Premium Intraocular Lens Technology

For the past 35 years, the implants (intraocular lens or IOL’s) used in cataract surgery have been a one size fits all technology. They are called “monofocal” IOL’s as they focus light for only one distance. These Implants (IOL’s) replace the natural focusing lens in the eye that becomes cloudy with age (called a cataract). Usually, cataract patients with “monofocal” implants can see well at distance but need bifocals or trifocals to see to read (near vision) or to see the dashboard of the car or a computer (intermediate vision).   

                 

As the “baby boom” generation turns 60 they bring greater expectations as to what IOL’s need to deliver so as to “rejuvenate” their sight. These boomers are familiar with Lasik and many of the other “refractive surgeries” currently available to lessen the need for glasses. This has led to a new generation of implant technologies called “Premium IOL’s”. These premium implants are now available for cataract patients and for those wishing simply to lessen the need for reading glasses (Prelex).             

 

Four categories of Premium IOL’s exist. These include multifocal and accommodative IOL’s (which allow a wider range of vision and lessen the need for reading glasses), Toric IOL’s to get rid of astigmatism (asymmetric curvature of the eye), and Aspheric IOL’s for highly demanding visual tasks such as truck drivers and photographers who cannot tolerate any glare in their work.                                                                     

 

With all of these IOL options, special care and attention must be given in deciding which patients should receive which implants as we really do not live in a one size fits all world. For instance, we (at John-Kenyon American Eye Institute) have 3 different styles of implants used to lessen the need for reading glasses. Two of these (the Rezoom IOL and the Restor IOL) are multifocal IOL’s and work by focusing light at different focal points. The Crystalens IOL is an accommodative IOL and actually “flexes” or moves within the eye to change the focus of light. All 3 have particular strengths and some are better suited for one patient versus another. Sometimes we mix and match eyes with 2 different styles depending on patient needs.                                                     

 

Our pre-operative workup must take into account many factors including occupation, hobbies, pre-existing eye disease, pupil size and astigmatism. We must select the appropriate style of implant, correct pre-existing astigmatism, and take measurements that are used to calculate the strength of the IOL.                                                    

 

Post-operatively, patients should expect their best near and distance vision to occur only after both eyes are corrected (we do not perform both eyes on the same day at the John Kenyon American Eye Institute). Glare and halos, especially at night, are common for many weeks after surgery and are adapted to by 96% of patients. If the implant power is not yet giving the optimal vision, then enhancements can be performed. These “touch up” procedures take many forms including astigmatism correction, Lasik (laser vision correction), piggyback IOL’s or exchanging the existing IOL for a different strength.           

 

The surgeon must therefore be able and capable of matching the needs of these patients with the correct IOL’s and have the correct technology for “touch ups” on hand.                      

 

In other words, cataract and Prelex surgery (to lessen the need for reading glasses) are no longer a simple one size fits all procedure. They require complex decisions, skills, and technology to ensure a wide spectrum of near, intermediate, and distance vision without glasses.