For years, ophthalmologists have treated cataracts by removing the natural lens of the eye and replacing it with an intraocular lens (IOL), or implant. Traditional IOLs improve vision at one focal point only, usually distance; and patients require glasses for up close and intermediate vision after cataract surgery.

Now there are new IOL options for patients with cataracts. These IOLs assist patients with their ability to see up close, intermediate, and at a distance, making them less dependent on reading glasses after cataract surgery. The cataract surgeons at Richie Eye Clinic now perform this new procedure. The new IOLs called Presbyopia Correcting IOLs are named after the natural aging process that leads to the need for reading glasses or bifocals.

Hey, What about Reading Vision?

Vision following cataract surgery is usually very good, but will not adjust from distance to near. Most people will require reading glasses or a bifocal to see up close for near tasks and reading. Several options exist, however, to minimize your dependency on glasses after cataract surgery, each with its own advantages and disadvantages.

• MONOVISION is a technique used to minimize glasses by choosing a conventional intraocular lens implant (IOL) for the dominant eye focused for distance, but using a similar IOL in the non-dominant eye focused up close for reading. This technique is commonly used with contacts and LASIK and works very well. The key is to understand that monovision is not perfect vision; rather it is a compromise in vision. Binocular vision (both eyes working together) is the best vision we can achieve with the best contrast sensitivity. Breaking the eyes apart with one eye focused for distance and the other for reading allows better versatility, distance and near, but reduces contrast sensitivity. Your vision will be more light-dependant, needing better lighting for reading, but monovision provides very good “indoor” vision. You may also have trouble with headlights and night driving since one eye is focused at the dash board instead of the headlights. Some people prefer “monovision driving glasses” to focus the reading eye at distance, restoring binocular vision for night driving. How well you are able to adapt to this technique depends on how your brain can adjust; we can even demonstrate monovision with contact lenses prior to surgery if you choose.
  
  
• DELUXE LENS IMPLANTS are now available, at an additional cost, to help remedy the distance/near dilemma. Multifocal and accommodating IOLs are designed to give both good distance and near vision after cataract surgery. They all work well, but none are perfect; each has its own unique characteristics and shortcomings, but provides good versatile vision. The surgery itself, however is the same cataract surgery we have been doing for years, just with a new implant.
  1. MULTIFOCAL IOLs are lens implants with a bifocal/trifocal design, the extra power in a ring pattern around the lens. They project several images onto the retina at the same time (distance, intermediate, and near); fortunately, the brain is able to interpret all this information quite well. They provide very good distance vision with very reliable reading and computer vision. As with monovision, you lose some contrast sensitivity and will be light-dependent for reading. Expect halos around lights at night as a result of the “ring” design of this lens. This lens is very stable in the eye and causes no surgical complications.
  2. ACCOMODATING IOLs (the Crystalens) is a single vision IOL with a hinge system that allows the implant to adjust its position in the eye, thus changing focus from distance to near. It provides excellent vision with minimal loss of contrast sensitivity (because it is a “single vision” IOL), good for far and computer distances, less glare at night, but less predictable for reading than the multifocal IOLs. Near vision is good for most things and requires good lighting, but you may need weak readers for the small print or extended reading tasks. The Crystalens provides a smooth range of vision from distance through intermediate to near, maintaining good contrast with less glare at night. Because of the hinge design, this lens may slip and require repositioning.