OMNI EYE SPECIALISTS. The Intraocular Lens

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1 OMNI EYE SPECIALISTS Intraocular Lens Options In Cataract Surgery Or Refractive Lens Exchange Surgery Your decision to have vision surgery is important and the doctors at Omni Eye Specialists will explain your choices specific to your goals and your vision. We have designed this packet to help you with some of the terminology and concepts that may be presented to you. There is an area for you to make note of your questions on the last page. Please discuss any questions you might have with your doctor. The Intraocular Lens The intraocular lens (IOL) is a small optical device implanted inside the eye during either cataract surgery or refractive lens exchange (RLE) surgery. The clouded natural lens of the eye is removed during cataract surgery. The implantation of a standard monofocal IOL is part of cataract surgery and its cost is covered by insurance. Removal of the cataract offers improved vision; however, a standard implant IOL is a fixed focus lens, a monofocal, meaning it has one fixed focus point and is unable to change from distance focus to near focus. After cataract surgery with a standard monofocal IOL, the eyes still need glasses to allow focusing from distance to near vision unless the patient is intentionally left nearsighted (then glasses would be needed for distance). Occasionally, post-operative cataract surgery patients only need reading glasses, but it is also common to need bifocal glasses. Some patients may elect to upgrade to a special type of IOL that is designed to reduce dependence on glasses. There are now lenses available that can improve both distance and near vision after cataract surgery. These presbyopia-correcting IOLs and the extra services involved with their use are not covered by insurance providers. Thus there is an out-of pocket expense. Eyes with other medical conditions, such as macular degeneration, diabetic retinopathy, advanced glaucoma, or severe dry eye syndrome, are not eligible to have this upgrade IOL. Accommodation Accommodation is the process by which the eye adjusts its own focus from far to near vision. In accommodation, the shape of our natural lens changes inside the eye, causing a change in the focus of light rays entering the eye. In youth, the human lens is transparent and flexible. In people under age 40, the natural lens of the eye can change focus through a full range of vision from distance focus to near focus (assuming a normal healthy eye with good distance vision). Presbyopia Presbyopia is a natural age-related condition in which the eye loses its ability to change focus from distance to near vision. The eye s natural lens hardens as we age. As the lens loses its flexibility, we lose our accommodation. The word presbyopia, from Greek language, means aging eye. The symptoms of presbyopia usually appear between the ages of 40 and 50. The first symptom most people notice is difficulty focusing at close length to read small print (assuming the eye has proper distance vision focus). Many people compensate for this condition by holding reading material further away until they eventually may complain that their arms are too short. Most people with presbyopia start to use reading glasses. 01/11

2 Non-surgical treatment options for presbyopia include optical correction with spectacle lenses, contact lenses or a combination of contact lenses and glasses. Presbyopic patients who have good distance vision without spectacle correction typically get reading glasses. Myopic (near-sighted) patients who develop presbyopia often simply take their distance vision glasses off to read and put them back on to see far away. Varieties of bifocal lens glasses are available that can be more convenient than repeatedly putting glasses on and taking them off. Presbyopes who are accustomed to wearing contact lenses in both eyes for best distance vision can simply use reading glasses for near vision. Presbyopic patients who have excellent distance vision can use a contact lens in one eye, giving that eye better near vision. This is called monovision. There are also bifocal contact lenses. A standard monofocal IOL, used in cataract surgery, is much like presbyopia. In either case, one cannot change focus from distance vision to near vision without the aid of glasses. Monovision One option with cataract surgery is monovision. As in contact lenses, one eye is outcome targeted for near vision and the other eye is targeted for far vision. This can be done with standard monofocal IOLs. This arrangement has notable limitations (such as reduced depth perception), but many patients have increased freedom from spectacles by choosing this option. Patients should not select this option with surgery unless they have had been previously successful when wearing monovision contact lenses. Presbyopia-Correcting IOLs There are now several FDA-approved IOLs in use in the United States for the purpose of correcting presbyopia. There are two different mechanisms of achieving distance and near vision in the same eye. One mechanism of action is an IOL that uses the eye s natural ability to change focus from distance to near vision. An implant that uses this mechanism is called an accommodating IOL. In addition to the accommodating IOL option, the other method of restoring distance and near vision in each eye after cataract surgery is by the implantation of a multifocal IOL. There are now several types of multifocal IOLs in the United States. The different multifocal IOLs use either a refractive or diffractive multifocal technology. All of the accommodating or multifocal IOLs are designed for the purpose of giving distance and near vision and can significantly reduce dependence on glasses. They each have different strengths and weaknesses. It is impossible to know in advance who might still need glasses some of the time, but the presbyopia-correcting IOLs offer the convenience of less dependence on glasses compared to standard monofocal IOLs. The doctors of Omni Eye Specialists can help determine which technology is best for each patient depending on their unique needs. Refractive Lens Exchange Also known as clear lens exchange, refractive lens exchange (RLE) is one approach to surgical presbyopiacorrection in patients who cannot tolerate monovision. RLE is a more invasive surgery than LASIK or PRK, but RLE has an optical advantage over monovision in that it can allow each eye to see both distance and near focus. This form of refractive surgery can be done in presbyopic patients without a significant cataract, and it continues to become more popular with advances in IOL options. The technology continues to improve every year with new options available to the refractive and cataract surgeons. Like LASIK, refractive lens exchange is an elective procedure that is accompanied by risks and ethical considerations. For many people the improvement in quality of life by eliminating their visual disability outweighs the risks. No refractive surgery can create perfect vision, like that of a young fighter pilot. But we can reduce dependence on spectacles, thus improving visual freedom.

