Premium lens options (Presbyopia Intraocular Lenses) are more recent innovations that are designed to improve significantly the depth of focus after cataract surgery. Use of these IOLs during cataract extraction or refractive lensectomy may reduce or eliminate the need for corrective lenses for distance, intermediate and near visual tasks. Drs Erdey, Searcy, and Kaswinkel offer all of these premium lens options to enhance your vision with cataract or refractive surgery. We'll be happy to explain which lens option might be best for you when we see you. Call for your appointment today at 614-863-3937!
Accommodation refers to the ability of the crystalline lens (located behind the pupil) of the eye to instantly change shape in order to bring into focus objects located at different distances from our face. For example, we might need to focus on the moon (infinity), our computer (intermediate, or about 60 cm) or a book (near, or about 40 cm). Different objects located at varying distances require our crystalline lens to quickly adjust to see them clearly. This process is similar to focusing a camera lens on an object when taking a picture.
There is a natural, but inevitable loss in the focusing power of our crystalline lens as we age, called Presbyopia. The ability of the crystalline lens to instantly change shape in order to focus light rays on the retina for near vision tasks gradually declines throughout life. Around age 43, most people begin to notice they must hold reading material farther away than usual. To correct this problem, bifocals, reading glasses or monovision contact lenses are increasingly required so by age 50 there is generally total dependence on corrective lenses.
The lens of an eye which is cloudy and no longer adequately transparent to light is called a Cataract. This causes vision to be blurry, hazy and colors to be washed out; much like foggy sunglasses that need to be cleaned. Once vision is sufficiently compromised, cataract surgery may be recommended by your doctor. The eye’s cloudy natural lens is removed during cataract surgery and exchanged with an intraocular lens implant (IOL). It’s much like replacing a dirty, brown-tinted camera lens with a clear replacement lens.
If you’re considerably younger than 50, and require cataract surgery, consider that any remaining natural ability to focus (accommodate) is immediately lost. After cataract surgery, you will require bifocals for near vision. For example, if a 30 yr old requires cataract surgery, removing this “young” lens that fully changes shape to focus on near objects and replacing it with standard implant with fixed focus may improve uncorrected distance vision but reading glasses or bifocals will immediately be required. This may be quite a lifestyle change! Conversely, older patients who require cataract surgery are already accustomed to bifocals and will still require them after surgery with a standard IOL.
Standard IOL’s have a fixed focus and are not designed to restore the eye’s natural ability to accommodate following cataract removal. Until recently, patients undergoing lens implant surgery had no other choice but a monofocal, or single focus IOL. Monofocal IOL’s implanted in both eyes generally provide excellent uncorrected vision if both IOL’s are powered for distance (infinity) and pre-existing astigmatism, if any, is corrected at the time of cataract surgery; however, patient’s typically remain dependent on spectacle correction for near and intermediate vision.
Single focus IOLs can be electively targeted for distance focus in one eye and intermediate or near focus in the other eye. When both eyes are open, this optical condition, called “monovision” provides good simultaneous distance and intermediate (computer distance) or reading distance but the downside is some loss of binocularity or sterovision. Not all patients tolerate such an imbalance and may not accept “monovision”. Others may gradually adapt to this imbalance over time (several months). Still others only notice problems in low light or night illumination. Distance driving glasses may be all that is needed.
If you are approaching or are in the presbyopia age range (above age 40), you may already be familiar with this arrangement if you’ve worn contact lenses set up for monovision. If you have an interest in this option, you may ask your doctor to “tailor” the surgery (leave some residual near-sighted ability in your non-dominant eye) to allow some independence from reading glasses.
Presbyopia IOLs are more recent innovations that are designed to significantly improve depth of focus. Use of these IOLs during cataract extraction or refractive lensectomy may reduce or eliminate the need for corrective lenses for distance, intermediate and near visual tasks. Since both eyes are generally focused at a similar distance, stereopsis or depth perception is maximized. While Presbyopia IOLs have definite advantages over conventional monofocal IOLs it is important to realize that they do not yet simulate the full range of accommodation provided by the young human crystalline lens!
Unlike Conventional IOLs, Presybopia IOL’s are NOT a covered benefit of your health insurance and instead are considered an optional “upgrade”. Additional out-of-pocket fees will apply if you elect this option. Payment plans are provided. Please contact us for more information.
