Multifocal IOL Implants

Excitement is in the air, as a revolution in technology allows people over the age of 40 to see not only far away, but up close, too! Presbyopia, or "old eyes" happens to everyone over age 40. By age 60, 80% of the population have cataracts, a clouding of the crystalline lens inside the eye, resulted in blurred vision.

We use 4 intraocular lenses (IOL's) approved by the Food and Drug Administration (FDA) for the correction of presbyopia (literally, "old eyes"!). In the past, we corrected cataracts with monofocal lenses. These IOL's have a fixed point of focus. Typically, most folks want to see well to drive, so the target we choose is for the best distance vision. If a visually significant cataract is present, insurance will pay for the procedure. We like to call that "chocolate cake". Visually significant means that the cataract must be:  1. affecting the activities of daily living (ADL's), and

2. decreasing the vision to a level that matches the cataract seen on the doctor's examination that also meets insurance criteria.   So, for example, if the vision is 20/40 and decreases to 20/80 with glare, and glare is affecting night driving (an ADL) then the surgery is medically necessary and insurance will pay for it.  Insurance typically does not pay for the upgrade to a presbyopia correcting lens. We like to call that ice cream. Because insurance companies, and Medicare believe that you can wear reading glasses, they won't pay extra for the tremendous amount of work and effort to implant a multifocal or accommodating lens that allows you to not only see to drive and watch TV, but also read and see computer without dependence on eyeglasses!

There are 4 "ice cream" IOL's approved by the FDA . They are the ReZoom, ReSTOR aspheric, Tecnis Multi-Focal, and Crystalens HD IOL's. The ReZoom, ReSTOR and Tecnis Multi-Focal lenses are multifocal lenses, that is they have concentric rings in their design that allow for focus far away and up close. The brain learns to choose the desired image, and ignore the rest. This process is called neuro-adaptation, and like a new pair of eyeglasses, takes time to get used to. Halos at night around lights are normal, but after time they are hardly noticeable for 95% of people. The Crystalens HD is an accommodating lens, so it uses your own eye muscle to focus. It doesn't have halos, but the reading power is not as strong as the ReZoom, ReSTOR or Tecnis Multi-Focal.  The purpose of all four lenses is to decrease the dependence on eyeglasses, although the majority of patients usually don't need to wear glasses. Sometimes people will wear "cheaters" (over the counter reading glasses) to help with specialized tasks, such as reading in bed, in poor light, prolonged computer use, seeing tiny print such as a number in the phone book, or on a medicine bottle, etc.