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
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. There are options for surgical correction of presbyopia 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.
Correcting Presbyopia: Monovision
Dr. Daniel Goldberg offers monovision for presbyopia patients in Monmouth County.
As people get older, they gradually lose the ability to change focus from distance to near. This condition is called presbyopia and comes from a loss of flexibility of the lens inside the eye, as well as other age-related changes. This is a gradual change throughout life, but it usually is not noticeable until a person’s mid-forties (“presby” means older and “opia” refers to eyes). Although people may call this “reading vision,” it is the vision used for eating, putting on make-up, looking at a watch, and other near tasks. If you are nearsighted and also presbyopic, you may use this to your advantage by removing your glasses or contact lenses to see up close.
After laser vision correction, the natural focus of the eye has usually been adjusted for distance. It is as if you are always wearing your distance glasses or contact lenses and can’t take them off to read. Regardless of the previous prescription, if both eyes are corrected for distance, reading glasses will be necessary for people with presbyopia.
To decrease the need for reading glasses, some of our presbyopia patients in Monmouth County opt for the technique of creating monovision. With monovision, Dr. Goldberg fully treats one eye (usually the dominant eye) for distance and the other eye for near. This leaves one slightly nearsighted (myopic) eye for strong near vision without glasses.
Monovision can help you maintain reading vision in one eye to avoid total dependence on reading glasses. With monovision, you must often give up some distance sharpness to avoid the reading glasses. A weak distance lens for the nearsighted eye may be helpful for night driving. Near glasses may be needed for times of extended or difficult reading. Many patients already experience monovision in their contact lenses and are aware of its benefits and limitations. A trial period with contact lenses may help determine if monovision would be a good option for you.
Monovision is a compromise of both distance and near vision. Depth perception is also affected. Monovision is best for those people over forty who want to avoid reading glasses enough that they are willing to accept a reduction in their distance vision. For people with high visual demands like sports or constant near work, Atlantic Laser Center recommends full distance correction with glasses for near vision. Monovision is reversible, and additional laser treatments usually bring that eye to distance correction, if desired, and generally at no charge.
The chart above may help you to make a decision between full distance and monovision correction. Please contact Dr. Goldberg with any questions you may have!
Your vision is both precious and personal, and before making any changes to your eyesight – either surgical or otherwise – it is best to consult with an expert. Dr. Goldberg has published two groundbreaking scientific studies on surgical monovision. When it comes to experience, few eye surgeons top Dr. Goldberg’s credentials. If you are interested in monovision, Dr. Goldberg will be happy to help you decide which procedure is best for you during your consultation.
Intraocular Lens Options for Presbyopia
There are currently the following options for freedom from glasses for reading following intraocular lens implantation.
- Monovision Intraocular Lens: similar to LASIK Monovision, this strategy is based on correcting the dominant eye for distance and the non-dominant eye for near vision.
- Multifocal Intraocular Lens
- EDOF: Extended Depth of Focus Intraocular Lens
EDOF (Extended Depth of Focus)
In 2016, the FDA approved a new category of intraocular lenses for presbyopia called Extended Depth of Focus IOLs. The lens is known as the Tecnis Symfony IOL, and is also available to correct astigmatism (Tecnis Symfony Toric) as well as distance and near vision. Using advanced diffractive optics, the Symfony IOL creates sharp vision over the range of distances from far to near. Our IOL patients are enjoying freedom from glasses with fewer side-effects noted (e.g. halo and glare at night) compared to night-time side-effects noted with multifocal IOLs. Sometimes over the counter readers are needed for very small print or extended reading. Watch the video to learn more or review the Symphony Patient Brochure.
Multifocal Intraocular Lens
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. Its 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 Tecnis Lens: Manufactured by AMO, the Tecnis is a multifocal diffractive IOL. Advantages include less dependency on pupil size for obtaining near vision.
Weaknesses inherent in all multifocal IOL designs include aberrations that can cause glare and halos, especially at night. 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.
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 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.
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.
Accommodating IOL Crystalens Blended Vision
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 improve 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.
Atlantic Eye Physicians and Atlantic Surgery Center are proud to be recognized as a Center of Excellence for Crystalens. Dr. Goldberg has developed a unique technique to provide enhanced near vision with Crystalens. We would be happy to provide details and video education during your visit.
We expect advances in accommodating intraocular lens design, as well as other options including corneal inlays or scleral laser treatments to add to our choices for surgical correction of presbyopia in the next few years.