Cataracts & Implants
Choosing the Best Implants
In the past, all intraocular lenses were monofocal, which means that they only focused at one distance. Glasses were needed in order to focus on other areas. Today, we can offer patients the choice of a multifocal lens implant that provides excellent vision after cataract surgery at a variety of distances—far, near, and in-between. Our state-of-the-art center offers patients many options, including self-focusing, accommodating, and multifocal implants, as well as toric lenses for treatment of astigmatism. Additionally, we participate in clinical research studies and have lens options that are made available to only a handful of surgeons in the U.S. Compared to a monofocal implant, multifocal lenses have a significantly expanded range of focus, from distance to near, minimizing dependence on glasses. Most patients find this to be a wonderful way to enhance their lifestyle.
AMO TECNIS & ALCON ACRYSOF®
A monofocal lens implant provides excellent vision after cataract surgery, but only at one set distance (usually for seeing things at a distance). When focused at distance, these lenses work well for seeing distant signs when driving, going to a movie, or watching TV. Monofocal lens implants will require usage of glasses for any type of near vision activity, like reading, knitting, sewing, playing cards, or using a computer. You may also need glasses for distance, especially if you have astigmatism.
There are traditional as well as “new technology” aspheric monofocal implants. Unless there is a reason not to, we only use aspheric lenses. These implants can provide better quality vision, especially at night. Two examples are the AMO Tecnis and Alcon Acrysof® lenses. Each patient will decide how they would like their monofocal lens best focused: distance, near, or a combination called monovision. Most insurance companies pay for a monofocal implant as part of cataract surgery.
CRYSTALENS AND SYNCHRONY
Crystalens and Synchrony are accommodating intraocular lenses that, unlike a standard IOL, can treat both a person’s cataracts and presbyopia—in particular, loss of intermediate vision. People generally notice a loss of some up-close vision in their 40s, and start wearing reading glasses at that time. Crystalens not only treats cataracts (a clouding or hardening of the lens), but can also reduce dependence on glasses. It does so by recreating accommodation similar to the eye’s natural lens.
Accommodating lenses are modeled after the human eye. Like the natural lens, they use the eye muscle to flex and accommodate in order to focus on objects in the environment at all distances. Both Crystalens and Synchrony dynamically adjust to a person’s visual needs and are designed to allow the optic, or the central circular part of the lens that you see through, to move back and forth as you constantly change focus on images around you. Accommodating lenses focus only one image to the back of the eye, unlike a multifocal lens that projects multiple images, requiring your brain to “adjust” to the differences. After implantation of an accommodating lens, most patients will see brighter and clearer from distance to intermediate. While patients who opt for an accommodating lens do often use reading glasses for small print, most are pleased with their overall decreased dependence on glasses.
THE SYNCHRONY® DUAL OPTIC ACCOMMODATING LENS IS CURRENTLY IN CLINICAL INVESTIGATION PHASE.
We are proud to be 1 of only 20 practices selected as investigators for the new Synchrony® Dual Optic Accommodating lens. Our clinical research team is currently studying patients to evaluate the safety and effectiveness of the lens and the potential for functional near vision without glasses. The Synchrony lens is currently an investigational device within the U.S. and is not yet commercially available.
The Synchrony dual optic accommodating IOL is designed to allow patients to see well at near, intermediate, and far distances without glasses or contacts. It features a plus-powered anterior lens and a minus-powered posterior lens that are joined by a unique spring system. When the two lenses are close together, the eye is set for distance. When the ciliary body contracts, reducing capsular bag and zonular tension, the front lens moves forward, changing the eye’s focus to intermediate or near vision.
TECNIS MULTIFOCAL & ACRYSOF® ReSTOR
The Tecnis Multifocal and AcrySof® ReStor implants are multifocal intraocular lenses designed to allow good vision at distance and reading. They work by focusing both distances simultaneously onto the retina. The brain is able to adapt and allow only the desired image to be clear. These lenses differ from an accommodating lens (like Crystalens) in that they do not allow near vision by flexing, but rather focus the near vision through their design. This has benefits as well as disadvantages. The primary benefit is that these lenses allow most patients to read well without glasses. They are much more successful at allowing “glasses free” reading than are the accommodating lenses that only allow most to read objects when they are further away, at about arm’s length or “computer distance”. The primary disadvantage of multifocal lenses is that they can cause some halos and glare at night around lights. Many are not bothered by the haloing, and of those in whom it is more initially prominent, most find that they adapt or have the symptoms minimize or disappear with time.
In summary, we have found that if the goal is to see at distance and read up close well without glasses, the multifocal lenses tend to be the best choice. For those who don’t mind wearing glasses for reading, but would like to minimize dependence on glasses for intermediate vision while minimizing their risk of halos around lights, an accommodating lens may be the best option.
Toric intraocular lenses correct astigmatism. Astigmatism is defined as the surface of the eye not being perfectly round (like a basketball), but rather oblong (more like an American football). Astigmatism can be corrected with either glasses or contact lenses, special corneal relaxing incisions (as is often done in conjunction with one of the other kinds of implants), or with toric implants. For those with significant astigmatism, and the desire to minimize their dependence on glasses at one distance (usually far away), toric implants can be an excellent option. We perform several technologically advanced imaging procedures to determine the value of this option.
In summary, there are several different intraocular lenses, each with their own advantages and disadvantages. Rest assured that our vision care team will do its best to educate each patient so that an informed decision can be made as to which option will be appropriate. At SoCal Eye, we are pleased to offer all options to ensure our patients have every opportunity to benefit from the choices available—and to choose the option that is best for their anatomy and their lifestyle.