Refractive Cataract & IOL Surgery

Intraocular lens surgery for cataracts is the most common refractive surgical procedure performed today. The design and development of IOL technology has continuously evolved so that we can regularly make our patients less dependent on eye glasses. Some patients are able to eliminate glasses entirely, although it is impossible to guarantee with any of these technologies that you will be able to function without glasses for all tasks.

NT IOL- New technology intraocular lenses are now routinely used in cataract surgery performed by Atlantic Eye Physicians.

Standard spherical lens designs can lead to a reduction in vision quality due to spherical aberration. Our increased knowledge of wavefront technology has led to aberration free IOL’s with exceptional optical performance.

Presbyopic IOLs

What is presbyopia

Presbyopia is a condition that is a part of the aging process. It occurs when the natural lens of the eye becomes harder and less elastic. This loss of flexibility reduces the eye’s ability to switch from seeing objects at a distance to seeing objects that are close up. Over time, while distance vision may still be very good, near vision gets progressively worse.

Signs of Presbyopia

• Difficulty reading
• Difficulty seeing the computer screen clearly

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The final frontier for refractive surgery is the surgical correction of presbyopia. One strategy that is useful is surgical monovision which is a strategy to correct presbyopia by correcting one eye for distance vision and one eye for reading vision. Monovision can be achieved with laser vision correction before cataracts develop. Now, there are options for surgical correction of presbyoipia at the time of cataract surgery. These include monovision with single vision IOLs and now the option of aiming for both near and distance vision in both eyes with multifocal or accommodating lenses.

Multifocal or accommodating lenses offer the best potential for reducing your dependence on glasses and contact lenses. Our practice has extensive experience with multifocal lenses dating back to 1997. Multifocal lenses work by providing simultaneous near and distance vision in each eye, thus allowing both eyes to work together for both distance and near. In 2005, the FDA approved two new multifocal IOL’s with advanced optics having fewer aberrations than previous multifocal IOL designs such as Array. Each of these designs has relative strengths and weaknesses as follows:

• The Restor Lens: Manufactured by Alcon, the Restor lens provides excellent distance and reading vision. It’s intermediate vision (computer screens, etc) is not quite as good as the distance and reading vision typically achieved by most patients with this implant.
• The Rezoom Lens: Manufactured by AMO, the Rezoom provides excellent distance and intermediate vision, and good near vision.
• The Tecnis Lens: Manufactured by AMO, the Tecnis is a multi-focal difinitive IOL. Advantages include less dependency on pupil size for obtaining near vision.

Weaknesses inherent in all multifocal IOL deisngs include aberrations that can cause glare and halos, especially at night. About 1 in 20 patients describe the glare and halos with multifocal lenses as “severe”. Multifocal lenses work best with binocular vision (both eyes working together). Therefore, you will not get the full effect of multifocal vision until you have had surgery on your second eye.

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Accommodating IOL Crystalens HD 500

Because side effects of multifocal IOLs limit their use, we often recommend Crystalens, the first and only FDA approved accommodating lens. Crystalens delivers uncompromising vision quality without the side effects of multifocal IOLs. The Crystalens ‘flexes’ to accommodate near, intermediate, and distance vision. Movement of the lens is enabled by a flexible hinge within the lens. Some Crystalens patients require over-the counter-readers to see very fine print. We recommend Crystalens to avoid the side effects of multifocal IOLs. In order to imporove the reading function, the non-dominant eye can be targeted for mild monovision.

Crystalens accommodates like the natural lens. After implantation of Crystalens, most patients will see brighter and clearer from distance, intermediate to near like they did when they were younger.

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 to reduce or eliminate dependence on glasses. 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.

Although multifocal or accommodating lenses may represent your best opinion for reducing your dependence upon glasses and contact lenses, it is impossible to guarantee that you will be able to throw away your glasses. Reading glasses, for instance, will always magnify near objects, thus making them easier to see, even with multifocal lenses.

Because Medicare and private insurance companies generally consider multifocal and accommodating lenses to represent luxury technology that is not absolutely necessary for good vision, multifocal lenses and accommodating lenses are not covered by Medicare and insurance.