There are currently four US FDA approved Presbyopia IOL designs each using different optical principles to achieve better depth of focus. Each has advantages and disadvantages:
- Crystalens ™ (Baush and Lomb)
- Crystalens Trulign ™ (Baush and Lomb)
- Restor™ (Alcon)
- Technis Multifocal ™ (AMO)
The following is a brief summary of these lenses which do not attempt to present a full discussion of the benefits and risks that may be associated with their use. Be sure to talk to your doctor who will determine if you are a suitable candidate and before making any decisions about vision improvement procedures, as this information is not intended to replace the advice of a healthcare professional.
Is Crystalens right for you?
What is Crystalens?
Crystalens is an artificial lens implant that, unlike a standard IOL, can treat both a person’s cataracts and presbyopia—loss of near and intermediate vision. You probably noticed in your forties that you started to lose some of your up-close vision and had to start wearing reading glasses. Crystalens not only treats your cataracts (a clouding or hardening of your lens); many patients hardly if ever wear glasses after surgery. It does so by recreating accommodation similar to your eye’s natural lens. The unique Crystalens is designed to allow you to enjoy a fuller, more natural range of vision for most activities, including: reading a book, working on the computer, and driving a car.
Crystalens was modeled after the human eye. Like the natural lens, it is a lens implant that uses the eye muscle to flex and accommodate in order to focus on objects in the environment at all distances. Crystalens dynamically adjusts to your visual needs.
Crystalens is 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. Crystalens, like your natural lens, flexes as you focus your vision.
- The first and only FDA-approved accommodating intraocular lens
- The only FDA-approved intraocular lens that uses the natural focusing ability of the eye
- The only FDA-approved presbyopia correcting IOL for cataract patients that provides a single focal point throughout a continuous range of vision
Few patients with Crystalens have experienced problems with glare, halos and night vision. Crystalens focuses 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.
The effectiveness of Crystalens was proven in clinical trials:
- Significantly more patients implanted with a Crystalens (88.4%) could see better at all distances than patients implanted with a standard IOL (35.9%).
- 98.4% of patients implanted with crystalens in both eyes could pass a driver’s test without glasses
- 100% could see intermediate (24″ to 30″) without glasses, the distance for most of life’s activities
- 90% could see well enough to read the newspaper without glasses
- Some patients did require glasses for some tasks after implantation of the crystalens
- Most patients have continued to report excellent vision 7 years after implantation with Crystalens. More than 200,000 Crystalens intraocular lens implants have been implanted worldwide, and that number is growing daily.
- Crystalens accommodates like the natural lens. (see animation below). After implantation of Crystalens, most patients will see brighter and clearer across a wider range of distances like they did when they were younger.
|View: Crystalens Animation|
ONLY FDA-Approved accommodating IOL
Crystalens was the first presbyopia correcting IOL introduced into the United States market and is currently the only FDA-approved accommodating IOL. Crystalens addresses the limitations of standard monofocal IOLs and multifocal IOLs by providing the following advantages to patients:
- Provides a Broad Range of Vision: Crystalens moves and changes shape using the eye’s natural focusing mechanism, instead of remaining fixed and stationary within the eye. This movement, or accommodation, allows the eye to focus on objects across a broad range of distances. Many patients hardly if ever wear glasses after surgery. In particular, this accommodation provides significant advantages in addressing intermediate vision.
- Maintains Clarity of Vision: Unlike multifocal lenses, Crystalens directs all available light received by the eye to a single focal point, comparable to that of a healthy natural lens.
- Patient Adjustment Not Required: Crystalens produces a single image consistent with normal vision, meaning patients do not need to neuroadapt to viewing multiple images. Patients also do not need to tolerate or adjust to high levels of halos and glare often associated with multifocal IOLs
August 8, 2013: NBC4 Columbus – “New Surgery Corrects Cataracts, Astigmatism“
Most patients prefer to reduce their dependence on corrective lenses and bifocals after cataract surgery.
That means they want to see clearly, without glasses not just at distance but also at arms length – their speedometer in their car or their computer monitor, and at near: the ladies want to look in the mirror to put on their make up, the men want to shave, and we all want to see our smartphone!
