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Intraocular Lenses

Intraocular Lenses

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Intraocular lenses, or IOLs, are implantable lenses that are used to replace the natural lenses of the eyes when they have become damaged. Scientists originally designed IOLs to treat cataracts. When your doctor removes your old, clouded lens and replaces it with an IOL, you could enjoy significantly enhanced vision at all distances. Like many patients, you could even enjoy 20/20 vision or better without glasses or contacts.

Additionally, doctors have begun to use IOLs to treat presbyopia. When your natural lens loses flexibility as a result of age, your close-up vision will suffer. IOLs can replace these compromised lenses to significantly improve your vision. In some cases, IOLs can also correct myopia, or nearsightedness.

There are several varieties of IOLs. Choices include monofocal, multifocal, and toric lenses. As scientists continue to research cataracts and ocular health, we are likely to see even more types of IOLs. Nevertheless, today's lenses offer outstanding results. Most patients are happy with their procedures, and they enjoy significantly improved vision. Additionally, IOL surgery involves very few risks, minimal discomfort, and a brief recovery time.

Candidacy

If you are in good health and have sufficient corneal thickness, you are likely a good candidate for IOLs. Before beginning treatment, your surgeon will conduct a complete evaluation to determine whether IOLs are right for you.

Cataract Patients

Cataracts are an extremely common age-related condition. As you get older, you face a high probability of getting cataracts. However, cataracts are not just limited to those who have reached their golden years. This condition has also been linked to eye injuries, genetics, overexposure to sunlight, and some medications. They can afflict young adults and even children. Most surgery for vision correction with intraocular lenses, however, is performed on older individuals.

If you are between the ages of 21 and 80, and you suffer from cataracts, IOLs may be the solution. Signs that you may need IOLs include:

  • Blurred vision
  • Difficulty driving at night because of glare
  • Problems reading
  • Overall diminished vision that is not improved by your recent-prescription contact lenses or glasses

Presbyopia and Myopia Patients

Presbyopia is another common age-related condition. As you reach middle age, you will typically notice that your vision gradually becomes less sharp. This is especially true for near-vision tasks, such as reading. The problem occurs because the natural crystalline lenses eventually become rigid and lose their ability to focus correctly. If you suffer from presbyopia, and you prefer not to use reading glasses or bifocals, intraocular lenses offer an effective solution.

Some doctors also recommend phakic IOLs to correct myopia, or nearsightedness. This type of lens does not replace the natural lens, but it goes in front of it. Phakic IOLs are not as popular as LASIK (Laser-Assisted Stromal In-situ Keratomileusis) and other laser vision correction. However, in some cases, they can be a great way to reduce or eliminate your dependence of glasses or contacts.

General IOL Requirements

Prior to accepting you for intraocular lens surgery, your ophthalmologist will assess your general and ocular health. You are a likely candidate for intraocular lenses if you:

  • Are in good health
  • Have healthy eyes free of disease and infection
  • Have sufficient corneal thickness
  • Are between the ages of 21 and 80

You may not be eligible for intraocular lenses if you:

  • Have diabetes or hepatitis C
  • Suffer from persistently dry eyes
  • Have excessive corneal scarring
  • Are taking certain drugs
  • Use a pacemaker
  • Are pregnant
  • Are HIV positive

Cost

Typically, the cost of a lens implant is $1,500 to $3,000 per eye. However, the cost of your IOL surgery will depend on several considerations.

Type of IOL

The type of lens you choose is the most significant factor when it comes to the cost of your surgery. Monofocal lenses correct your vision at only one distance. Premium IOLs, on the other hand, correct both distance and close-up vision. Additionally, toric lenses can be a great choice if you suffer from astigmatism. Basic monofocal lenses will always cost less than premium lenses. However, if you would like to reduce or eliminate your dependence on glasses or contacts, you may be willing to pay more for multifocal or toric IOLs.

Surgeon

Often, doctors with extensive training may charge more than their less experienced colleagues. Though you may be tempted to choose a less costly surgeon, it is important to remember that your intraocular lens surgery is an invaluable investment in your future. Good eyesight is essential to your quality of life. Higher costs may seem a small price to pay in exchange for greater peace of mind and a higher likelihood of success.

Location

Medical costs vary from place to place. Therefore, the area where your surgery takes place will influence the cost of your treatment. In general, IOL surgery will cost more in major metropolitan areas. However, this is certainly not a hard and fast rule.

Payment

If you are receiving IOLs to correct cataracts, your health insurance will probably cover the cost of your lenses, at least in part. However, most health insurance policies will only cover the cost of basic monofocal lenses. Multifocal lenses are primarily beneficial because they can reduce or eliminate your dependence on glasses or contacts. Because this is largely a cosmetic concern, insurance does not usually cover the extra costs. Many times, however, your insurance will cover the base cost of the monofocal lens. Then you can make up the difference yourself. Your surgeon's staff can help you file your claim and get more from your insurance plan.

Without the presence of cataracts, intraocular lenses are considered an elective treatment. Therefore, insurance will not usually cover an IOL when it is used to correct presbyopia alone.

