Cataract surgery can be thought of as a two step process. The first is the complete removal of the natural lens of the eye which has become darkened and cloudy, ie the cataract. The second step is the replacement of the lens with an artificial lens implant. These highly sophisticated lenses are manufactured using special materials that have allowed them to remain in our eyes indefinitely. Their refinement since the 1950’s has evolved to the current lens implants which are not only exceptionally safe, but also can be customized for each individual.

I have written several articles outlining the methods surgeons use to customize lens implants (click here to see a list of links). I invite all patients to take the time to review these more detailed articles, but I’d like to give a brief overview here.

Fundamentally, there are three excellent categories of lens implants currently available in the U.S. that have undergone extensive FDA trials and approval. I have used each of these lens implants extensively since 2005 when they became available. I recommend a specific lens for each patient depending on their individual needs.

Alcon Toric Lens Implant

This category is for patients with astigmatism (warping of the front surface, or cornea, of the eye resulting in blurred vision at all distances). Patients can achieve freedom from glasses for driving and other distance activities 97% of the time with this lens. I think this is an excellent choice for any patient who wants freedom from full time glasses, but is willing to wear glasses for near and intermediate activities like reading or computers.

 

Alcon Restor Multifocal

This category is for patients who want the best chance of not needing any glasses after cataract surgery. The “multifocal” lens has a built in bifocal essentially, which allows patients to see both far and near without glasses. In the FDA study of the Restor Lens, 80% of all patients were free from glasses after surgery. My personal experience is that 90% or more can achieve that goal. This category is not perfect however, since some patients still require glasses for some activities, and some patients have imperfect night vision after surgery. Despite these limitations, when the goal is the most freedom from wearing glasses after cataract surgery, the Restor Multifocal is the first choice for most surgeons.

Bausch and Lomb Crystalens

This category is called an “accommodating” lens implant. The idea is to mimic the natural focusing ability of our eyes when we are young by using a very flexible lens implant that responds to our eye focusing muscles. In practice this works extremely well for both distance and intermediate vision (think cell phones, computers, dashboards of cars etc.). Nearly 100% of patients with a Crystalens are able to function without glasses except for reading finer print. This lens gives excellent night vision, comparable with the best lenses available. The limitation of this lens is the ability to give good reading vision for all patients. About 80% of patients still use reading glasses for some activities. If the goal is the best possible range of focus with the best optical quality throughout that range, Crystalens is the first choice for most surgeons. The Crystalens now has a similar market share to the Restor Multifocal in the U.S. and I use both lens implants frequently in my practice.