Premium lens technology has expanded greatly over the last few years. We have trifocals in addition to the classic multifocal option of the past. We have extended depth of focus (EDOF). We have toric lenses and can do relaxing incisions to treat astigmatism. Let’s start with defining a few terms:
Presbyopia – loss of accommodation or near vision. Everyone experiences this and on average, begins to occur in the mid-40s
Myopia – “nearsightedness”. Once presbyopia sets in, these individuals have the ability to take off their glasses and still see well. Many patients enjoy their near vision without glasses and thus, this needs to be addressed at the time of cataract surgery so that we can make sure we give you all of the spectacle freedom that you desire.
- If you myopic prescription is high (>6.00), we may discuss your increased risk for having retinal problems like retinal detachment.
Hyperopia – “farsightedness”, which is actually a misnomer because people with this prescription can neither see near nor far. They are blurry at all distances without their glasses.
Astigmatism – virtually everyone is familiar with this term, but few truly understand it’s implications on vision. If regular, which most eyes with astigmatism are, it is completely correctable with glasses or contact lenses (i.e. toric lenses). Basically, it describes the natural curvature of the eye. The eye is shaped more like a football than a basketball.
- During cataract surgery, astigmatism can be corrected with a toric lens or relaxing incisions on the cornea. Insurance does not cover this cost. Your surgeon will discuss which is best for your eyes.
Toric lens – much like astigmatism correction in a pair of glasses, this lens is designed to correct the astigmatism that remains after cataract surgery, which is predominantly in the cornea.
Multifocal – this is the first iteration of a cataract surgery lens that gives 2 separate focal planes of vision (i.e. distance and near). In this way, it acts like a bifocal in the eye (without the lines). The lines are actually rings etched into the lens that split light, allowing you to see distance and near. (examples: Alcon Restore).
Extended depth of focus – a newer design of lenses lenses that stretches out the focal point allowing for distant, intermediate and some near vision to be in focus. The ‘sweet spot’ is in the intermediate range (i.e. computer work). This is accomplished with a different form of etched rings as well as reshaping the center of the lens similar to how the cornea is reshaped in LASIK (i.e. wavefront technology). (examples: Tecnis Symfony, Alcon Vivity)
Trifocal – this is the most recent technology approved in the US. This technology has been available internationally for several years. In this way, it has a long track record of success. It also utilizes rings in the lens. (examples: Alcon PanOptix, Tecnis Synergy)
Monofocal – this is the standard lens that is covered by insurance. It corrects your vision to one focal point. You can choose whether you want this set at distance, intermediate or near. Whatever you don’t choose, you will need glasses or contact lenses to correct the rest of your vision.
- For example, most patient will choose a distance target and then will need over-the-counter readers for intermediate (i.e. computer) and near vision tasks. You can also opt for full-time glasses like bifocals or progressives.
A note on premium lenses: Insurance does not cover these lenses. No artificial lens is perfect and can replicate the 20 year old natural crystalline lens. They all come with trade-offs. For the trifocal/EDOF/multifocal lenses, this involves a slight diminishment in vision quality mostly seen at night and in low lighting scenarios. The ring technology (i.e. diffractive optics) produces glare/halos/starbursts at night. It also reduces the amount of light that hits the retina for each of these focal points and thus, the reduction in vision in dim lighting. For most patients, this is negligible and able to be ignored over time. For the majority of patients asked in FDA clinical trials for the trifocal lenses (~95%), they would repeat the procedure if given the opportunity and would recommend it to friends and family members.