Other Financing Options

If you do not have insurance, or if you would like the benefits of a multifocal lens, there are several options to help you cover the cost of your surgery. First, many doctors offer their own financing options. You may be able to set up an affordable repayment schedule with his or her office. Some doctors also offer discounts if you pay for your IOL surgery upfront. You should discuss these options at your initial consultation.

You might also choose third-party financing. There are many medical financing companies that help patients pay for elective or non-covered procedures. Often, you can obtain a fixed, low, or even no-interest repayment plan with these companies. You can also acquire funding through banks and other lending companies. Your doctor's staff may be able to help you find the best financing option for your budget.

How to Choose an IOL Surgeon

For optimal results, you should choose a highly qualified eye surgeon. DocShop's online directory can help you locate a skilled IOL specialist in your area. There are several things you should keep in mind when selecting your doctor.

Experience

First, you should choose a doctor who has performed numerous IOL surgeries. At the same time, a practitioner with an unusually high number of procedures may not give you the personalized care you deserve. Ideally, you should find a surgeon that has performed IOL surgery regularly for the last year. This experience will indicate that he or she is familiar with the latest techniques and technology.

Additionally, if you are interested in multifocal lenses or if you would like to try monovision, choose a doctor with experience in these areas of treatment.

Hospital Privileges

IOL placement is a safe, low-risk procedure. However, on the slight chance that something does go wrong, you should choose a doctor with hospital privileges. This will ensure that you have access to emergency care, if needed. Additionally, hospitals are very particular about granting privileges. When a doctor has these rights, it indicates that he or she adheres to proper safety and ethical protocol.

Surgical Center

IOL surgery is an outpatient procedure. It will typically take place at a hospital or surgical center. An outpatient center should be certified by the American Association for Accreditation of Ambulatory Surgery Centers. To receive accreditation, a surgical center must follow correct safety and hygiene standards.

What Others Say

To feel more confident about your choice, consider asking others for recommendations. Family and friends who have received an IOL may have great things to say about their surgeons. Your primary care physician may be able to recommend an excellent doctor in your area.

"If you have selected a potential doctor, check his or her safety track"

If you have selected a potential doctor, check his or her safety track. State medical boards are legally required to make all records public. You can look to see if anyone has lodged any complaints against the surgeon. You should also check to see if he or she has ever been accused of malpractice. In most states, these records are available online. In some areas, you may have to request them through the mail.

Personal Comfort Level

While safety and experience are obviously your top concerns, you should also choose a doctor with whom you feel at ease. After all, IOL surgery is an important step for your future health and quality of life. You will want a compassionate and caring practitioner at your side throughout the process. You will also want a doctor who puts your interests first. If a surgeon pressures you to choose premium lenses or to undergo further elective treatment, this may indicate that he or she is not a good fit for you.

The Initial Consultation

Your first consultation with your doctor gives you a change to get to know each other. In this way, your surgeon can determine your exact needs and develop your personal treatment plan.

Determining Candidacy

Before anything else, your doctor will decide whether you are a candidate for IOL surgery. He or she will closely examine your eyes and conduct a vision test. The doctor will also look at your physical and ocular health history. Finally, the surgeon will explain the procedure in detail and make sure that you have reasonable expectations for your results.

Choosing Your Lens

Once the doctor has determined that IOLs are right for you, you will work together to choose the right lens for your needs. The surgeon will explain the advantages and disadvantages of each type of lens. You can then choose the optimal solution for your health needs, lifestyle, and budget.

Planning Your Procedure

After you have selected your IOL, your doctor will begin to develop your unique treatment plan. There are several methods of IOL placement, including extracapsular, intracapsular, and laser-assisted surgery. Your surgeon may prefer a specific method. He or she may also recommend a technique that is particularly suited to your needs. You will also decide whether local or general anesthesia is right for you. Typically, surgeons place IOLs under local anesthesia. However, if you are particularly nervous, general sedation may be a better option.

Types of IOLs

If you are considering cataract surgery to replace the lens in your eye, you should discuss the different types of IOLs with your doctor. There are two main lens types to consider: monofocal and multifocal intraocular lenses. However you may also want to consider toric, aspheric, phakic, and blue light-filtering IOLs.

Monofocal Lenses

Originally, all IOLs were monofocal. These lenses correct vision at one distance only. They can be set for near, intermediate, or far vision. With monofocal lenses, you will still need glasses, especially if you suffer from presbyopia (age-related farsightedness). Most patients receive monofocal lenses for distance vision, and they wear glasses for reading and other close-up work.

You may also want to consider monovision. With this technique, your doctor will implant one monofocal lens set for distance. In the other eye, he or she will implant a lens set for close-up objects. Your brain will adjust the two distances to create a single, sharp image. It can take some time to get used to this new way of seeing. Some patients cannot ever fully adjust. You may want to try monovision with removable contacts before committing to a surgical procedure.

Multifocal Lenses

Newer, multifocal intraocular lenses will correct vision at multiple ranges without glasses or contact lenses. A multifocal IOL is designed with a series of "visual zones." Much like bifocals or trifocals, multifocal IOLs can correct both near and far vision. Your brain must learn to select the visual information it needs to form an image. Therefore, multifocal lenses may require a period of adjustment. You may get used to multifocal IOLs more easily if you receive them in both eyes.