3 Astigmatism & Cataract (or RLE) Surgery Astigmatism is a common form of visual impairment that can be caused by an irregular curvature of the clear cornea at the front of the eye. This refractive error may co-exist with other errors that result in blurred vision. Cataract surgery, by itself, does not eliminate astigmatism, but there are some options. If a patient desires to be less dependent on glasses after cataract surgery, then astigmatism must be addressed. In addition to post-operative glasses, there are several options to reduce astigmatism after cataract surgery whether a presbyopia-correcting IOL is used or not. The extra services involved with astigmatism correction are not covered by Medicare or other insurance providers. Limbal Relaxing Incision (LRI) is an elective procedure that may be done at the same time as cataract surgery. The procedure consists of making precise microscopic curved incisions at the edge of the cornea. This procedure often accompanies the use of a premium IOL to help reduce the need for spectacle correction after the eye is healed. Toric IOLs are intraocular lens implants that have built-in astigmatism correction and can be used during cataract surgery. The lens is inserted during the surgery, and it is precisely aligned with the corneal astigmatism to reduce the overall astigmatism of the eye after it is healed. This IOL may be an option even if the eye does not qualify for the presbyopia-correcting IOLs. Many patients with high astigmatism choose the toric IOL to reduce their post-operative glasses prescription. Toric IOL with astigmatism alignment markings Laser refractive surgery such as LASIK or PRK can often be done for residual astigmatism that may remain when the eye is healed from cataract or RLE surgery. This procedure is sometimes planned in advance to be done after the eye is healed from cataract surgery. Even the most state-of-the-art, modern techniques of measuring the eye and calculating IOL powers may occasionally be unpredictable. In the case where the IOL power does not result in the desired outcome, laser refractive surgery is often used as a means of tuning up the final result.

4 OMNI EYE SPECIALISTS Intraocular Lens Options In Cataract Surgery Or Refractive Lens Exchange Surgery Comparison Chart of IOLs Intraocular lens (IOL) Type Method of Presbyopia correction Standard Monofocal Toric ReStor Crystalens AO Tecnis Multifocal None None Apodized diffractive multifocal Accommodating Lens moves in the eye No No No. (Flexible IOL) Zones of best vision without glasses. *Zones of vision: 1) Far: TV, Driving 2) Mid-Range: computer, desk-work 3) Near: reading documents up-close, sewing Success rate of patients achieving spectacle independence with IOLs in both eyes Rate of night-time severe glare & halo effects Usable with previous radial keratotomy (RK) Usable with previous laser vision correction (LASIK/PRK) Far OR Near (not both). Most patients with a standard IOL will use glasses after surgery for most activities (Bifocals). 90% at desired (chosen) distance if no or low astigmatism Far OR Near (not both). Most patients with a Toric IOL will see very well at their chosen distance but will still need glasses for the other distances. 90% at desired (chosen) distance Far-mid-near Nearly 80-90% of patients do not require glasses Far and mid-range yet limited at very near Approx. 50% Diffractive multifocal No Far-mid-near Nearly 80-90% of patients do not require glasses 2% 2% 2-5% 2% 5% Not recommended Not recommended Not recommended

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6 Questions to ask my doctor: OMNI EYE SPECIALISTS Specializing in Medical and Surgical Care of the Eye 55 Madison Street Ste 355 Denver CO South Yosemite Street Centennial CO GO 2 OMNI OMNI EYE SPECIALISTS - SOUTH 6881 South Yosemite Street Centennial CO Madison Street Company is proudly owned by employees.