Increased Freedom from Glasses after Cataract Surgery with Presbyopia-Correcting Advanced Technology Intraocular Lens Implants
 
Recent developments have produced Advanced Technology implants that can give a much broader range of focus than ever before.  These Advanced Technology, “presbyopia-correcting” intraocular lens implants (IOLs) work by either splitting light (with refraction or diffraction technology) to provided distant and near vision to the retina at the same time or by changing the focus point of the implant (called accommodation).
 
 
As we get older, the eye begins to lose its focusing power, this is called presbyopia.  Eventually, the lens of the eye can become cloudy and images become blurred (the cloudy lens is called a cataract).
 
Cataract surgery can restore vision loss due to cataract.  After a cataract is removed, an intraocular lens (IOL) implant is placed permanently into the eye to help it focus.  The basic implant, covered by Medicare and other insurances, provides clear vision at one distance, thus it is called a single-vision or mono-focal intraocular lens.  The Basic single-vision IOL focus is usually set for distance and glasses are typically needed for intermediate and near vision (trifocals and stronger bifocals, respectively).  Basic Single-vision implants do not have a wide range of focus, but rather one set point of focus.  Single vision implants do not correct presbyopia, the loss of focusing power.
 
Advanced Technology Implants provide a range of vision, restoring the age related loss of focusing power.
 
Advanced Technology Implants are not covered by Medicare or other insurances (unlike basic single-vision implants which are included in the cost of surgery). The additional cost for the presbyopia-correcting Advanced Technology IOL surgery is paid by the patient who chooses this technology.  Choosing the Advanced Technology IOL is not medically necessary and completely optional.  The major difference between cataract surgery with a traditional basic IOL versus cataract surgery with a presbyopia-correcting Advanced Technology IOL is the degree of dependence on eyeglasses thereafter; it’s probably significantly less with the Advanced Technology IOL. 
     
There are currently four major technologies for Advanced Technology Implants. 
 
Advanced IOL Types
 
 
Diffractive Technology 
The ReStor and Tecnis Multifocal implants split the light entering the eye to focus distant, intermediate and near images on the retina simultaneously; this is done by diffraction of the light rays, respectively. Patients that opt for this type of implant should expect to achieve spectacle independence for distance.  Most patients who choose the Tecnis Multifocal or the ReStor Lens are able to pass the driver’s test without glasses and achieve good reading vision; however, some patients with a multifocal lens note glare and halos when driving at night (a side effect of the diffractive multifocal optics).  Intermediate vision will be acceptable, but some patients who perform considerable computer work find that they may need to sit closer to the screen or make the font size larger. This technology is best for distance and near vision.
 
 
Extended Range of Focus Technology
The new Symfony impant is placed at the time of cataract surgery to give patients an extended range of vision. Drs. George, Strickler and Lazer were the first eye surgeons in our region to use this new innovative advanced technology implant. 
 
What is so great about this implant?  
Basic implants are set for one point of of focus. The Symfony implant had an extended range of focus allowing patients to focus on things in the distance, at an intermediate range (like dashboard or computer) and it also provides some near vision. This implant uses a combination of diffractive and refractive technology providing more vivid images and colors compared to diffractive implants. Thus, the Symfony lens allows us to see more things without glasses. It also comes in a toric model that reduces astigmatism. Glasses may still be needed for some things; such as reading fine print or prolonged reading.
 
The Eye MDs are pleased that AMO chose our practice to roll out this new technology in the region for our patients.
 
 
 
 
Accommodating Technology 
The Crystalens intraocular lens changes focus by shifting its position when the eye’s natural muscle attempts to focus, a process called accommodation.  Crystalens has a hinge design that  allows 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 clear optic has advantages compared to the fine circular lines required for the diffractive IOL optic…it is less likely to cause glare and halo. 
 
All of these Advanced Technology Implant  technologies provide a wider range of focus and thus greater freedom from glasses.  Patients opting for these lenses should expect to achieve greater spectacle independence at distance and likely will be able to pass the driver’s test without glasses.  They should also expect to achieve “social” near vision for viewing items such as menus, watch faces, cell phones, price tags, grocery labels, computer screens, and magazines under average lighting conditions.  Patients with Crystalens implants will still likely need reading glasses for some things such as fine print or prolonged reading.
 