Accommodative IOLs

Like multifocal lenses, accommodative IOLs can help you see both distant and close-up objects. However, advanced accommodative lenses are flexible and closely mimic the movements of your natural lens. They come in a range of strengths. Your surgeon will help you select the one that is most suited to your visual needs. If you have severe nearsightedness or farsightedness, or if you have had previous laser vision surgery, you may not be a candidate for accommodative IOLs. These factors may make it difficult for your doctor to determine the right lens strength. Although accommodative lenses can reduce your reliance on glasses or contacts, you will probably still need them for long periods of reading or close-up work.

Toric Lenses

If you suffer from astigmatism, and you are seeking treatment for cataracts, toric IOLs may provide an excellent solution. Astigmatism occurs when your cornea is irregularly shaped. As a result, your eye cannot properly refract light. In response, your brain registers a distorted image.

Toric lenses are not flexible, but they do refract light at different distances. Therefore, if you suffer from astigmatism, toric IOLs are the only lens that can reduce your dependence on glasses or contacts. Like most patients, you will probably need to wear glasses during long periods of distance vision. Placing a toric IOL requires a great deal of precision and experience. Therefore, you should be especially selective when you are choosing your eye surgeon. When you receive a toric IOL, you have a higher risk for lens rotation. However, in the vast majority of cases, your doctor can perform a quick, easy corrective procedure.

Aspheric Lenses

Aspheric IOLs are a new development in eye surgery, and they have become increasingly popular in the last ten years. Based on developments in laser vision correction, scientists created these lenses to be flatter on the edges than traditional IOLs. Because of their unique design, you may have a greater ability to distinguish between shades of light and dark. This ability, known as contrast sensitivity, is especially important if you do a lot of night driving. Typically, aspheric lenses are more suitable if you are a younger cataract patient, since you are more likely to enjoy healthy contrast sensitivity for years to come.

Blue-Light Filtering Lenses

You may already know that UVA rays are bad for your skin. However, you may not have heard that blue light and UVA rays can increase your risk for cataracts, macular degeneration, and other forms of retinal damage. Blue light-filtering IOLs have a slight yellow tint that can block some of these harmful rays. Although they have a yellow tone, these lenses should not affect your color perception. In some cases, however, they may impact your contrast sensitivity. Talk to your doctor to learn more about blue light-filtering IOLs and to find out if they are suitable for you.

Phakic Lenses

Phakic IOLs can be a great way to treat nearsightedness. These lenses are also known as implantable contact lenses, or ICLs. Unlike other types of IOLs, phakic lenses do not replace your old lens. Rather, your doctor will insert it between your cornea and iris or behind your iris. They function much like regular contact lenses, but they offer permanent vision correction.

Phakic lenses are not as popular as LASIK surgery for correcting vision aberrations. Not all surgeons are trained to perform this treatment. However, doctors report that the lenses can be just as effective as LASIK, if not more so. According to a 2010 study by Allon Barsam, MD, of the Moorfields Eye Hospital NHS Foundation Trust in London, patients with phakic IOLs had better contrast sensitivity that LASIK patients. They also faced lower surgical risks.[1]

If you are considering vision correction surgery, and you do not suffer from cataracts, your doctor can explain more about phakic IOLs. He or she can also compare this treatment to LASIK and help you choose the right procedure for your needs.

FDA-Approved IOLs

The FDA has approved several types of premium, multifocal IOLs, including:

AcrySof®

Alcon® manufactures several types of AcrySof® IOLs. These include:

  • AcrySof® IQ: Both toric and aspheric IOLs can correct vision in difficult cases and low-light situations. They provide excellent contrast sensitivity. These IOLs also pose a low risk of lens rotation.
  • AcrySof® IQ ReSTOR®: ReSTOR® multifocal IOLs are uniquely designed to improve vision at all distances. ReSTOR® lenses are modeled after microscope and telescope technology. These IOLs focus at both near and far distances to decrease your dependency on glasses. In some cases, they can eliminate the need for glasses entirely.

ReZoom™

ReZoom™ IOLs, manufactured by Abbott Medical Optics, are next-generation multifocal lenses. They offer farsighted patients greater independence from glasses than monofocal IOLs. They contain three concentric "visual zones" and provide excellent vision correction under all lighting conditions. ReZoom TM IOLs are especially effective in enhancing intermediate vision.

TECNIS™

Like ReSTOR® and ReZoom®, TECNIS™ intraocular lenses have concentric visual zones. In this way, they can correct vision at all distances. TECNISTM IOLs minimize glare. They also allow significantly greater detail and contrast than traditional IOLs. TECNIS™ lenses may be particularly effective if you have reduced contrast sensitivity in low-light situations.

SofPort® AO

SofPort® AO by Bausch + Lomb is an aspheric IOL. It is the only IOL with two aspheric surfaces. Thanks to its unique design, SofPort® provides enhanced contrast sensitivity in low-light situations. It is also aberration-free and will not affect your depth of focus.

