Advanced Lens Implants for Cataract Surgery (IOLs)

Your eyes function by constantly adjusting focus – up-close for reading, or increasingly further away for watching television, working on the computer or driving.  This ability to quickly change focus between distances is called “accommodation.”

As a natural result of aging, accommodation diminishes, requiring many of us to wear bifocals or reading glasses to correct our vision in later life.

Traditional lens implants during cataract surgery generally provided good distance vision. However, most patients will still need reading glasses following surgery and others may need glasses for astigmatism or distance vision. Such lens implants are generally covered by insurance. 

Modern lens implants open up the possibility of correcting astigmatism as well as near vision, thereby greatly reducing or potentially eliminating the need for glasses following cataract surgery. 

The Board certified surgeons at Northeastern Eye Institute choose from a variety of advanced lens implants depending upon the prescription and ocular condition of the patient undergoing  cataract surgery.

Also known as premium lens implants, these advanced IOLs preferred by the surgeons at Northeastern Eye Institute include:

• Toric
• RESTOR
• Crystalens
• Tecnis

The choice of lens is dependent upon the patient’s prescription and his/her vision goals and needs. 

There are many benefits to an advanced lens implant:

• Better range of vision - Following cataract surgery, most patients implanted with a premium lens will have excellent near and distance vision, plus good intermediate vision without reading glasses or bifocals.  Many patients generally have their vision improved to a point that they would be able to pass the visual acuity portion of the driver's license exam in most states without corrective eyewear. 
• The ability to read quickly and easily - Depending upon the lens, patients experience a vast improvement in reading and near vision capabilities, enabling them to read newspapers, labels, and other close-up objects. 
• Better vision for various lighting situations - An advanced, premium lens delivers quality vision for various lighting situations, similar to the way the eye naturally adjusts to a change in brightness.  In brightly lit conditions, the central diffractive portion of the lens sends light waves simultaneously to both near and distant focal points. In dimly lit conditions, the surrounding refractive area uses greater energy for distance vision. 

Challenges

Cataract surgery outcomes are generally predictable. Advanced or premium lens implants can do wonders for your near, intermediate and distance vision following cataract surgery. However, there can be potential side effects from certain lens implants which you should discuss with your ophthalmologist at Northeastern Eye Institute. 

Such IOLs can provide improved vision but not perfect vision. And while you could receive at least some benefit of vision at all ranges, a monofocal or standard IOL might be the best choice for crisper distance vision. However, even standard monofocal IOLs also can be associated with night vision problems such as glare and halos.

As with any IOL used in cataract surgery, a side effect that causes subtle clouding in the lens capsule (posterior capsule opacification) may occur. A procedure called a YAG laser capsulotomy may be needed to clear up the clouding.

In some cases, excimer laser vision correction is also utilized to attain the desired visual outcome following cataract surgery. 

A brief overview on each of these advanced or premium lens implants including the types of visual correction that each provides is provided below:

Toric Lens:

Astigmatism is a condition that occurs when the cornea has an oval shape instead of a spherical shape, and causes blurry vision at all distances.  Toric IOLs are designed to compensate for this while simultaneously correcting near and distance vision in the same way as glasses or contact lenses. These IOLs are known as "Premium Lenses" because of this double correction.

A toric lens can be implanted during cataract surgery to correct a patient’s astigmatism, thereby eliminating or reducing the need for glasses following cataract surgery. 

While cataract surgery can improve distance vision, a Toric lens is an excellent solution to correct astigmatism during the same procedure, further reducing the need for eyewear following cataract surgery.

The FDA approved the AcrySof IQ Toric IOL (Alcon) in September 2005.  Toric IOLs can correct 1.50 to 3.00 D of astigmatism.  This lens also is available in aspheric versions for crisper vision.  Different models also can filter potentially damaging ultra-violet or blue light. 

Risks include poor vision due to the lens rotating out of position, with the possibility of further surgery to reposition or replace the IOL.  These can be discussed with your cataract surgeon at Northeastern Eye Institute. 

Risks include poor vision due to the lens rotating out of position, with the possibility of further surgery to reposition or replace the IOL.  These can be discussed with your cataract surgeon at Northeastern Eye Institute. 

RESTOR Lens:

Until recently, intra-ocular lenses (IOLs) used in cataract procedures provided good functional distance vision, but most cataract patients still required reading glasses or bifocals following surgery.

