Premium Intraocular Lenses

A wide range of lenses can be placed within the eye, although typically the measurements that are taken of your eye prior to surgery guide the placement of a lens of the correct power to achieve the appropriate vision desired in your eye after surgery. Most people choose to have a lens placed in the eye that typically allows them clear distance vision without glasses, but, with the placement of a ‘standard’ IOL, patients would almost certainly require reading glasses for close work. With modern laser eye measuring techniques, the overwhelming majority of patients achieve their ‘refractive’ goal (i.e. the desired spectacle prescription, if any, after surgery).

There are four main kinds of premium intraocular lenses (IOLs), which may be suitable for you, which will increase the chance of you not needing glasses after surgery:

• ‘Toric’ IOLs, which allow the correction of pre-existing astigmatism.
• ‘Multifocal’ IOLs are similar in concept to varifocal glasses, except that the lens is within the eye; the goal of these lenses is to reduce dependance on glasses for all three distances i.e., allow the ability to see distance (e.g. driving), intermediate (computer and dash board in the car) and near (e.g. reading) without glasses.
• Extended depth of focus (EDOF) IOL lets you see clearly at intermediate and far distances. They combine the advantages of both monofocal and multifocal IOLs, providing the perfect balance between freedom from glasses and fewer side effects.
• The Enhanced Monofocal IOL is a new kind of monofocal lens. Until very recently, there was only one kind of monofocal lens, so patients who wanted a standard lens only had one option to choose from. The Enhanced Monofocal is a midway point between a standard and premium lens.

Toric lenses

When most people think of an eye’s shape, they think of round structure, like a football. In truth, most eyes are more rugby ball-shaped, with the eye being a little squashed in one direction. This irregularity is known as astigmatism and is easily corrected with glasses, but, if marked, a patient’s vision without glasses will be quite poor.

A toric IOL is a bespoke lens placed inside an eye to correct a patient’s astigmatism, at the same time reducing the patient’s short- or long-sightedness. After surgery, the chance of needing glasses for distance is greatly reduced, although without the simultaneous placement of a multifocal lens (‘toric multifocal’), patients should still expect to need reading glasses. Cataract surgery in patients with marked astigmatism using standard, non-toric IOLs does typically lead to improvements in vision, but patients should not expect that their final distance or near vision will be perfect without glasses.

Multifocal lenses

Multifocal lenses are specially designed to create (at least) two images at the same time, one of which is in focus for near and one for distance. The patient’s brain decides which image will be ‘inspected’ depending on what is being looked at. With such lenses, about 85% of people achieve day-to-day spectacle independence, meaning that typically they can both drive and read, e.g. a restaurant menu, without glasses. For more prolonged reading, such as a novel, however, many patients still choose to wear reading glasses.

As multifocal lenses split the light entering the eye into at least two images, there is sometimes a compromise in the quality of vision achieved. Although around 85% of patients are spectacle-independent after surgery, the distance & near vision achieved is unlikely to be as impressive as if a standard, monofocal lens (with reading glasses) had been used instead, the upside of course being the lack of a need for glasses.

Multifocal lenses are probably unsuitable for patients with optically demanding hobbies & occupations, such as astronomers or photographers, although the golfer Gary Player has notably done very well after such surgery! In the dark, some patients do complain of haloes around lights; multifocal lenses are thus unsuitable for occupational night drivers.

Toric multifocal lenses

These lenses combine the benefits of both toric and multifocal lenses, i.e. simultaneously improving astigmatism and aiming to achieve spectacle-independence for distance and near.

Extended Depth of Focus (EDoF)

These lenses provide sharp vision over a wide range, allowing you to see objects clearly at different distances from far to intermediate: approximately at arm’s length. EDoF IOLs enable you to perform a broad spectrum of activities without visual aid, including sports, socializing, cleaning, cooking, shopping and other typical home and garden tasks, also working on the computer, watching TV or driving a car. Daily tasks become easier and more enjoyable. Most activities can be fulfilled without needing to wear prescription glasses, however, reading glasses may be necessary for fine print and precision work.

EDoF lenses offer increased freedom from glasses while, at the same time, reducing visual side effects typically associated with multifocal IOLs. Some patients are more, others less sensitive to these light phenomena, most of which may be experienced as halos or glare around light sources, especially at night. Patients with EDoF lenses generally enjoy good night vision, which is particularly important for driving after sunset, for example. The undisturbed and reliable visual performance that EDoF lenses provide also gives patients a feeling of added comfort and safety.

Enhanced Monofocal IOL

This lens is designed to enhance intermediate vision while providing distance vision comparable with an aspheric monofocal IOL. Because this lens is designed to keep the benefits of a monofocal IOL and to add intermediate vision, it is considered an enhanced monofocal IOL designed to provide additional benefits of improved intermediate vision. 

Risks

Although your eyes will have been measured using a modern, laser-scanning technique, there is no absolute guarantee that the refractive outcome (spectacle prescription, if any, following surgery) will be perfect due to: the empirical nature of the formulae used to estimate the lens power; and the variation between individual patients’ eyes in their response to surgery (e.g. lens position within the eye and astigmatic effect of incisions).

This means that for distance, approximately 90% achieve a refractive outcome within 1 Dioptre of their goal, and approximately 70-75% within 0.5 Dioptre. In other words, despite using modern laser-scanning techniques for measuring eyes, there is a small, but significant chance of being spectacle-dependent following surgery, for both distance and near.

The chance of patients having a significant postoperative refractive error (need for a small spectacle correction or a “refractive surprise”) is typically greater for patients whose eyes are either very long- or short- sighted to start with. Subsequent corrective refractive surgery may be possible for some patients at a later date, but is not included as part of this surgical package.

In the unlikely event of a surgical complication, it is possible that a premium lens would not be an appropriate choice of lens, the decision being taken during surgery. It is important to understand that, in this eventuality, it may be necessary to use a standard intraocular lens (i.e. not a toric or multifocal lens). For some such patients, subsequent surgery to achieve spectacle-independence may be possible.

The risks discussed in the standard cataract surgery leaflet also still apply for patients undergoing implantation of a premium lens; these have not been repeated in this additional leaflet for brevity but it is important that you still read the standard cataract surgery leaflet.

It is important that you contact me in advance of surgery if you wish to be considered for an alternative type of lens.

Downloads

• Ziess Trifocal Information leaflet
• Ziess EDOF IOL information leaflet
• Ziess Trifocal IOL Video

Which is Best?

There is no single IOL that is “best” for every person. It all comes down to finding the best set of lenses to address your specific needs. Our surgeon Mr Anandan, will use the knowledge gained from performing thousands of lens replacement operations to advise you on the best cataract lenses to suit your lifestyle, and correct your vision problems.If you’re a candidate for cataract surgery and have questions about which intraocular lens is right for you, contact Mr Anandan Secretary at 07900210191 to schedule an appointment.

Costs

The cost of Premium lenses are significantly greater than for standard intraocular lenses. Most of the larger insurance companies do not fund the extra cost of these lenses, the cost being passed directly to the patient as an ‘excess’. It is worth considering, however, the potential likely savings made on, for example, varifocal glasses in the future.

Call LVCND for more information and pricing