Crystalens®

Crystalens® was the first accommodating lens with FDA approval. With normal vision, your outer membrane and inner lens work together. In this way, your eye can adjust to near and far distances. Crystalens® is designed to mimic the eye's natural process of accommodation. These lenses are flexible. Therefore, they can adjust focus between near, far, and midrange vision. According to the makers of Crystalens®, 88.4 percent of all patients with these accommodating lenses could see better at all distances. In comparison, 35.9 percent of patients with a standard IOL had better close-up, distance, and mid-range vision.[2]

Trulign®

Trulign® received FDA approval in 2013. It is the second accommodative lens to be approved by the administration. These lenses can effectively treat astigmatism, as well as nearsightedness and farsightedness. According to the FDA's Trulign® Toric IOL study, 100 percent of patients who received these lenses were able to pass a driver's test without glasses or contacts.[3]

FDA-Approved Phakic Lenses

Currently, there are two phakic lenses that have been approved by the FDA

  • Visian ICL®: These ICLs (or implantable collamer lenses) received FDA-approval in 2005. It goes between the iris and the natural lens. This type of lens is very flexible. Therefore, doctors can fold them up and insert them through tiny incisions.
  • Verisyse®: The FDA approved these phakic IOLs in 2004. Verisyse® is particularly suitable if you have moderate to severe nearsightedness. They go in front of your iris.

Visual Errors IOLs Can Address

Although IOLs were originally developed as a way to treat cataracts, premium lenses can address other vision problems.

Presbyopia

Presbyopia is an age-related condition. As people get older, their natural lenses become less flexible. Therefore, they are no longer able to focus on close-up objects. Presbyopia is an inevitable part of aging. Around age 40 or 50, most people notice gradual changes in their eyesight. Even those who previously had 20/20 vision will eventually rely on reading glasses. Toric and Trulign® accommodative lenses can effectively correct this condition.

Nearsightedness

If you suffer from nearsightedness, or myopia, you are able to see close-up objects clearly. However, you have difficulty focusing on objects that are far away. This condition occurs when your eye refracts light incorrectly. Normally, light should focus directly on your retina. When you suffer from myopia, light refracts in front of your retina. Phakic IOLs can be a great way to nearsightedness, especially if you have severe myopia. These lenses can also be an ideal solution if you are not a good candidate for LASIK due to thin corneas.

Researchers are currently conducting studies on phakic IOLs. They hope that they can also use these lenses to treat farsightedness in the near future.

Before IOL Surgery

Before beginning treatment, you and your doctor will work carefully to determine the right type of lens for your needs. Your surgeon will measure the depth of your eye, the size of your pupil, and the curvature of your cornea. If you wear contacts, you should stop wearing them for a few days before your surgery. Otherwise, they could prevent your doctor from obtaining completely accurate measurements.

The Days before Your Procedure

At your consultation, you doctor will also review your current list of medications. Certain drugs could inhibit the healing process. In some cases, your surgeon may ask you to stop taking a medication before your surgery. He or she may also prescribe an alternative. In preparation for your procedure, you should also arrange for time off work, and you should find someone to drive you to and from the surgical center.

The night or morning before your treatment, take a shower and wash your hair to reduce the risk of infection. Avoid alcohol for 24 hours before the procedure. Some doctors may advise you to eat a small meal before treatment, while others may tell you not to eat after midnight. Always follow your doctor's pre-surgery instructions.

Before Phakic IOL surgery

If you are going to receive a phakic IOL, your doctor may perform a laser iridotomy to prepare your eye for the new lens. First, he or she will numb your eye with eye drops. Then the doctor will place a lens over your eye and make tiny holes in the outer edge of your iris. The iridotomy will keep fluid from accumulating inside your eye once your new lens is in place. The procedure is quick and typically discomfort free. It will take place in your doctor's office. In most cases, you can drive yourself home afterwards. You will need to use anti-inflammatory eye drops after this treatment.

The Surgical Procedure

IOL placement can vary a bit for each patient, but doctors follow the same general outline for each procedure. In most cases, your doctor can perform intraocular lens surgery in less than an hour. However, the benefits last a lifetime.

Anesthesia

Before your surgery, you will receive general or local anesthesia. In most cases, doctors will use eye drops to numb your eye. Occasionally, he or she may inject local anesthetic in the surrounding tissues. Local anesthesia eliminates the risks associated with general sedation. However, if you are particularly anxious, your doctor may recommend complete anesthesia.

Lens Removal

Once you are comfortable, your ophthalmologist will remove your eye's natural lens. The methods for removing the damaged lens vary. The type your doctor chooses will depend on his or her experience, your needs, and the type of IOL you are going to receive. Options include:

  • Phacoemulsification: This technique is the most common method of lens removal. Your surgeon will create two miniscule incisions between your cornea and the white of your eye. A tiny phaco probe will go inside these incisions. The probe will emit ultrasound waves to break the lens apart without damage to the surrounding tissues. Then your doctor can gently suction out the pieces before placing the new lens behind your iris.
  • Standard extracapsular cataract extraction (ECCE): Your doctor will make a small incision, about 8 to 10 mm long, between your cornea and the white of your eye. He or she will create an additional incision in your lens capsule. Through these incisions, your surgeon will remove your damaged lens and place the IOL behind your iris. Finally, he or she will close the incisions.
  • Intracapsular surgery: This method was invented in the 1980s, and most doctors use newer techniques to perform IOL surgery. Nevertheless, in some cases, intracapsular surgery may be the right choice. With this method, your doctor will inject a special solution to dissolve the fibrous tissues around your lens. Then he or she will freeze the damaged lens with liquid nitrogen. As your doctor removes the liquid nitrogen wand, the lens will come out at the same time. Then your doctor will place your IOL in front of your iris.
  • Laser-assisted surgery: During laser-assisted surgery, your doctor will make all needed incisions using femtosecond lasers. These devices will be calibrated according to a highly precise digital map of your eye. The treatment will involve minimal implant to the surrounding tissue, and the lasers can further reduce the already low risks of IOL surgery. Laser-assisted surgery can also minimize your discomfort and recovery time.

