what types of lens implants are available in the US for cataract surgery and refractive
lens exchange surgery? How are they different? Which one should you choose
for your eyes? To learn more keep watching. Hello everyone This is Dr Audrey Tai, I'm a
board-certified and fellowship trained Cataract and refractive surgeon, ophthalmologist and cornea
specialist, welcome back to my channel - eye Channel by eye surgeon. I am here to bring you the
latest information on eye health and medicine. In today's video, I will review lens implant options
for cataract and refractive lens exchange or RLE surgeries. Both eye surgeries involve removing
the natural crystalline lens, and replacing it with an artificial lens implant. We can call
both types of surgeries lens implant surgery. Whether you are thinking about having cataract
surgery to restore your vision, or are considering RLE surgery to treat presbyopia
a.k.a. the aging process of the eyes that causes you to require reading glasses,
and are looking to find out what lens implant options are available, I hope you will find this
video helpful to learn more about lens implant options and how to choose the right one for you.
To learn all about what is refractive lens exchange surgery and presbyopia treatment options,
you can watch this video – “say goodbye to reading glasses refractive lens exchange.”
In general, there are three lens implant types available – basic single vision implants,
single vision astigmatism correcting implants, and presbyopia correcting implants. The range of
vision each type of implant corrects is different. Before we talk about the available implant
options, it is important to understand the three different zones of vision,
and how glasses prescriptions are written for correcting each zone of vision.
There are three zones of vision, distance vision – seeing things more than 20 feet away,
such as reading the road signs when driving or reading the captions when watching TV;
intermediate vision, seeing objects at arm’s length,
around 24 inches, like using a desktop computer or reading the gauges on a car dashboard;
and near vision, like reading small print up close up around 12 - 16 inches,
reading texts on a cell phone, or reading a book. For most of us who don’t have perfect vision,
we typically require some correction to one or more zones of our vision.
There are 4 common vision conditions that require glasses: the first one is nearsightedness or
myopia; where things are more clear up close than far away; this is the opposite of farsightedness
or hyperopia, this is when things are more clear faraway than up close. The third condition is
called astigmatism, which means that the curvature of the windshield of the eye – the cornea
is not round, The cornea should be shaped like a basketball, but in people with astigmatism,
it is shaped more like an american football which causes you to see a slight shadowy or ghost image
next to the main image without correction; And the last vision condition is called presbyopia,
meaning a progressive increase in the need for reading glasses to see small print
up close. Presbyopia usually starts after about age 40 to 45, and gradually gets worse over time.
You can think about having lens implant surgery as putting the glasses prescription in the eyes
instead of an external lens in a glasses frame. If you take a look at the written glasses
prescription that your eye doctor gave you, you can see that there are [three or] four
different sets of numbers on the prescription. It is typically written like this -3.00 + 2.00 x 180,
sometimes, there is a numeric value in the “add” section as the fourth value. The first number
indicates how nearsighted or farsighted your eye is; in this prescription this person has 3
diopters of nearsightedness. The second and third numbers indicate how much astigmatism there is
and at what Meridian the astigmatism is aligned. In this prescription this person has two diopters
of astigmatism aligned at 90° perpendicular to 180°. The fourth number in the add section,
if present, indicates the strength of reading glasses prescription a.k.a. presbyopia.
The basic single vision implant, also called monofocal implant, only corrects the first
number of a glasses prescription. This means it corrects the nearsightedness or farsightedness
of the prescription, but it does not correct astigmatism or reading glasses prescription.
So if your eye has astigmatism and you choose to have basic single vision lens implant, you will
still need either glasses or contact lenses, or refractive surgery such as LASIK surgery
after the lens implant surgery in order to correct the astigmatism to see clearly both far away
and up close. With monofocal lenses, you do have the option of selecting a target vision zone,
it could be any of the three zones, but the other two zones will be blurry without correction. But
it doesn't matter which target you choose, you will need some type of correction,
either glasses or contact lenses to see clearly in the zones of vision you didn't choose to correct,
hence the implants are called single vision implants. Let's say if you choose a basic
single vision implant, and you choose to have as clear as possible distance vision without glasses,
that means you still need reading glasses for presbyopia correction to read small
prints up close, and if you have a significant amount of astigmatism, you will need glasses
or contact lenses to correct astigmatism in order to see clearly after the surgery for both distance
and near vision. So I tell my patients, if your eyes don't have a lot of astigmatism,
and you don't mind wearing glasses to read small prints, such as cell phones, books,
or the gauges on the Dashboard when driving, basic single vision implant may be right for you.
The second option is called single vision astigmatism correcting lens implant, or toric
implant. A toric implant will correct the first three sets of numbers on a glasses prescription.
In this case, the toric implant will correct nearsightedness of 3 dpt,
and 2 dpt of astigmatism. But because it is a single vision implant,
you will still have to choose either set your vision to be more clear to see things far away,
or set it to see things clearer up close. I often recommend this toric lens option for people who
have significant astigmatism and would like to reduce (but not eliminate) the need of glasses
after the surgery. For example, someone who has astigmatism and chooses to have
a toric lens implant and decides to set his vision clarity for distance vision,
the person will only need wear reading glasses to read, but not when watching TV, or playing sports.
The third option is called a presbyopia correcting lens implant, or multifocal and
extended depth of focus implant. This lens option is the most advanced lens implant.
Instead of only targeting a single vision zone such as either distance or near vision correction,
a presbyopia correcting lens implant can provide a much wider range of clear vision,
hence the term multi-focal. Typically the implant has a set of concentric rings on the implant,
so the different zones of the implant have different strengths of correction,
in order to correct distance, intermediate, and near vision. This type of implant corrects all
four sets of numbers on a glasses prescription, nearsightedness or farsightedness, astigmatism,
and presbyopia or reading vision. The goal of the presbyopia correcting implant is to significantly
reduce the need of glasses after surgery at multiple distances. The degree of presbyopia or
reading vision correction is different for each multifocal and EDOF lens implant, depending on
each person's need for reading vision correction. However presbyopia correcting lens implants are
not for everyone- they require the retina layer of nerve tissue inside of the eye to be healthy,
meaning the people who have significant eye diseases such as macular degeneration,
significant glaucoma, or significant diabetic eye disease are not a good candidate for presbyopia
correcting lens implants. Also there is a slightly increased risk of more glares at night and slight
decrease in contrast sensitivity with presbyopia correcting implants, so it is very important for
you to discuss with your eye surgeon to see if presbyopia correcting implant is right for you.
No matter which type of lens implant you choose for your lens implant surgery,
it is very important for you to have an individual consultation with your eye surgeon,
as the lens implant placed during surgery typically stays permanently in the eye,
it determines whether you need glasses, or how often you need glasses after surgery,
and that could determine how well you see for decades of your lifetime. Therefore, every patient
needs a personalized surgical plan, to customize their vision correction with surgery individually.
One thing to know is that, sadly, in the US, health insurance companies typically
only cover the first option, the basic single vision lens implant, and there is typically an
out-of-pocket expense for the other advanced implants. Make sure you understand
both your lens implant options and insurance coverage prior to your lens implant surgery.
If you are interested in learning more about the steps of both conventional cataract surgery
and laser assisted cataract surgery, you can check out this video – laser
cataract surgery versus conventional cataract surgery what is the difference.
Have you had either cataract surgery or RLE surgery, or planning on having either surgery?
Please let me know which lens implant you have or would choose for yourself in the comments below.
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Thank you again for watching and I will see you in my next video.