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Multifocal and Premium Intraocular Lenses

Dr. Wong offers the most advanced options to customize your vision after cataract surgery, based on your individual lifestyle needs. We hope that the following information will help you understand the different options available to you.

What Types of Lens Implants Are Available?

Dr. Wong will help you decide on the type of lens implant that will replace your cataract. There are lenses available to treat nearsightedness (myopia), farsightedness (hyperopia), and astigmatism. Lens implants usually provide either near or distance vision: these single focus lenses are called monofocal IOLs. Some newer lens implants can provide for near, intermediate, and distance vision: these multiple focus lenses are called Multifocal IOLs. Lens implants that treat astigmatism are called Toric IOLs. You can also have one eye corrected for near vision, and the other for distance vision, a choice called monovision.

Presbyopia And Alternatives for Near Vision After Surgery

Patients who have cataracts have, or will eventually develop presbyopia, which is a condition caused by aging that develops when your eye loses its ability to shift from distance to near vision. Presbyopia is the reason that reading glasses become necessary, typically after age 40, even for people who have excellent distance and near vision without glasses. Presbyopic individuals require bifocals or separate (different prescription) reading glasses in order to see clearly at close range. There are several options available to you to achieve distance and near vision after cataract surgery. This is probably the most important decision you need to make about your cataract surgery, so please take the time to review your options and ask questions.

GLASSES. You can choose to have a monofocal (single focus) lens implant for distance vision and wear separate reading glasses, or have the lens implant for near vision and wear separate glasses for distance.

MONOVISION. Dr. Wong could place lens implants with two different powers, one for near vision in one eye, and one for distance vision in the other eye. This combination of a distance eye and a reading eye is called monovision. It can allow you to read without glasses. Many patients who wear contacts or who have had refractive surgery have monovision and are happy with it. Dr. Wong may discuss and demonstrate this option to see if it might work for you.

MULTIFOCAL IOL. Dr. Wong could implant a “Multifocal” IOL. This is a newer, “deluxe” type of lens implant that provides distance vision AND restores some or all of your eye’s ability to focus. It corrects for both distance vision and other ranges, such as near or intermediate. Choosing this option will usually lead to higher out-of-pocket expenses since most insurance companies only pay for a monofocal (single focus) lens.

NEARVISION CK (conductive keratoplasty). This is a refractive procedure that uses radiofrequency energy to reshape the cornea in order to improve near vision. This procedure is typically performed in one eye, while the other eye remains corrected for distance. It is, therefore, another form of monovision correction.

What is Astigmatism? Are There Other Treatments For It?

Patients with nearsightedness and farsightedness often also have astigmatism. Astigmatism is caused by an irregularly shaped cornea; instead of being round like a basketball, the cornea is shaped like a football. This can make your vision blurry. In addition to Toric IOLs, astigmatism can be reduced by glasses, contact lenses, and refractive surgery (LASIK or PRK). There is also a procedure called a limbal relaxing incision (LRI), which can be done at the same time as the cataract operation, or as a separate procedure. A limbal relaxing incision (LRI) is a small cut or incision the ophthalmologist makes into your cornea to make its shape rounder. Any attempt at astigmatism reduction could result in over- or under-correction, in which case glasses, contact lenses, or another procedure may be needed.

Traditional Monofocal Lens Implant

This lens is used for the majority of patients. It gives excellent quality of vision but it has a fixed focal distance. This means that you will need eyeglasses to correct your full range of vision after surgery. If your preference is to have your best vision without glasses for far vision, then you will need glasses for most near-vision activities after surgery, even if you do not wear near vision glasses now. These activities include reading, applying makeup, shaving, sewing, reading your watch and dialing a cell phone. If your preference is to have your best vision without glasses for near vision activities, then you will need glasses for far vision activities, such as watching T.V. and driving. The focal distance preferred is a personal decision based on which types of activities you would most like to perform with reduced dependence on eyeglasses. If cataract surgery is needed for only one eye, some patients may prefer to wear glasses for all focal distances in order to maintain balance with the unoperated fellow eye. The monofocal implant is best suited for people who do not mind wearing glasses or people who have certain eye diseases that may limit their vision after surgery. Medicare and most private insurers will pay for the cataract surgery and the cost of this implant.

The following are options that are considered premium surgical options. Medicare and commercial insurance carriers will pay for the cost of the surgery but the cost of premium implants and surgical techniques for astigmatism are not covered by insurance.

Toric lens implant or Limbal Relaxing Incision
(LRIs) for Astigmatism

A toric implant reduces astigmatism and can help provide either good far vision or near vision without glasses; but not both. Astigmatism is a common irregularity of the front surface of the eye (cornea) that creates a blurred image. If you would like to maximize your uncorrected vision after cataract surgery, a toric implant can be used to reduce astigmatism. Incisions in the cornea (LRIs) can also be performed at the time of surgery and represent another option to treat astigmatism.

restorReSTOR Multifocal Lens Implant (Alcon)

This lens is an “apodized” lens, giving good distance and good near vision without glasses. It has limited arm’s length vision. Some patients may experience night time halos around lights, which typically becomes less of an issue with the passage of time.

rezoomReZoom Multifocal Lens Implant (Abbot Medical Optics)

This lens has three focal zones for far vision, arm’s length vision and near vision without glasses. The lens can cause some halos around headlights and street lights which typically becomes less of an issue with the passage of time.

crystalensCrystalens Accommodating Lens Implant (Bausch & Lomb)

This lens accommodates by moving back and forth (auto focus) within the eye. Distance and computer vision tends to be good without glasses; many people still need glasses for reading.

Each of the premium lenses has its own advantages and disadvantages and none of them guarantee that you will be completely free of glasses for all activities. You should consider these premium implants or surgery for astigmatism if you strongly desire to be less dependent on glasses.