Implanting the IOL

After removing the natural lens, your surgeon will implant the IOL. There may be some variation in the procedure. Your surgeon will typically fold the intraocular lens to properly fit it through the incision. Once inside your eye, the IOL will open to its permanent position. Although not used as often, the doctor can also insert a non-foldable IOL. This method will require a slightly larger incision. Your ophthalmologist can discuss the various types of IOLs available. Then he or she can help you decide which type will be most effective for your surgery.

If you choose a doctor who performs laser-assisted IOL surgery, he or she will use an optical coherence tomography test (OCT). This test will send light waves through your eye to create an extremely accurate, 3-D map. Then your surgeon can determine the optimal position for your IOL based on these images.

In most cases, the incisions will heal on their own. However, if you have a larger incision, you doctor may place several tiny, dissolvable sutures.

Recovery

The recovery time for intraocular lens surgery is relatively short. In most circumstances, you should be able to resume some normal activities within a day of your surgery. Reading, watching TV, and computer use are generally fine, as long as you do not experience eye fatigue. However, you should not undertake any strenuous activity for a few weeks, since overexertion may cause your blood pressure to rise. You should also avoid bending over and rubbing your eyes.

Within 24 hours of your procedure, you should return for a follow-up visit with your surgeon. You will continue to have routine check-ups for several months. At these visits, your doctor can monitor your progress and check your vision. He or she will also guide you as you return to your normal day-to-day life.

"It could take about six months to reach optimal vision correction"

It could take about six months to reach optimal vision correction. During this time, your body will need to adjust to the new lenses. You should engage in a wide range of activities to help your eyes and brain learn how to work together with the new lenses.

Protecting Your Eyes

Following surgery, you will typically receive prescription eye drops. These drops will reduce your risk for infection and minimize any discomfort. Your surgeon may also provide a clear shield to protect your eye from external damage. For additional protection:

  • Avoid swimming, hot tubs, and contact sports for two to four weeks after your surgery.
  • Do not wear eye make up for at least one week.
  • Be careful not to get soap or shampoo in your eyes.
  • Wear sunglasses with high UVA/UVB protection (continue to wear them, even after recovery).
  • Avoid situations that could expose your eyes to wind, dust, and dirt.

Results

After receiving IOLs, you will typically experience slightly blurred vision. Even with this blurring, however, your vision will be significantly better than it was with your cataract-clouded lens. Blurring will clear up within a few days or weeks. After recovery, you should enjoy clear, healthy sight.

Visual Acuity

When you receive premium or phakic IOLs, it may take several weeks to realize the full extent of your vision correction. Following your recovery, however, you should see a significant improvement in the clarity of your sight. Most ophthalmologists will encourage you to wait four to six weeks before obtaining new glasses. If you choose multifocal IOLs, you may eliminate or greatly reduce your reliance on corrective lenses. In fact, most patients enjoy at least 20/40 vision, the legal limit for driving without glasses. A large percentage of patients enjoy 20/20 vision or better. Many do not need glasses or contacts at all.

Reasonable Expectations

Before undergoing IOL placement, it is important to establish realistic expectations for your treatment. The procedure can greatly enhance your vision; however, you will not necessarily enjoy the same clarity of vision that you enjoyed in your youth. Nevertheless, if you previously suffered from cataracts, your sight and quality of life will greatly improve. Additionally, when you choose premium IOLs, you will typically rely on glasses far less, even if you require them for some activities.

Benefits

Of course, the most noticeable benefit of IOLs is their effect on your eyesight. Intraocular lenses are the only treatment for cataracts. Without IOLs, your vision would continue to deteriorate. Thanks to this advanced treatment, you will be able to enjoy a full range of activities. IOLs can also reduce your risk for vision aberrations. After surgery, you may have fewer problems with night vision, and you may no longer suffer from glares and halos.

Personal and Professional Life

Cataracts can significantly affect your quality of life. As your vision worsens, you may rely far more on others to help you with daily tasks. You may not be able to drive. You may also have a higher risk for falls and other accidents. With your unclouded IOL, you will enjoy greater freedom and mobility. You will also be able to enjoy your hobbies and see your loved ones' faces clearly.

Premium or phakic lenses can give you a life free from the hassle of glasses or contacts. Driving, sports, and other activities will be easier and more enjoyable. If your job or hobbies require sharp vision, you may enjoy greater success in these areas, as well.

