There are some decisions that Dr. Winthrop can help you make regarding the type of lens (IOL) we will use in place of your own clouded lens.
The IOL used in conventional cataract surgery is a monofocal lens; it will have only one focal point. The focal point that is most often chosen by patients is distance/infinity vision. Thus, the majority of patients will need glasses to assist with near tasks.
Occasionally, patients who have been nearsighted their entire life will be given a monofocal IOL to retain nearsightedness (where they see fine up close with the naked eye). In this case, they will wear glasses that assist them with distance/infinity vision.
There are some patients, regardless of whether they are nearsighted or farsighted, who will wear bifocals simply for convenience.
Finally, patients who have moderate or excessive astigmatism may be required to wear glasses for all fields of vision (near, intermediate, and far.)
Many patients with astigmatism can be helped to great near or far (but not both) vision through the use of what is called a Toric IOL. Dr. Winthrop uses the Acrysof Toric Intraocular lens from Alcon Laboratories, the world’s leader in ophthalmic surgical products. Many professions as well as leisure activities such as golf, biking, bird watching, and flying require or are at least improved by excellent uncorrected distance vision such as the Toric IOL offers.
Accommodative and Multifocal IOLs can be a great way to minimize or, in some cases, eliminate dependence on glasses.
An Accommodative IOL – such as the Crystalens from Bausch & Lomb – will perform in such a way as to provide far, near, and intermediate focus. This is accomplished by a lens that accommodates or flexes to provide a "zoom" function. The IOL rests in the natural lens capsule, which is connected by marionette-like strings called zonules to the same muscles that provided our natural lens with the ability to accommodate or zoom itself before we experienced presbyopia. By exercising these muscles, we can cause a bowing of the Crystalens and induce accommodation to provide varying degrees of near vision. Relaxing these same muscles allows the lens to focus at distance.
Multifocal lenses – like the ReStor from Alcon Laboratories, the ReZoom from American Medical Optics, or the Technis Symfony multifocal – provide two focal points, far and near, with what is called "simultaneous vision." That is, portions of the IOL focus at distance, while other portions or zones of the same lens focus at near. The brain naturally takes the portion that is required for the given task and dismisses the other portion or zone. These lenses may also be referred to as "zonal" lenses.
There are several factors involved when considering whether someone is a good candidate for these lenses, including the presence and degree of astigmatism, diseases of the retina (diabetic maculopathy and macular degeneration among them), diseases of the optic nerve (including severe glaucoma), and other ocular diseases.
Accommodative and Multifocal lenses, just like Toric lenses, are considered Premium IOLs and, as such, they are usually not reimbursed by insurance carriers; thus the patient must incur some additional expenses in the process.