 
Florence Henderson for Crystalens
 
Florence Henderson discusses
her lens implant experience
 
 
Crystalens

Graphic depicting change in position of the Crystalens implant with the patient's effort to focus. Distant Vision
(posterior)
Intermediate Vision Near Vision
(implant more anterior)

 
 
 

 
 
 
 
Eye MDs logo  
 
The Eye MDs have been designated a “Crystalens Center of Excellence” for their expertise with the Crystalens implants. Bausch and Lomb, the manufacturer of Crystalens, selectively designates this honor to a few ophthalmology practices that have great experience and excellent results using the Crystalens.
 
In summary,  Advanced Technology (Presbyopia-Correcting) Implants can provide a wider range of useful vision without glasses, thus increasing freedom from spectacles. The goal for Advanced Technology implant patients is to maximize the patient's ability to function without glassses. Such functional vision is generally considered 20/40 or better; which provides legal driving vision and reasonably good reading vision, but not necessarily vision as sharp as 20/20 at all distances that some can obtain when wearing their glasses.  Even with these Advanced Technology Implants, glasses may be needed for some things like fine print or prolonged reading. Results will vary with Advanced Technology Implants, but most patients will enjoy a greater freedom from glasses with the wider range of vision provided by the Advanced Technology IOLs.
 
 
 
Astigmatism Correcting (Toric) Technology  
Advanced Technology Toric implants have the astigmatism correcting optics within the implant.  These implants are only used when patients have significant astigmatism and they come in several powers so as to be able to customize the amount of astigmatism correction provided.  The implants must be oriented in the eye precisely to have the astigmatism correction line up with the patient’s axis of astigmatism. There are two catagories of Toric (astigmatism - correcting) implants: 
  • The Basic (single focus) Toric implant provides improved distance vision without glasses; however, glasses will still be needed for intermediate and near vision with a basic Toric implant as it has a single point of focus.  
  • The Trulign Toric implant is an accommodatiing (presbyopia-correcting) implant that can both reduce astigmatism and privide a greater range of vision; including distance, intermediate and some near vision. The goal with the Trulign implant, like other presbyopia correcting implants, is to maximize the patient's function without glasses; glasses may still be required for some things such as fine print or prolonged reading. Our surgeons at The Eye MDs were chosen by Bausch and Lomb to be amongst the first ophthalmology practices in the country to use the Trulign Toric implant after it received FDA approval.
 
Toric Implant
 
Basic Toric Implant- dots aligned
with axis of astigmatism
 
 
 
 
 
 
 
Alternative Considerations for Advanced Technology Implants
 
As we get older (e.g., after age 50) we lose focusing power (a process called presbyopia) and  thus require reading glasses or bifocals.  Some patients choose to have these special advanced technology implants placed before they develop significant cataract. This is a procedure is called “Refractive Lens Exchange.”  Because this is considered surgery for refractive reasons, this procedure is considered cosmetic and not covered by insurance (no cataract).  The lens of the eye is removed and the advanced technology implant is placed.  Motivated presbyopic patients really enjoy greater freedom from glasses after a refractive lens exchange. 
 
 
Drs. David George,  Scott Strickler and  Zane Lazer pioneered small incision topical cataract surgery, as well as the use of Advanced Technology Implants in the mid-Ohio Valley. They are also experienced in astigmatic reductions by Limbal Relaxing Incisions or Toric Advanced Technology IOLs for patients who would benefit by such a reduction in astigmatism.
 
You can also use your Health Care Savings Account (HSA) or Flex Spending Account to help cover the additional cost of the Advanced Technology Implant and related services; this saves you money by using pretax dollars.  Financing can often be arranged for those who qualify by Care Credit.  Contact us today to learn more about payment options.
 
 
 
*There are no guarantees regarding surgical results. Results for individuals vary; individual needs and perceptions vary as well. The purpose of the Advanced Technology (Presbyopia- Correcting) Implant  is to try to reduce dependency on glasses or contacts. Even with Advanced Technology (Presbyopia-Correcting) Implants, glasses may be needed for some tasks. 
 
Laser Assisted Cataract Surgery
 
Laser assisted catarct surgery (LACS) is an advance technology that pateints can now choose for thier surgery. Traditional manual surgery uses blades to make the incisions and other intruments to manually open the anterior aspect of the cataract (called a capsulotomy) and break up the cataract. LACS relies on the femtosecond laser to make precise incisions,make corenal incisions to reduce astigmatism, provide exacting centration and shape for the capsulotomy and break up the cataract...all with laser precision and without blades.