Refractive Lens Options

Phakic Lens Implants (Visian ICL)
The phakic lens implant procedure and cataract surgery are similar because in both procedures, the surgeon makes a small incision to access the anterior chamber in which the iris and the natural lens of the eye are found. In cataract surgery, the surgeon removes the natural lens, and replaces it with an artificial lens. During phakic lens implant surgery, the surgeon keeps the natural lens intact and places an artificial lens in front of the natural lens. For specific patients, the phakic lens implant procedure is more predictable than LASIK, and a safer procedure for correcting high levels of near-sightedness.

Clear Lens Extraction
Clear lens extraction is performed exactly like modern day cataract surgery. This brief outpatient procedure is completed in just minutes, and is typically done under topical (numbing drops) anesthesia. Clear lens extraction describes a method of refractive correction in which the natural lens of the eye is removed, and a new lens implant is placed into the eye. This lens implant is specifically calculated to correct most or all of the patient’s nearsightedness or farsightedness, and will remain permanently. It is very well tolerated by the eye, and does not require cleaning or replacement. Since the natural lens does not grow back, cataract surgery will not be necessary in the future.

This procedure is ideal for those patients with medical conditions or prescriptions which do not allow laser vision correction as an option. For many patients, this procedure (unlike laser vision correction) allows for the implantation of a bifocal lens implant, which may provide the opportunity for BOTH distance and near vision with much less dependency on glasses or contact lenses, even after the onset of presbyopia (need for reading glasses). Unlike monovision patients who depend on one eye for distance and the other for near, the bifocal lens implant provides binocular distance and near vision, without limiting depth perception.

What is a lens implant?
A lens implant replaces your natural lens. It is made out of acrylic or silicone and will last for the rest of your life. Many  different types of lens implants are used today, and your surgeon will recommend the best lens implant for your eyes. There are two categories of lens implants; standard and premium.

Standard lens implants correct for only one range of vision either distance or near vision, but not both. If you choose to see well in the distance, reading glasses are necessary to see up close (Figure 1). Standard lens implants provide excellent quality of vision and are a good choice for patients who will not mind using glasses after surgery for certain activities.

Fig 1. With a standard lens implant distant objects are clear without glasses. However, intermediate and near objects are blurred without glasses.

Premium lens implants offer an opportunity to achieve a continuous range of vision without corrective lenses, from near to far and everything in between (Figure 2). In contrast to standard lens implants that require glasses for distance or near, premium lens implants expand your range of functional vision and enable you to function at distance and near with seldom use of glasses.

Fig 2. With a premium lens implant the distant, intermediate and near objects are seen well without glasses.

One of the most exciting and important developments in both refractive and cataract surgery is the use of premium bifocal (multi-focal and pseudo-accommodating) lens implants. No other technology can provide distance and near vision in the same eye, and after removing the natural lens, implantation of a bifocal lens in both eyes provides remarkable, binocular (using both eyes) vision for both distance and near activities. This technology has been FDA approved since the mid 1990's, enjoyed by millions of happy, satisfied patients. Corrective eye wear may still be necessary for some activities, but the freedom from glasses and contact lenses is incredible. The newest generation of this technology is here, and for the first time, is now offered to patients undergoing routine cataract surgery as well as those looking for a solution to both their nearsightedness, farsightedness, and presbyopia (the need for reading glasses).

How does the healing process differ if a premium lens is used?
While virtually everyone implanted with a premium lens will experience significant improvement in their uncorrected vision after surgery, some people might not see 20/20 at all distances. In some situations such as reading fine print or dim lighting glasses will help. Patients who choose the premium lens implant may initially notice some glare or haloes, but this will diminish over time as the eye and brain work together to adapt to your new lens. Preoperative measurements to choose your lens implant are accurate to a hundredth of a millimeter, but the final visual outcome may be affected by your healing process. Any significant residual refractive error such as nearsightedness, farsightedness or astigmatism may be improved with another procedure.

Is there an additional cost?
The cost of cataract surgery, anesthesia, and the standard lens implant is covered by your insurance. The premium lens implants are not covered by Medicare, Medicaid and other health insurance. An out-of-pocket expense for the premium lens implants will cover the increased cost of the lens itself. Sometimes there will be an additional expense to you in the rare situation when an additional procedure is required to optimize your vision.

Ask your surgeon if you are able to take advantage of this exciting once-in-a-lifetime opportunity to achieve a more youthful and versatile view of the world.

Which Premium Lens do I choose?

Crystalens
Crystalens is an accommodating intraocular lens that, unlike a standard IOL, can treat both a person's cataracts and presbyopia—loss of near and intermediate vision. You probably noticed in your forties that you started to lose some of your up-close vision and had to start wearing reading glasses. Crystalens not only treats your cataracts (a clouding or hardening of your lens), but can also reduce or eliminate your dependence on glasses. It does so by recreating accommodation similar to your eye's natural lens. The unique Crystalens can reduce or eliminate glasses for most activities, including: reading a book, working on the computer, and driving a car.

Crystalens was modeled after the human eye. Like the natural lens, it uses the eye muscle to flex and accommodate in order to focus on objects in the environment at all distances. Crystalens dynamically adjusts to your visual needs.

Crystalens is designed to allow the optic, or the central circular part of the lens that you see through, to move back and forth as you constantly change focus on images around you. Crystalens flexes as you focus your vision.

ReSTOR
ReSTOR is a unique technological innovation that can provide you with quality vision throughout the entire visual spectrum – near through distance – with increased independence from reading glasses or bifocals! Apodization is the gradual tapering of the diffractive steps from the center to the outside edge of a lens to create a smooth transition of light between the distance, intermediate and near focal points. Diffraction involves the bending or spreading of light to multiple focal points as it passes through the lens. On the AcrySof® ReSTOR® IOL, the center of the lens surface consists of an apodized diffractive optic. This means that the series of tiny steps in that center area work together to focus light for near

Near vision: Refers to focal points that are typically 16 inches or closer to your eyes. This is also known as "reading vision." Items that typically fall within the near range of vision are books, newspapers, and medicine bottles.

Distance vision: Refers to focal points that are typically 7 feet or further from your eyes. Items that typically fall within the distance range of vision are billboards, street signs, and movie screens.

Tecnis
One of the most important benefits of improved functional vision with the TECNIS® Lens is safety. With compromised functional vision, even patients who have no problem reading the letters on an eye chart can be at a serious disadvantage in low-light situations because they have reduced contrast sensitivity.

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.(3) The improvement in functional vision may also improve safety in other low-visibility situations.

In addition to receiving sharp distance vision with the TECNIS® Lens, in many cases we can also correct pre-existing astigmatism at the time of cataract surgery.