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MultiFocal IOLs

Dr. Goldberg is the first surgeon in New Jersey to have implanted the revolutionary new ReSTOR® lens. ReSTOR® is a breakthrough lens for the millions of Americans relying on bifocals or reading glasses. ReSTOR® is a lens implant that uses a special new technology to give patients a full range of vision – near through distance. It greatly reduces their reliance on reading glasses or bifocals. The AcrySof® ReSTOR® intraocular lens (IOL) is an artificial lens used in cataract surgery for patients with and without presbyopia. The unique patented optic design results in highly-predictable visual acuity – meaning patients can read the font on items such as prescription bottles, magazines, newspapers and computer screens, while also providing the ability to see items at a distance independent of reading glasses or bifocals. It’s a major step forward for the millions of people whose vision isn’t what it used to be.

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Like ReSTOR, the Rezoom IOL lens (made by AMO) is a fixed implant that replaces your lens. Both were developed originally for cataract patients, but are now approved for wider use. For the end user, the impact of ReSTOR and Rezoom is similar. but how they achieve their results is different. Rezoom focuses light through three different zones and can dramatically improve near, arm’s length, and distance vision. ReSTOR has an “aphodized” surface that provides a gradual blending of focusing power throughout the lens surface. Ask Dr. Goldberg which of these powerful lenses is right for you.

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The TECNIS® Lens is the only wavefront-designed lens with FDA-approved claims for improved functional vision and improved night-driving simulator performance. Good functional vision is especially important when driving at night. Based on night-driving simulator results in a controlled clinical study, the TECNIS® Lens provided improved visibility that may allow for quicker reaction time, which is likely to provide a meaningful safety benefit to elderly drivers. The improvement in functional vision may also improve safety in other low-visibility situations.

In a simulated night-driving study, at 55 mph the TECNIS® Lens provided an additional 45 feet of identification distance, allowing for a 1/2 second of additional reaction time, when compared to a leading competitor.

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Astigmatism: Toric IOLs

Another option for refractive cataract surgery is correction of astigmatism. For many years, corneal relaxing incisions have been helpful in reducing astigmatism. Recently the FDA approved the Acyrosof toric IOL for astigmatism and other toric IOLs are likely to be approved in the near future. The toric IOL adds to the choices of the refractive surgeon and increases the amount and the accuracy of astigmatism correction.

Sometimes, the surface of the cornea is curved more like a football, with both flatter and steeper curves. When the surface of the cornea has an uneven curvature, vision becomes distorted. This common irregularity, called ‘corneal astigmatism’, causes blurred or distorted vision because light rays are not focused at one spot to provide clear vision.
A person who has both a cataract and a corneal astigmatism will not regain high-quality distance vision after surgery to remove the cataract unless the astigmatism is also corrected.

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Cataracts & Astigmatism?

What are your options for correcting astigmatism? If you depend upon eyeglasses, you may have experienced the inconvenience of not being able to find your glasses when you really need them. Eyeglasses are easily lost or damaged, expensive to replace, and inconvenient to clean and maintain. The more active you are, the more eyeglasses interfere with yout lifestyle by complicating your participation in daily and recreational activities. Many people do not like the ‘look’ of glasses and prefer another type of vision correction, such as contact lenses. ‘Toric’ contact lenses designed to correct astigmatism are an option; however, some users find them uncomfortable and experience difficulty in adjusting to wearing them. There are several surgical options your surgeon may choose to treat astigmatism, such as LASIK laser vision correction, astigmatic keratotomy (AK), or limbal relaxing incisions (LRI). However, if you are planning to have surgery to remove a cataract, you now have an additional option…an implantable lens that makes it possible to treat the cataract and correct the corneal astigmatism at the same time. Dr. Goldberg will recommend the option that is best for you.

What is the AcrySof® Toric IOL? The AcrySof® Toric lens is a foldable, single-piece lens that an eye surgeon implants during cataract surgery to replace the clouded lens. The unique design of the AcrySof® Toric IOL makes it possible to reduce or eliminate corneal astigmatism and significantly improve uncorrected distance vision. AcrySof® Toric lens provides QUALITY distance vision, independent of eyeglasses and contact lenses. The AcrySof® Toric lens is made of the same biocompatible lens material already successfully implanted in more than 25 million eyes since 1991.