfony® IOL?
A complete eye exam is needed to determine the overall health of the eye. Patients with severe glaucoma, macular degeneration, corneal scarring and other significant eye disease may not benefit as much from this IOL. Patients with very mild macular conditions can be considered for this IOL. The Symfony® IOL is a better choice than the multifocal or trifocal lenses if there is very mild macular pathology. Our doctors can help determine if this IOL type is a good choice for your eye.
WHAT IS THE PANOPTIX® TRIFOCAL IOL?
The PanOptix® Trifocal Lens is the first and only trifocal IOL available in the United States. It is a type of multifocal IOL, but generally provides a broader range of vision without glasses than previous multifocals. It is designed to provide distance, intermediate (computer), and near (reading) vision. Like other multifocal IOLs, it is designed with multiple rings of different power (unlike trifocal glasses). This IOL is available with astigmatism correction as well (Toric PanOptix® Trifocal Lens). The full benefit of this IOL is seen when it is placed in both eyes. All multifocals can cause some glare, halos, or a mild decrease in contrast sensitivity, but these are generally mild and overall patient satisfaction with this lens is excellent. While we can’t guarantee independence from glasses with any IOL, most of our patients do not need glasses most of the time with this IOL.
What is an intraocular lens?
An intraocular lens (IOL) is an artificial lens that is implanted during surgery to replace your cataract lens. You can choose from many different types of IOLs—some are designed to provide only distance vision, while trifocal lenses deliver near, intermediate, and distance vision for clear, complete focus. After a surgeon removes your cataract-clouded lens, he or she will implant the IOL that you chose before your procedure.
Does the PanOptix® Lens correct astigmatism?
Yes, the PanOptix® Lens is available in a toric option to correct astigmatism. Toric lenses sharpen vision and clear the distortion caused by astigmatism.
Are there risks or side effects with the PanOptix® Lens?
Due to the design of multifocal IOLs, there are some side effects that can be associated with the AcrySof® IQ PanOptix® Trifocal IOL models. These may be worse than with a monofocal IOL, including visual disturbances such as glare, rings around lights, starbursts (rays around light sources), and reduced contrast sensitivity (decrease in ability to distinguish objects from their background, especially in dim lighting). Nonetheless, overall patient satisfaction with this IOL is excellent. While we can never guarantee independence from glasses, most of our patients with this IOL do not need glasses or contacts.
WHAT IS THE CRYSTALENS® IOL?
What is a Lens Implant?
A cataract is the clouding of the natural lens in the eye that occurs with age. During cataract surgery, the natural lens is removed and replaced with a man-made lens (an intraocular lens implant or IOL). A traditional standard lens implant (monofocal IOL) has a single focus point. This sets vision without glasses at either distance or near. Glasses can then be used to provide sharp vision at all distances. More advanced technology lenses, such as the Crystalens®, provide a broader range of focus without glasses. This makes patients less dependent on glasses.
What is a Crystalens® Implant?
The Crystalens® is a type of lens implant (IOL) that is designed to help patients see better with less need for glasses. It is designed to work somewhat like your eye’s natural lens, using the muscles that cause the natural lens to change shape. In cataract surgery using the Crystalens®, the natural lens is removed, and just as in standard cataract surgery, the IOL is placed in the capsule that held the natural lens. Tiny muscles in the eye cause this capsule to change shape. The Crystalens® is unique in that its structure flexes and changes shape when these tiny muscles contract and relax. This changes the focus of the lens allowing you to see a broader range of distances without glasses. It simulates the action of the natural lens in the eye accommodating to change focus. It is the only FDA approved lens that works this way – the only accommodating IOL. While there are multifocal lenses available that also provide a range of focus, they work without changing shape and instead have rings of varying power. The Crystalens® provides more range of focus than a standard IOL. This range is however generally a lot less than a mutifocal IOL. For patients with a healthy eye, the multifocal IOL is often a better choice, but there are some circumstances where the Crystalens is still a good option (see below).
How do I know if I am a Candidate for a Crystalens® IOL?
When evaluating a patient for cataract surgery, we do a variety of measurements and scans of the eye including corneal mapping, ultrasound measurements of the size and shape of the eye, and a macular scan. If there is excessive astigmatism in the cornea (an irregularity in the curvature of the surface of the eye), a Trulign® Toric IOL can be used. This lens is identical to the Crystalens®, but also has astigmatism correction.
Why Choose Crystalens® when it provides less range than a multifocal?
One key advantage of the Crystalens® is that it can be used in patients who have underlying eye conditions. While multifocal IOLs (such as the PanOptix®, Tecnis Synergy, ReSTOR® or Tecnis® IOLs) are not well suited to eyes that have vision loss from macular degeneration or macular wrinkling, the Crystalens® can be used in these eyes in some cases. The limiting factor in the visual outcome is still the overall health status of the eye, but if the underlying condition is not severe, these patients can still achieve a range of focus with the Crystalens®. Every patient is different, so this is an issue we discuss in detail with each patient so that their expectations are in line with the vision that we think this lens can provide for them.
What are the Side Effects of the Crystalens® IOL?
The Crystalens® design and shape are a little different from a standard IOL. The lens, however, is inserted in the same way as a standard IOL, so the surgery does not carry added risk. The lens itself is a tiny bit smaller than the average standard IOL, so there is a small risk of glare from the edge of the IOL in a patient with a large pupil. This is rarely a significant issue, and most patients adapt quite well. We find that the uncorrected reading vision (i.e. the reading vision without glasses) is not nearly as good as with the multifocal IOLs (PanOptix®, Tecnis Synergy, ReSTOR® and Tecnis®), but there is usually more range of focus than with a standard IOL. Patients often need reading glasses, but they are generally independent of glasses for many activities. We recommend this lens implant for patients who wish to be more independent of glasses but also have a mild underlying macular condition that precludes use of a multifocal IOL.