The innovative AcrySof® ReSTOR® IOL by Alcon, popularly known as the ReSTOR® Lens, now provides cataract surgery patients with good or improved vision at near, far and all distances in between – to a degree not previously possible using conventional or standard IOLs.

The ReSTOR IOL is not moved by the ciliary muscles. Instead, built-in concentric steps create circular areas across the lens that react to light differently. The center step contributes to near vision; and as the steps move towards the periphery provide distance vision. The ReSTOR IOL is made of a proprietary material called AcrySof.

With the ReSTOR® Lens, 80% of ReSTOR® Lens patients in a clinical trial reported able to read, drive and do other tasks after having the lens implanted in both eyes without having to wear glasses, compared to only 8% of patients with monofocal IOL lenses.

However, as with many things, there may be a tradeoff. Before cataract surgery, discuss all of the benefits and risks of the AcrySof® ReSTOR® IOL with your Northeastern Eye Institute ophthalmologist.

Crystalens:

The ability to quickly change focus between distances is called “accommodation.”  Crystalens is the only accommodating IOL.  When placed in the eye, the same ciliary muscles that previously controlled the natural lens' shape can create accommodation in the Crystalens.  The muscles push it forward for near vision, and pull back a little for distance vision. 

Crystalens, by Bausch + Lomb, is currently one of the only FDA-approved intraocular lenses (IOL) that uses a method called accommodation, enabling sharper vision at multiple distances for people who have undergone cataract surgery. 

The Crystalens IOL shifts its position to adjust with the action of eye muscles and movement to improve eyesight. 

A Crystalens is ideal because, beginning at around middle-age, most people lose the ability to see at multiple distances due to the occurrence of presbyopia, an age-related condition that necessitates the use of reading glasses.  This condition develops when the eye's natural lens focusing system grows more rigid and can no longer move or change shape sufficiently enough to enable sight at all distances.

If you receive a standard IOL during your procedure instead of one that corrects or minimizes presbyopia, you may have great distance vision but likely would need reading glasses following cataract surgery.

In June of 2008, the FDA approved the "HD" or high-definition version of Crystalens.  This version of Crystalens incorporates an improved optic design enabling better near vision, without hampering distance or intermediate vision.  According to Bausch + Lomb, the Crystalens HD is less likely to cause side effects of glare or halos at night.  In the U.S., clinical studies involving 125 patients implanted with the Crystalens HD, 80 percent achieved 20/20 or better near vision quality.

In early 2010, Bausch + Lomb introduced another version of the IOL — the Crystalens Aspheric Optic (AO). This lens has an elongated shape designed to improve contrast sensitivity and reduce higher order aberrations that can distort vision.

Tecnis:

The Tecnis IOL is a clear intra-ocular lens (IOL) that replaces the eye's natural lens and restores vision including night vision. The Tecnis IOL is implanted during cataract surgery. 

While some people notice vision improvement immediately, most will notice clearer vision the following day.

The unique design of the Tecnis IOL provides many benefits. The lens addresses the spherical aberrations in the cornea.  The Tecnis IOL can allow for vision correction far superior to traditional lenses, correction comparable to the vision of a young adult.

Though some patients may require corrective lenses in some situations after their procedure, most will enjoy excellent vision. The haziness and blurred vision of cataracts disappear, and color vision returns to full saturation. Controlled studies have shown that the Tecnis IOL provides up to a 31 percent improvement in contrast sensitivity in normal light conditions compared to traditional lenses.

Perhaps most impressive is the improvement in night vision with the Tecnis IOL. Studies have shown that patients enjoy up to a 53 percent improvement in contrast sensitivity in low-light conditions over traditional lenses. Ability to detect a pedestrian while driving at night was significantly greater with the Tecnis IOL in direct comparison with a control lens. Many patients report that after their procedure they regain confidence to drive at night.

The Tecnis lens also has concentric areas that react to light differently.  However, its design is based on Wavefront technology data - the same technology used for laser vision correction (Custom LASIK). This corrects myopia, hyperopia, astigmatism and other vision defects in the same way as LASIK and corrective lens, and provides better night vision than standard IOLs. 

As with any surgery, there are some risks associated with the Tecnis lens.  Though rare, the eye may react adversely to the intraocular lens, resulting in infection, inflammation, and/or thinning of the cornea.  Prescription eye glasses or contact lenses may be necessary in some situations following implantation of the Tecnis lens.   

Contact Northeastern Eye Institute today to learn about advanced or premium lens IOLs for cataract surgery.  Call toll-free (800) 334-2233 or (570) 342-3145 or email us to schedule an appointment.

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