Cataract & RLE Interocular Lens Options
From standard to premium IOLs, Dr. Cavanaugh has extensive experience in all different kinds of interocular lens implant options
Deciding on the Best Interocular Lenses for You: IOL Options
Recent technological advancements offer us wonderful choices of IOLs, but the variety of options can sometimes be confusing and overwhelming. There is no need to worry, however, as Dr. Cavanaugh will recommend the best Lens Implant Package for you based on exam findings, discussion during the exam, and your completed “Vision Questionnaire.”
How Age Affects Vision (Presbyopia and Cataracts)
At Cavanaugh Eye Center, your doctors may evaluate the progress of your presbyopia and/or cataract formation. When your natural focusing lens is removed, an intra-ocular lens implant (IOL) is placed inside the eye to replace the cloudy human lens (cataract) or correct your eyes prescription (RLE). Presbyopia is the need for most adults over 45 to use reading glasses or bifocals in order to see up close due to a progressive stiffening and loss of flexibility of the human lens.
In the past, patients required glasses for close-up vision after cataract and RLE surgery. Now, at Cavanaugh Eye Center, there’s a better solution. Premium intra-ocular implants (IOLs) improve vision for cataract patients, but also treat presbyopia essentially turning back the clock to give you the ability to see up close as well as at a distance without glasses. The elective upgrade to a Premium Presbyopic IOL is not covered by insurance or Medicare and will be the patient’s financial responsibility.
There are three different categories of Interocular Lenses
- Single Focus (monofocal)
- Single-Focus lens implant with “blended” monovision
- Astigmatism Correcting Options
- Toric Lens Implants
- Limbal Relaxing Incisions (LRI)
- Multi-focus (Presbyopia correcting)
- Multifocal Lens Implants
- Crystalens “Accommodating” Lens Implant
- Extended Range of Vision (ERV) IOLs – A New Lens Implant Category Multi-Focus (Presbyopia Correcting) IOLs
All of these options available to you are detailed below.
Single Focus (monofocal) Interocular Lenses
Single-focus interocular lens implants provide excellent distance vision but do not correct astigmatism or presbyopia. If a patient has pre-existing astigmatism (that is not surgically corrected as outlined below), glasses will be needed for distance vision. Regardless of astigmatism status, all patients choosing this type of lens will need reading glasses for near work. Monofocal lenses are best for patients who do not mind wearing glasses most of the time for distance and reading. These are the least expensive option as they are covered by insurance for cataract patients.
**Single-Focus lens implant with “blended” monovision:
Using a single-focus (monofocal) lens implant, the dominant eye is focused for distance and the non-dominant eye for near. This is achieved by leaving the non-dominant eye slightly nearsighted so near objects at arms’ length are in focus. As a trade off, the distance vision in the reading eye is somewhat blurry. Patients will need reading glasses for small print or distance glasses for driving. This is strongly recommended for functional near vision to allow visualization of food on your plate, dashboard, cell phone, watch, computer screen, etc.
Astigmatism Correction Options
Astigmatism is a condition where the cornea (the front window covering of the eye) is oval rather than round. This results in blurred vision and ghost images around objects. In order for light to focus precisely, the cornea needs to be as round as possible. Astigmatism may be traditionally treated with glasses, gas permeable contacts or toric soft contact lenses. However, even if you plan on wearing glasses after surgery, you will benefit from surgical astigmatism reduction as your glasses will have less edge thickness and peripheral distortion. If you desire the most freedom from glasses at any distance, it is imperative that your astigmatism be surgically corrected.
In general, low astigmatism is corrected with a Monofocal IOL and LRI while high astigmatism is corrected with a Toric IOL. Extremely severe astigmatism may require a Toric IOL supplemented by either LRI or LASIK.
Toric Lens Implants
Toric IOLs have your astigmatism power incorporated into the lens optic and provide the most precise way to reduce or eliminate astigmatism at the same time they correct a patient’s myopia or hyperopia. These interocular lenses are for cataract and refractive lens patients with pre-existing astigmatism who want spectacle reduction for distance vision or a reduction in the thickness of glasses. Most Toric IOLs are monofocal IOLs and cannot correct presbyopia but there is now a revolutionary IOL called the Crystalens Trulign that not only corrects astigmatism but also flexes inside the eye to provide an expanded range of vision from distance to near in order to reduce dependency on reading glasses.
Limbal Relaxing Incisions (LRI)
LRI is a procedure which corrects astigmatism by using incisions to relax the tension in the cornea causing it to be out of round. Incisions are placed near the junction of the white and colored parts of the eye (the limbus) and effectively convert an oval to a circle, thereby correcting the astigmatism.
Multi-Focus (Presbyopic Correcting) IOLs
Multi-Focus lenses are the implants of choice for patients wanting the greatest freedom from glasses for a full range of vision—so they can see distance and near objects simultaneously quite well in both eyes without glasses, in most cases. For this group of patients, these implants can be the best investment they ever make.
The two classes of Presbyopic Lens Implants available are:
1. Multifocal Interocular Lenses
The ReSTOR and Tecnis multifocal interocular lenses have a small trifocal built into the implant optic that allows for clear vision at all distances. Unlike bifocal glasses, you do not have to move your head to see through the different zones or lines of correction. These IOLs provide useful vision at all distances and the most independence from glasses. The main side effects of these IOLs are temporary halos seen around lights (such as headlights) at night due to a reflection off of the multifocal circles on the IOL. These halos do not prevent you from driving at night and usually dissipate and improve after 90 to 180 days. We typically achieve 80-85% complete spectacle independence with these IOLs but reading glasses may be needed for extremely small print or to read in dim light situations. Dr. Cavanaugh will help you select the lens that best suits your visual needs.
2. Crystalens “Accommodating” Lens Implant
The Crystalens is a uniquely designed lens implant that provides dynamic focus for “accommodation.” This lens implant mimics the movement of the younger, natural human lens by using the eye’s own focusing muscles to flex the lens. Compared to multifocal lenses, the Crystalens has less halo side effect and provides excellent focus for distance as well as intermediate or computer distance. Small print at near is more difficult to achieve with this lens and is variable depending on the strength of your focusing muscles. Crystalens IOL patients should avoid excessive reading for the first 2 weeks after surgery to allow the IOL to seat properly. Reading glasses of +1.00 or higher should be used during this time.
The new Crystalens Trulign is the first IOL that is engineered to correct both astigmatism and presbyopia (reading vision). It incorporates a Toric astigmatism correcting optic into the flexible platform of the Crystalens to achieve simultaneous correction of both problems. This revolutionary lens allows patients with higher levels of astigmatism to gain more independence from both distance and reading glasses.
“Extended Range of Vision (ERV) IOLs – A New Interocular Lens Implant Category
The Tecnis Symfony and Tecnis Symfony Toric intraocular lens implants (IOLs) are new “Extended Range of Vision” products. Symfony lens implants utilize two separate technologies that allow patients multiple points of focus. It is easy to think of this class of presbyopia correcting IOLs as a hybrid between a true mutlifocus and accommodative platform lens.
Tecnis Symfony IOLs provide a greater depth of high quality vision when compared to monofocal lens implants. In addition, patient’s experienced less side effects of glare and halos when compared to traditional multi-focal IOLs.
The introduction of the Tecnis Symfony technology will provide patients another great option to improve their range of vision and reduce their dependence on glasses and contacts.