Southwest, FL | Cataract Surgery Intraocular Lens | Cataract & Refractive Institute of Florida

Dr. Croley discusses the different types of intraocular lenses available for insertion during cataract surgery. There are many choices of lenses that can be used to correct a person's vision after cataract surgery.


Dr. Croley: Hello and welcome to Case Of The Day. I'm Dr. Croley and today we're going to talk about cataract surgery and the different kind of intraocular lenses available with cataract surgery. And so we've had patients who are always asking questions about how am I going to see after the cataract surgery? And so we're going to go over that. This is a program that I have in my office called Precision Cataract Surgery and other doctors have other programs as well. But we go through all the different kinds of lenses available and we have sort of a brochure on each type of lens. And so this is just a overall review of what cataract surgery is and what type of lenses.

Dr. Croley: So a cataract is your lens behind your pupil becomes cloudy. So when we're doing cataract surgery, we're taking that cloudy lens out and replacing it with a clear lens. Most people think that a cataract is a growth that's growing over their eye and that this growth is removed. But that's not correct. Cataracts is actually like your windshield of your car fogging up. So the foggier that windshield gets, the worse your visions, the cloudier your lens gets, the worse your vision gets. And so cataract surgery then is taking that cloudy lens out, like I said, and then putting a clear lens in.

Dr. Croley: Well, there's different ways of doing that now. And so there are options with cataract surgery. So a few years back there were not really any options. It was just one kind or style of lens and that was it. So a regular lens that's been around forever and ever, for more than 30 years, that lens is still pretty similar today to what it was 30 years ago, and we still use that lens on lots of folks and it provides good vision. There's absolutely nothing wrong with that lens and you can, if your eye is normal, you certainly can get 20-20 vision out of that lens. But we actually have newer technology.

Dr. Croley: So the sort of next level up from a regular implant is a wavefront, our sort of high definition lens. And I explain this to patients as an example, it's like going from a regular TV to a high-def TV. You can still see the TV program on both TVs, that is you can still have 20-20 vision on them both. One is just crisper and sharper than the other, and so now when we do cataract surgery, we do a lot of testing of a patient's eye to see any aberrations in their vision system, and the different qualities of their vision. And that way that helps us lead them to using the right type of lens that will maximize their vision.

Dr. Croley: Then we have another lens that is a still different type of lens that is called a toric lens or an astigmatism lens. So patients who have enough astigmatism that is effecting and blurring their vision, they can now correct that vision during their cataract surgery, with having a toric interocular lens placed inside their eye. Just like glasses couldn't correct your astigmatism. So if you have a lot of astigmatism, the astigmatism corrections in your glasses, you could wear contact lenses, again, correct your astigmatism. But now with cataract surgery, we can correct your astigmatism as well. So this type of lens is placed in the eye and we have to do a lot of measurements again and we want to line up that lens inside your eye. And once the lens goes in your eye, we have to line that up with the astigmatism of your eyes.

Dr. Croley: So we measure how much astigmatism you have and the access that is where is the steep side of the football. Astigmatism means your eye is shaped more like a football than a basketball, that is it's steeper in one area or direction than it is in the other. And so we need to line that lends up to match your astigmatism so it will correct your vision. These lenses work fantastic, so people who've worn glasses all their life can have these lenses put in and now they have, in most cases, their glasses-free, far as the distance vision is concerned.

Dr. Croley: Then we have another group of lenses that are going to try to correct someone who also wants to see at distance and up close. That is, we have either multifocal lenses, are a focusing lens that is available for patients who wish to be glasses free. And better than 90% of those cases, we can get people where they can see distance and read without glasses. And so there's two or three different types of lenses in that category as well.

Dr. Croley: The first type of lens is called a crystal lens and a crystal lens is designed to flex somewhat inside the eye, and give some focusing so you can then see distance and then focus up close. Depending on your overall prescription and the strength of that lens, that focusing can vary a little bit. And so not everyone is totally glasses-free, at least, had been in my experience with the lens. But it has certain other qualities that make it a very nice lens in lots of folks. So a crystal lenses is as an option depending on your job, your lifestyle, what you're trying to accomplish. And so these lenses are a valuable tool in order to provide people distance vision and reading vision without glasses.

Dr. Croley: And the next category of these sort of multifocal or distance and reading intraocular lenses is we have diffractive lenses, our multifocal lenses. So now there's a bifocal built into the implant and it's different than the bifocal on your glasses. Where the bifocal's below, this bifocal is more like a set of rings around the lens and it actually gives you then two images. So there's an image that's focused at distance and there's an image that's focused for near. So when you see a distance, the image up close, the near image is blurred out to where you do not notice it. And then when you look up close, the only image that's clear is the one for near. So it doesn't matter where you look up, down, right, left, it's the distance that you're looking at. And these lenses work very well as well.

Dr. Croley: The only thing about these lenses are there's pluses and minuses always to all things. So the multifocal lenses, because of those rings of the bifocal, you will see rings around lights at night. And usually that's not a problem for patients. And usually after a time, your brain gets used to using this lens and you adapt to the lens and it has not typically been a problem. Also, you need pretty good light to read with these lenses because we're actually splitting the image where it has two images in your eye and neither image has 100% of that light. So you do lose a slight amount of contrast sensitivity, but people who are good candidates for this lens really love it and are happy. And so there's a restore lens and a Tecnis multifocal lens that we use.

Dr. Croley: And it's very important, at least in my experience that you have a very thorough workup and we do lots of Wavefront screening scanning. We make sure that it really gets technical, that the center of your pupil and the center of your visual access are very close together because if they're separated out some then people tend not to do as well with that lens. And so you need to make sure that you have a healthy eye and that you're a good candidate for that type of lens before you choose to have that lens put in.

Dr. Croley: So you can see we have all kinds of options to provide people correction of their vision. So now not only are we talking about taking your cataracts out and getting a good result with that surgery, but also how do you want to see after the surgery's done. Do you don't mind wearing glasses? You'd like to have good vision without glasses at distance. Or you want to be totally... You hate glasses, you want to be totally glasses-free, you now have options. It's just very important that you have a really thorough workup before the surgery so that way those options that you get to choose the right one for you.

Dr. Croley: So cataract surgery is a fabulous procedure anymore. We actually now have a laser that does portions of the cataract surgery in a very precise way that is now another part of the surgery that can be added to your surgery. And so if you're considering having cataract surgery, then you can discuss all these things with your eye doctor and make a very intelligent choice for you, which is a right way for you to go.

Dr. Croley: And the other thing is, unfortunately, sometimes I see people who really don't have much of a cataract, who are scheduled for cataract surgery. And so the reason you ever decide to have your cataracts removed is because you're unhappy with the quality of your vision. You're having trouble driving, reading, doing whatever your normal daily lifestyle activities are, and your vision is interfering and keeping you from doing those things. That's when you decide to do the surgery. The surgery doesn't need to be done because some doctor says it's time. It's done because you need to see better, okay. So if you have any questions about cataracts and cataract surgery and interocular lenses, we've got all kinds of options now, and it's a fabulous procedure. If not, may God bless you with healthy eyes and great vision.