Risks

Although complications are rare, there are certain risks associated with intraocular lens surgery. Your ophthalmologist will perform a thorough examination of your eyes. He or she will also research your medical history to determine whether you are at a higher risk for long-term complications.

Cataract Surgery Risks

Cataract surgery has a remarkably low complication rate. Nevertheless, like all surgeries, it does involve some risks.

  • Infection: Even when doctors follow proper safety protocol, all surgical procedures have some risk of infection. Symptoms include severe or worsening discomfort, inflammation, light sensitivity, and impaired vision. If you experience any of these symptoms, you should contact your ophthalmologist as soon as possible. Usually, antibiotics can clear up the infection. However, in a few cases, you may require further surgery.
  • Bleeding: In rare cases, the tiny blood vessels at the back of your eye may start to leak blood. Typically, your doctor can control this condition, although in some instances, it can affect your vision.
  • Cystoid Macular Edema: When the blood vessels leak, the blood can swell your macula. This area at the center of your retina is responsible for fine, detailed vision. In most cases, your doctor can treat edema with eye drops or steroids. In rare cases, you may require surgery.
  • Secondary Cataracts: "Secondary cataracts" is the more common name for posterior capsule opacity (PCO). This condition occurs when epithelial cells grow on your lens capsule. These cells will cloud your vision, much like cataracts. Treatment is typically simple. A quick YAG laser capsulotomy can remove the unwanted cells with no incisions and little impact to the surrounding tissues.
  • IOL Displacement: You intraocular lens may move out of place. This condition can cause moderate to severe vision impairment. Fortunately, displacement is always treatable. During a vitrectomy, your doctor will remove the fluid from your eye and reposition the lens. A gas bubble will replace the fluid until it regenerates on its own.
  • Retinal Detachment: If you have had cataract surgery, you are at a higher risk for retinal detachment. Detachment occurs when the gel-like vitreous inside your eye becomes loose and tugs on your retina. A retinal tear usually comes before complete detachment. Your doctor will be able to treat a tear before it permanently damages your vision. If you notice the symptoms of a tear, you should contact your doctor right away. These signs include flashes, floaters, and a "curtain" across your visual field.

Phakic IOL Risks

Like cataract surgery, phakic IOL placement has a very low complication rate. Nevertheless, as with all surgery, some risks do exist.

  • Compromised vision: In rare cases, phakic IOLs can cause glare and halos, especially in low-light situations. Even more infrequently, the lenses can cause moderate to severe vision loss.
  • The need for corrective surgery: If your IOL causes vision aberrations, you may require a further surgery. An additional procedure can also help if the lens moves out of place, or if it is not the right strength.
  • Overcorrection or undercorrection : Sometimes, it can be difficult to determine the right lens prescription. You might choose an additional procedure to replace the IOL with a different lens. However, most patients with this problem simply continue to wear glasses or contacts.
  • Infection, bleeding and retinal: As with cataract surgery, these problems are very rare. When they do occur, your doctor can treat them using the methods that are described above.
  • Increased risk for glaucoma: If you suffer from glaucoma, the pressure inside your eye will rise. In turn, this can damage the optic nerve at the back of your eye. Your doctor may be able to treat this condition with eye drops. In some cases, you may benefit from surgery.
  • Increased risk for cataracts: Because phakic lenses do not replace your natural lens, you can still develop cataracts. If you do, your doctor will remove both the natural lens and the phakic lens. Then he or she will replace them with a different IOL.
  • Clouded cornea: The endothelial cells in your cornea help to eliminate excess fluid from the surrounding tissues. Some IOLs may cause the number of endothelial cells to drop. When this occurs, your cornea will become cloudy. A corneal transplant is the only treatment for this condition.

Minimizing Your Risks

As stated above, IOL complications are extremely rare. However, there are some things you can do to reduce your risks even further. First, select a qualified doctor. Use the criteria listed above, along with DocShop's search tool, to choose an experienced, highly trained surgeon. When a doctor uses proper safety protocol, along with advanced technology and techniques, your surgery will have a much greater chance of success.

Second, be completely upfront with your doctor. Disclose all relevant medical information, and be honest about your lifestyle and habits. With a complete picture of your physical health, your doctor can determine if you have an increased risk for complications.

Finally, follow all post-surgical instructions. If your doctor prescribes a medication or eye drops, take the full regimen, even if you feel great a few days after your surgery. Wear your eye shield as directed, and do not resume strenuous activity until you have your doctor's permission. With proper care, you could enjoy low risks, an easy recovery, and outstanding surgical results.

Temporary Side Effects

IOL placement typically involves a quick and easy recovery. The most common side effects include:

  • Blurred vision
  • Bruising around your eyes
  • Mild headache
  • Itchy eyes
  • The feeling of something in your eye
  • Light sensitivity

Discomfort is typically minimal, and you can control it with eye drops and non-prescription pain medication. Side effects will typically clear up quickly. Like some patients, you may notice a significant improvement within a few hours of your procedure. In some cases, it may take a few weeks for all side effects to disappear.

