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The only proven treatment for a visually-significant cataract is cataract surgery.

Modern cataract surgery is a very successful procedure with well over 95% of patients achieving improved vision. Cataract surgery involves removing your opacified crystalline lens (i.e. the cataract) and inserting a clear, artificial lens. The procedure is done on an outpatient basis and typically takes 10-30 minutes long. Most patients experience no or minimal discomfort during the procedure with the use of modern anesthetic medications.

In the past, there was only one choice of artificial intraocular lens -- the “monofocal” intraocular lens. This lens could correct most of a patient’s refractive error (i.e. “glasses prescription”), but the patient would always have to use glasses for reading and sometimes for distance if he or she had a significant amount of astigmatism. Newer lens technologies give the cataract surgery patient more options for their post-operative vision. At Center for Sight Maui, we will counsel you on the different intraocular lens choices that may satisfy your visual needs.

Toric

“Toric” intraocular lenses are similar to the monofocal lens in that they are set for a certain focal length depending on the patient’s preference. Typically, the focal length is set at infinity so that the patient can see clearly at distance without glasses. The difference between the toric and monofocal lenses is that the toric lens will correct the patient’s astigmatism. This lens property translates into a higher chance that the patient will not require glasses for distance (or for whatever focal length the patient chooses). The monofocal lens will not correct a patient’s astigmatism and thus many patients will still need glasses for distance after surgery. Patients who choose the toric lens usually have the “crispest” or sharpest distance vision among the different intraocular lens options. In comparison to the monofocal lens, patients who choose the toric lens will still need reading glasses for up-close visual tasks. The Alcon AcrySof® IQ Toric Lens is an example of a toric intraocular lens (www.acrysofiqtoric.com).

Multifocal

“Multifocal” intraocular lenses have special optical properties that divide light to bring into focus more than one point simultaneously. The goal of these lenses is to reduce a patient’s dependency on reading glasses. Typically, patients can see well at far, intermediate, and near distances. Since these lenses split light, sometimes patients will see some extra “glow” or “haloes” around lights especially at night. Multifocal intraocular lenses do not correct any astigmatism, so occasionally limbal-relaxing incisions (LRIs) need to be performed at the time of cataract surgery to ensure the best possible outcome. Examples of multifocal lenses include the Alcon AcrySof® IQ ReSTOR® (www.acrysofrestor.com) and AMO Technis® (www.tecnisiol.com) multifocal intraocular lenses. A combined multifocal-toric intraocular lens is currently being used in certain European countries and will likely be available in the United States in 2012-13.

Accommodating

“Accommodating” intraocular lenses are like monofocal lenses in that they have a single focal point. However, unlike monofocal lenses, the accommodating intraocular lenses can shift the focal point in space so that objects at distance are clear when the eye focuses on them, but when the eye looks at a near object, the lens will shift its focal point to bring the near object into focus. Unlike the multifocal lenses, the accommodating intraocular lens does not split the light rays and therefore patients do not typically complain about “glow” or “haloes.” The main disadvantages of the accommodating intraocular lens are that it: (1) does not correct astigmatism; and (2) the level of acquired reading vision can be variable. The only accommodating intraocular lens that is FDA-approved is the Bausch and Lomb CrystaLens® (www.crystalens.com).

Which intraocular lens is the “right” one for you?

Cataract surgery is not a “one choice fits all” type of procedure. There is not one intraocular lens that is best for every patient. One patient may have visual demands that differ compared to the next patient. Therefore, the choice of which intraocular lens to use is an individualized one. This decision should be made only after a thorough discussion with your eye physician. In addition, the newer lens technologies (i.e. toric, multifocal, and accommodating lenses) will require an additional out-of-pocket expense not covered by medical insurances. We have financing options available to help you purchase your premium lens if you desire.

Our goal at Center for Sight Maui is to help maximize your visual potential. Dr. Sidney Chang will listen to your visual needs and desires and will help guide you toward the appropriate intraocular lens choice. Dr. Chang is well-versed in the intraocular lens options and the technical as well as human aspects of modern cataract surgery. We wish you the best in attaining superb vision!

Alcon SN60WF – example of a monofocal lens

Alcon AcrySof
toric lens

Technis multifocal –
example of a multifocal lens

Crystalens – example of a accommodating lens

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