Types of Advanced Technology Lens Implants
What is an Advanced Technology IOL?
When a person has cataract surgery, the natural lens in the eye is removed and replaced with a man-made lens (IOL). A cataract is a clouding of the natural lens that occurs with age, and replacing the cloudy lens with a clear lens gives clearer vision. There are many different types of IOLs available. A standard IOL will give clear vision, but generally glasses are still needed to see near and/or far. With Advanced Technology IOLs, also known as Premium IOLs, we can often reduce or eliminate dependence on glasses or contact lenses.
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.
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 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 Toric IOL will correct the astigmatism and provide clear vision at either distance or near. 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).
Sometimes a patient chooses to have 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 (bifocal) IOLs (TECNIS® multifocal and ReStor® multifocal)
These lenses provide good uncorrected near and distance vision. With this IOL in both eyes a patient usually does not need glasses most of the time. Both the TECNIS® and the ReStor® Multifocal IOLs have been widely used for many years with excellent results. The ReStor® Multifocal can now provide astigmatism correction (ReStor® Toric Multifocal). All multifocal IOLs can cause some glare, halos, or a mild decrease in contrast sensitivity, but these are generally mild and overall patient satisfaction with these lenses is excellent. While we cannot guarantee independence from glasses with any IOL, most of our patients do not need glasses most of the time with this IOL.
Extended Range IOLs
The TECNIS® Symfony IOL is a type of lens implant called Extended Range IOLs. These lenses are designed to have some of the advantages of multifocal IOLs without the disadvantages of a multifocal. The TECNIS® Symfony IOL provides good distance and intermediate vision without glasses, but patients may still need glasses for reading. This lens 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 compares to the standard monofocal IOL in contrast sensitivity. In addition, the Symfony is available as Symfony 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.).
How does an Intraocular Lens (IOL) Work?
An IOL has a prescription built into it, much like the lens in your glasses or contact lens. Special measurements of your eye are taken before surgery to help us determine the power of the IOL needed for your specific eye. The IOL, once in place in the eye, then focuses light on the retina, giving you a clear image.
How Long is Cataract Surgery?
Generally cataract surgery takes about 15-20 minutes. You will usually be at the surgicenter or hospital about 2 to 3 hours. During this time paperwork is filled out, dilating drops are administered, the staff will recheck your medical history, and you will be kept about a half-hour after the procedure to make sure you are feeling well and all of your instructions are clear.
Are there any Risks Associated with Advanced Technology IOL’s?
The general procedure for cataract removal and IOL insertion is the same regardless of the type of lens used, so for the most part the risk is not different. With a Toric IOL or limbal relaxing incisions to correct astigmatism, there is a risk of placing the IOL or the relaxing incision in the wrong position, which could actually increase the astigmatism in the eye. Our practice uses the VERION ™ Image Guided System to allow for the most accurate correction of astigmatism. This system images the eye in the office and then electronically transfers the patient’s unique imaging data to the operating room laser and microscope. This allows for the most precise placement of an astigmatism correcting lens or relaxing incisions. If a Toric IOL rotates, which is very rare and only occurs soon after surgery, it can be repositioned. This could be done in a second trip to the operating room within a couple weeks of surgery if needed to correct such a problem.
With multifocal IOL’s some patients have glare with night driving after surgery. This is generally mild and tends to dissipate over several months. Even when patients have some glare, most feel that the benefits of this lens allowing them to see near and far without glasses outweighs the mild glare symptoms. There is also a slight loss in contrast sensitivity with multifocal IOLs. Most patients do not notice this.
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