Our Doctors have successfully used the Crystalens for many years. This implant does reduce dependence on glasses but the challenge has been that up to 70% of patients that receive this lens during cataract surgery also have corneal astigmatism. If this condition is not also corrected by an additional surgical procedureusually performed at the same time this implant is placed, glasses are still required.
For the first time we now have a lens implant that addresses both problems with one procedure, making the additional surgery unneccessary… and this is exciting !!
About the AcrySof® IQ ReSTOR® IOL
Apodized Diffractive Optics for a Full Range of Vision
In the healthy eye, the lens flexes to focus on objects at varying distances. The AcrySof® IQ ReSTOR® IOL was designed to provide a complete range of vision independent of the ciliary body muscle. To achieve this, the AcrySof® IQ ReSTOR® IOL combines the functions of both apodized diffractive and refractive regions.
Apodization is the gradual reduction or blending of diffractive step heights. The AcrySof® IQ ReSTOR® IOL features patented apodized diffractive technology that distributes the appropriate amount of light to near and distant focal points, regardless of the lighting situation. The apodized diffractive optics are also designed to improve image quality and minimize visual disturbances—a significant improvement over traditional multifocal technologies.1
The apodized diffractive optics are found within the central 3.6 mm optic zone of the lens. This area comprises 9 concentric steps of gradually decreasing (1.3–0.2 microns) step heights that allocate energy based on lighting conditions and activity, creating a full range of quality vision—near to distant.
The refractive region of the optic surrounds the apodized diffractive region. This area directs light to a distance focal point for larger pupil diameter, and is dedicated to distance vision.
+3.0 D Add Power for True Performance at All Distances2
The AcrySof® IQ ReSTOR® IOL +3.0 D (SN6AD1) incorporates a +3.0 diopter correction at the lenticular plane (approximately +2.5 D at the spectacle plane), for improved intermediate vision over the original AcrySof® IQ ReSTOR® IOL +4.0 D (SN6AD3), with similar near and distance visual acuity.
In the late 1990s, Advanced Medical Optics (AMO) introduced its first multifocal IOL designed to provide multiple points of focus, thereby dramatically reducing the need for bifocals or trifocal glasses after surgery. Today, with its many optical design enhancements, AMO’s third-generation Tecnis Multifocal IOL ™ provides patients with a full range of vision and greater independence from glasses or contact lenses than ever before. Clinical studies show that 92% of those receiving this technology “never”, or “only occasionally,” need to wear glasses.1
With TECNIS® Multifocal IOL:
- High level of spectacle independence(1)
- Nearly 9 out of 10 patients NEVER wear glasses(1)
- Nearly 90% of patients are able to function comfortably without glasses at ALL distances(1)
- Excellent patient satisfaction(1)
Spectacle Usage (1 year)(1)
Ability to Function Comfortably Without Glasses(1)
Distance corrected binocular near visual acuity at best distance (1 year)(1)
1. The TECNIS® Multifocal 1-Piece IOL Advantage
*In the average cataract patient
1. Terwee T, Weeber H, van der Mooren M, Piers P. Visualization of the retinal image in an eye model with spherical and aspheric, diffractive, and refractive multifocal intraocular lenses. J Refract Surg. 2008;24:223-32. 2. Zhao H, Mainster MA. The effect of chromatic dispersion on pseudophakic optical performance. Br J Ophthalmol. 2007;91(9):1225-29. 3. Mainster MA, Turner PL. Blue-blocking IOLs decreoase photoreceptin without providing significant photoprotection. Surv Ophthalmol. In press. 4. Nixon DR. New technologies for premium outcomes: next generation phaco and TECNIS 1-Piece IOL. Presented at 25th Congress of ESCRS; 2007 Sep 8-12; Stockholm, Sweden. 5. TECNIS Multifocal Foldable Acrylic Intraocular Lens [package insert]. Santa Ana, Calif: Abbott Medical Optics Inc. 6. Miyata A, Yaguchi S. Equilibrium water content and glistenings in acrylic intraocular lenses. J Cataract Refract Surg. 2004;30:1768-72.
TECNIS Multifocal Foldable Acrylic Intraocular Lens [package insert]. Santa Ana, Calif: Abbott Medical Optics Inc.
Learn more about cataract surgery.