New Lens Implant Choices Revolutionizing Cataract Surgery
Newer lens implants available to patients undergoing cataract surgery offer another potential benefit to patients less dependence on eyeglasses.
Cataracts are a clouding of the eye's natural lens that may occur as a result of trauma, some medications, in association with certain diseases or just a consequence of aging. Years ago, before lens implants were used, cataract patients who had their natural lenses removed during surgery were prescribed thick "coke bottle" cataract glasses to see. Today, the use of artificial lenses (implants) to replace the cloudy cataractous lens removed during surgery have eliminated the need for thick heavy glasses after surgery.
Innovative new lens designs recently approved by the FDA can now simultaneously address other visual ailments including astigmatism and the need for bifocal glasses.
Astigmatism is an eye malady commonly corrected by eyeglasses with more power in one direction (for example horizontally) than the other (vertically). Now implants with astigmatism correction can be implanted at the time of cataract surgery to eliminate the need for eyeglass correction. One such lens is the Acrysof Toric intraocular lens.
As the eye ages, many patients will note a loss of focusing ability. This is a consequence of less flexibility of the natural lens. The fix for millions of Americans has been reading glasses or bifocals. The correction of this focusing inability that perplexes most individuals over the age of 40 with implants has occurred via two different lens designs. The Crystalens is an implant that flexes, thus restoring some focusing ability to patients
who receive this lens.
The Restor implant is a type of bifocal lens with both distance and near powers. It allows most patients who receive it the ability to see well at both distance and near without glasses.
For now, most insurance plans do not cover the extra costs associated with implanting these high-tech intraocular lenses. Patients who desire them must pay out-of pocket. In addition, they do not correct the full range of eyeglass problems and certain eye disorders preclude their use. Patients contemplating cataract surgery would be wise to ask their eye doctor if they are a candidate for these newer implants.
Dean Dornic offers all available premium intraocular lenses including the ReStor and Crystalens for his cataract patients. He would be happy to provide a detailed discussion on which might be the most appropriate for your particular situation.
This prospective, randomized study consisted of 43 eyes implanted with the TICL (20 bilateral cases) and 45 eyes receiving PRK with mitomycin C (22 bilateral cases) with moderate to high myopia (–6.00 to –20.00 diopters [D] sphere) measured at the spectacle plane and 1.00 to 4.00 D of astigmatism. All patient treatment and follow-up occurred at the Naval Medical Center San Diego. Study follow-up was 1 day, 1 week, 1, 3, 6, and 12 months postoperative.
Mean best spectacle-corrected visual acuity (BSCVA), change in BSCVA, proportion of cases with improvement of 1 or more lines of BSCVA, proportion of cases with BSCVA and uncorrected visual acuity (UCVA) 20/12.5 or better, proportion of cases with BSCVA and UCVA 20/16 or better (6 months, 88% vs 54%, P=.002), and predictability ±1.00 D (6 months, 100% vs 67%, P<.001) were all significantly better in the TICL group than the PRK group at all time periods studied postoperatively. Similarly, contrast sensitivity, tested at both the 5% photopic level and the 25% mesopic level, was significantly better at all postoperative time points in the TICL group. Mean spherical equivalent refraction was closer to emmetropia (0.28±0.41 vs 0.76±0.86, P=.005), and predictability 0.50 D and stability of manifest refraction (±0.50 D and ±1.00 D) were significantly better in the TICL group at all postoperative visits through 6 months. Mean astigmatism correction at 6 months was not significantly different between the two groups (0.52±0.33 vs 0.46±0.35, P=.450).
The TICL performed better than PRK in all measures of safety (BSCVA), efficacy (UCVA), predictability, and stability in this comparison, supporting the TICL as a viable alternative to existing refractive surgical treatments. [J Refract Surg. 2007;23:853-867.]