Safety Data

Cataract surgery has an extremely low complication rate. The American Society of Cataract and Refractive Surgery (ASCRS) reports that 3 million people undergo cataract surgery in the US each year. Of those millions of surgeries, 98 percent or more are successful. An additional study followed 200,000 Medicare beneficiaries who received cataract surgery between 1997 and 2006. The research, published in Ophthalmology magazine, found that 99.5 percent of all surgeries were free of serious complications.[4]

Rates of Common Complications

Even three of the most "common" risks of cataract surgery are quite rare. Posterior capsule opacity (PCO), or secondary cataracts, occurs in about 20 percent of all cataract surgery patients. Doctors can treat PCO with a YAG laser capsulotomy. This procedure is also very safe. Retinal detachment is the most common risk. Several studies indicate that there is a 1 percent risk of retinal detachment for all cataracts patients. If you have a YAG laser capsulotomy, the risk rises to 2 percent.[5]

A detached or misplaced IOL is another risk of cataract surgery. If this occurs, it will usually do so soon after your initial procedure. Your doctor can easily replace or reposition the IOL during a second surgery. The Mayo Clinic Conducted a study, looking at 14,000 cataract surgeries performed between January 1980 and May 2009. Researchers concluded that the risk of late IOL detachment is extremely low. After 10 years, the risk is 0.1 percent. After 20 years, there is a 0.7 percent risk, and after 25 years the risk rises to 1.7 percent.[6]

Reduced Accident Rate after Cataract Surgery

Several studies show that cataract surgery can dramatically reduce patients' risks for car accidents and hip fractures. According to research from the Hoskins Center and the University of California, Los Angeles, patients enjoyed a 16 percent reduction of in the one-year incidence rate of hip fractures. The reduction was greatest among patients in their eighties. This study is important because it reveals the importance of cataract surgery to overall health. It also indicates that there is no age limit for the treatment.

Additionally, an Australian study shows a clear link between cataract surgery and a reduced incidence of car accidents. Headed by Lynn B. Meuleners, PhD, researchers looked at 30,000 cataract surgeries performed in Western Australia between 1997 and 2006. After correlating this data with police accident reports, they determined that cataract surgery reduced accident rates by 13 percent. Dr. Meuleners indicated that this data may change the way doctors prioritize patients for surgery.[7]

Phakic IOL Safety

Phakic IOLs are a relatively new treatment. However, early studies indicate low risks and a high success rate. According to five years of data following 165 patients, 96 percent of individuals were pleased with their results. Their vision was stable, and most had enjoyed a significant improvement in their eyesight. Endothelial cell loss is a common concern, since this can lead to clouded corneas. However, according to this data, the rate of cell loss is only about 1 percent a year. This rate is too low to pose significant risk to patients' vision.[8]

Statistics

Cataracts are very common. The American Academy of Ophthalmology reports that nearly 22 million Americans over age 40 suffer from this condition. Cataracts affect more than half of all Americans over age 80.[9]

The condition is not simply an American concern, of course. Worldwide, there are an estimated 20 million cataract surgeries performed each year. The highest number of surgeries takes place in India, where there are 5 million procedures every year. In the US, there are approximately 3 million per year. Germany reports about 0.8 million surgeries, and France reports about 0.5 million.[10] Sadly, there are millions of people around the world who suffer blindness due to cataracts. Poverty or lack of proper medical supplies prevent them from receiving the care they need.

Increasing Need for IOLs

With an aging population, especially in the United States, analysts expect a huge rise in the need for IOLs. According to the World Health Organization, there were nearly 20 million cataract surgeries performed in 2010. This number is expected to rise to 32 million by 2020. [11]

Success Rates

Most patients are very happy with the results of their intraocular lens surgery. The success rates are truly impressive.

  • According to Drs. Kerry D. Solomon and Robert J. Cionni, ReSTOR® intraocular lenses are extremely effective. In their studies, 80 percent of patients never had to wear glasses after cataract surgery. Nearly 94 percent of patients were very satisfied with their results.

Additionally, 88 percent of patients had 20/25 or better vision. 63 percent had 20/20 or better vision. 53 percent had better than 20/20 vision. [12]

  • The University of Rochester Medical Center reports that more than 98 percent of patients who received Crystalens® IOLs in both eyes could pass a driver's test without glasses. 100 percent of patients had intermediate vision improvement adequate for most everyday tasks. More than 98 percent could read a newspaper or telephone book without glasses.[13]
  • Drs. Mark Packer and I. Howard Fine conducted a comprehensive study of the TECNIS™ IOL. In comparison to traditional IOLs, TECNISTM lenses result in 31 percent better contrast sensitivity in normal light and 51 percent better contrast sensitivity in low light. [14]

Frequently Asked Questions

Am I too old to receive an IOL?

There is no age limit for intraocular lens surgery. In fact, patients who are in their 80s or above often derive the most benefits from the procedure. However, if you are older, your doctor will be extremely careful with anesthesia. Typically, you will receive local anesthesia, rather than general sedation.

Can children receive IOLs?

In rare cases, children may be born with cataracts, or the condition may develop in childhood. Some doctors feel that children will benefit from immediate placement of an IOL. Others believe that children should use regular contacts until their eyes have finished developing. Because there is no defined answer to this question, you should consult with a pediatric ophthalmologist. He or she will help you decide what is best for your child.

Can any ophthalmologist place multifocal or accommodating lenses?

