Looking for next generation vision?

Advances mean freedom from glasses after cataract surgery

Author: Joan Fox Rose
Posted: Saturday, March 01, 2008
Soon after he turned 60 Martin Mayer of Saugerties was told he needed his cataracts removed. “I had been having trouble seeing in my right eye for some time and I knew that surgery was the next step,” he says.

Cataracts cloud and impair vision by blocking light from entering the lens of the eye. The lens is made up of proteins and water, and aging causes proteins to clump together and form cataracts. Cataracts are surgically removed by removing the natural lens of the eye to replace it with a pre-selected, artificial intraocular lens implant (IOL).

“Lens implant selection depends on differences in patients’ eye anatomy, physical health, individual lifestyles, and vision correction that is most important for each patient,” says Dr. John Chang, a Pearl River ophthalmologist. “Until recently, intraocular lens implants provided monofocal or single vision lenses that improved distance vision. After cataract surgery, patients would not need glasses for
distance vision but they would need them for reading vision.”

In recent years, multifocal intraocular lenses have undergone engineering refinements to improve their performance and are referred to as “Next Generation IOLs.” These updated lenses have the potential to free patients from eyeglasses after cataract surgery. “Each type of IOL has its strengths and weaknesses,” Chang says. “Sometimes it’s a matter of matching the right lens for the right patient.”

“Next Generation intraocular lenses will either give patients good distance or near vision, but not both,” adds Dr. Lawrence Fox, a Fishkill ophthalmologist. “Although they are good, these lenses are not recommended for all patients.”

Next Generation intraocular lenses include: ReStor, ReZoom and Crystalens. ReStor is a multifocal powered IOL that improves vision in multiple ranges by creating a smooth transition of light for distance, near and intermediate vision, according to Dr. Mary Davidian, an ophthalmologist with offices in Highland and Newburgh. “Its major advantage is that it is excellent for near and distance vision. Its disadvantage is that it is poor for intermediate vision. These lenses can produce glare and halos around lights but symptoms generally get better with time.”

“Nothing gives you reading vision like ReStor,” adds Dr. Satish Modi, a Poughkeepsie ophthalmolgist. “When ReStor lenses are used, 95 percent of my patients do not need to wear reading glasses.”

ReZoom lenses are good multifocal IOLs for people who like to be in the out-of-doors, Modi explains. “They are good for distance and intermediate vision but not good for near vision, and people who have them often need to wear over-the-counter reading glasses. ReZoom and ReStor work best when cataracts in both eyes are surgically corrected.”

An accommodative IOL, Crystalens corrects the eye’s ability to focus by allowing the optic of the lens (the part you see from) to move or accommodate in response to ocular muscles, Davidian explains. “Because they are a smaller lens, Crystalens can bend as you focus your vision,” she says. “Crystalens gives good near and distance vision but is not good for fine print.”

Made of silicone, Crystalens can produce higher levels of eye inflammation and is not recommended for diabetics, those with glaucoma, or people with dark colored eyes, Modi explains. “I’d say 75 percent of my patients who have Crystalens need to wear reading glasses.”

Doctors agree people who have astigmatism, an eye condition that causes blurry vision, should not use multifocal or accommodative  IOls. “Astigmatism needs to be surgically corrected with Toric intraocular lens implants because no other type lens can correct this eye condition,” Davidian explains. "Astigmatism must be corrected by a separate surgical procedure.”

“Today 2.3 million cataract surgeries are done each year nationwide,” adds Modi. “It is a very safe, minimally invasive surgical procedure.”

Cataracts are surgically removed when they cause visual impairments that limit and interfere with patients’ lifestyles. In the past doctors waited for cataracts to get “ripe” before doing surgery.

“Ripe is an outdated term,” Davidian says. “We waited until patients became legally blind because of surgical risks involved. Years ago the treatment was considered to be worse than the problem. Modern surgical procedures have been refined, post surgical complications dramatically reduced, and recovery time is quicker.”

Surgery is done on an outpatient basis and usually takes from under 10 minutes to 30 minutes, based on the patient’s needs and the doctor’s individual preferences. A topical type of local anesthesia in the form of eye drops is used prior to surgery, and most patients are awake during the procedure. When cataracts are removed from both eyes, one eye is done at a time and not on the same surgical day.

During surgery a sound wave device is used to break up the cataract, the natural lens is removed and replaced by a permanent intraocular lens. Bleeding and infection can occur after surgery but rarely do. Patients are advised to rest the day of surgery and to wash their hands often. Antibiotics may be routinely ordered.

Surgeons who perform cataract surgery should be experienced, board certified ophthalmologists with good reputations. Ask friends and others for referrals to find a doctor you feel comfortable with.

Joan Fox Rose is a freelance writer living in Saratoga Springs.

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