In theory, any doctor can place premium lenses. However, these IOLs require extreme precision. For best results, you should choose a doctor with extensive training and experience in this area.

How long do IOLs last?

All intraocular lenses, including basic, premium, and phakic lenses, are designed to last the rest of your life. Nevertheless, if you experience difficulties with your lens, your doctor can remove and replace it.

Can I receive an IOL in both eyes?

Cataracts will often develop in both eyes at the same time. It is safe to undergo surgery on both eyes at once. However, many doctors recommend that you receive two separate surgeries spaced about two weeks apart. This timing will make your recovery easier, and it will enable you to maintain a fuller range of activities.

Am I a candidate for a phakic IOL?

To be considered for a phakic IOL, you should typically be between 21 and 45 years old. You should also have good ocular health. If you have been diagnosed with glaucoma, macular degeneration, diabetic retinopathy, or a similar condition, you may not be a good candidate for this treatment. Phakic IOLs can be a good solution if thin corneas have kept you from undergoing LASIK surgery.

Will people be able to see the IOL in my eye?

No. Although the lens will be visible under magnification, people will not be able to see it when they look at your eyes.

Can I receive LASIK after I get an IOL?

Yes. In fact, many patients choose to combine monofocal lenses with laser vision correction.

When should I get new glasses?

It will take several weeks or even a few months for your eyes to adjust to their new lenses. Therefore, a vision test may not be accurate immediately after surgery. Typically, you should wait at least two to three weeks before you order new glasses or contacts.

How do I know which type of lens is right for me?

There are no "right" or "wrong" lenses. All varieties of IOLs can significantly improve your quality of life, especially if your vision is obscured by contacts. However, one type of lens may be more suited to your health needs, lifestyle, professional responsibilities, and budget. The best way to determine the right type of IOL is to schedule a consultation with a qualified eye surgeon.



[1] Barsam A, Allan BDS. Excimer laser refractive surgery versus phakic intraocular lenses for the correction of moderate to high myopia (Review). (Copyright 2010 The Cochrane Collaboration)

[2] Is Crystalens Right for You?. (Crystalens®, 2014) <http://crystalens.com/en-us/iscrystalensrightforyou.aspx>

[3] TrulignTM Toric Accommodating Intraocular Lenses Patient Information Brochure. (Food and Drug Administration) <http://www.fda.gov/downloads/AdvisoryCommittees/CommitteesMeetingMaterials/MedicalDevices/MedicalDevicesAdvisoryCommittee/OphthalmicDevicesPanel/UCM346391.pdf>

[4] Stein, Joshua D. MD, MS, et al. Severe adverse events after cataract surgery among Medicare beneficiaries. (Ophthalmology, 2011) <http://www.aaojournal.org/article/S0161-6420%2811%2900183-7/fulltext>

[5] Ranta, P, et al. Retinal breaks and detachment after neodymium: YAG laser posterior capsulotomy: five-year incidence in a prospective cohort. (Journal of Cataract and Refractive Surgery, 2004) <http://www.ncbi.nlm.nih.gov/pubmed/14967269>

[6] Pueringer, Sam L, et al. Risk of late intraocular lens dislocation after cataract surgery, 1980-2009: a population-based study. (American Journal of Ophthalmology, 2011) <http://www.pubfacts.com/detail/21683329/Risk-of-late-intraocular-lens-dislocation-after-cataract-surgery-1980-2009:-a-population-based-study>

[7] Karmel, Miriam. New Data Focus on Safety, QOL, and Cost Benefits of Cataract Surgery. (EyeNet Magazine, 2012) <http://www.aao.org/publications/eyenet/201211/cataract.cfm>

[8] Long-Term Data Show Safety and Efficacy of Angle-Supported Phakic IOL. (Helio Ocular Surgery News®, 2012) < http://www.healio.com/ophthalmology/refractive-surgery/news/print/ocular-surgery-news/ percent7Bda2fec54-8d40-4c26-8853-f4194053004c percent7D/long-term-data-show-safety-and-efficacy-of-angle-supported-phakic-iol>

[9] Vision 2020: The Cataract Challenge. (Journal of Community Eye Health, International Centre for Eye Health, London, 2000) < http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1705965/#__ffn_sectitle>

[10] The Global Intraocular Lens Market is Forecast to Reach $3.1 Billion by 2017. (ASDReports, 2012) < https://www.asdreports.com/news.asp?pr_id=275>

[11] ibid

[12] AcrySof ReSTOR IOL Provides the Highest Level of Spectacle Freedom for Cataract Patients. (EyeWorld News Service, 2014) < http://www.eyeworld.org/ewsupplementarticle.php?id=34>

[13] Crystalens: The First Accommodating Intraocular Lens Implant. (University of Rochester Medical Center, 2014) < http://www.urmc.rochester.edu/eye-institute/lasik/procedures/crystalens-iol.aspx>

[14] Greenburg, Kenneth A., MD. Aspheric Monofocal IOL Achieves Optimal Results. (Helio Ocular Surgery News®, 2006) <http://www.healio.com/ophthalmology/practice-management/news/online/ percent7B199b843e-02e1-4146-a523-128019cd73e8 percent7D/aspheric-monofocal-iol-achieves-optimal-results>

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