Oh, the joys of aging – wisdom, patience and, for many of us, cataracts.
As the years pass, the once-crystal-clear lens inside your eye gradually clouds over, thanks to the oxidation of its proteins. The result? A view of the world that’s more like peering through a fogged-up window than seeing in high definition.
The good news is that cataract surgery has come a long way in recent years, with better lens and surgical techniques. There now are several options that can restore sharp vision and even reduce the need for glasses.
Cataract surgery has long been a life-changing procedure, restoring vision for millions of people every year, but choosing the right intraocular (IOL) lens can be difficult. Among the viable options, the Light Adjustable Lens (LAL) and the Apthera Pinhole lens offer advanced features compared to the traditional monofocal lens.
“There’s several different types of lens implants,” said Dr. Stephen Tate, an ophthalmologist with New Vision Eye Center in Vero Beach. “Insurance typically covers a fixed focus or monofocal implant. They are very nice, but they don’t fix astigmatism, and they only provide a single plane of focus.
“For example, if you make it a focus for distance, you will still probably need glasses for reading. A lot of people don’t care, but others are very interested in not needing glasses for certain things. That’s where the specialty lenses come into play.”
Standard monofocal lens seemed miraculous when they first came along and remain a tried-and-true option with decades of successful use. They are affordable and usually covered by insurance. They provide excellent distance vision but, as noted by Dr. Tate, patients often will need reading glasses for near tasks.
Unlike specialty lenses, they are fixed focused and cannot be adjusted after implantation. And they are not designed to correct age-related loss of near vision or astigmatism.
Light adjustable lenses provide a more tailored vision approach with their ability to be fine-tuned after surgery using ultraviolet light treatments. Patients who struggle with refractive errors or astigmatism may benefit significantly from LALs and may achieve excellent vision at multiple distances without corrective glasses or lenses.
“Light adjustable lens overcome a lot of shortcomings that have always been inherent with cataract surgery,” Dr. Tate explained. “With the older style lenses, a computer takes some very sophisticated measurements of the eye and then uses those measurements to calculate what power lens would achieve the desired goal. But there are so many variables involved. It’s a biologic system and it is a prediction, so it’s not 100 percent accurate.
“With LAL, the lens is put in, then after a period of about three weeks of healing, the lens can be adjusted specifically to that person’s eye. You can measure the leftover distance prescription and astigmatism and program it into a computer. The computer shines a special pattern of ultraviolet light at the lens while the patient looks into the small machine, and it imprints the prescription onto the lens so that distance vision is very clear. The astigmatism can also be fixed with the ultraviolet light adjustment.”
The downside to LALs is the higher cost, which may not be covered by insurance. The treatment is longer than for the monofocal implants, and patients must follow a strict post-surgery protocol, including multiple UV light treatments to adjust vision and the use of protective glasses during the post-op period to prevent any unintended changes.
“Until the final light adjustment is made, patients must wear special glasses that shield them from ultraviolet sunlight,” Dr. Tate said. “Once the final treatment is done, those glasses are no longer needed. There’s a minimum of three and a maximum of five adjustments required, so it can end up taking a fair amount of time. We generally space the treatments a week apart to give the patient a chance to really see what they think and to test drive [the adjustment], so to speak.”
Another newer lens option, the Apthera Pinhole lens, is designed to optimize both near and intermediate vision.
“The Apthera Pinhole lens works on a simple technology of using a small aperture, similar to a pinhole camera that a lot of people made when they were children,” Dr. Tate explained.
“With a small aperture, your vision is much like when it’s bright outside during the day. The reason for that is because your pupil gets quite small, making a small aperture. So with the Apthera Pinhole lens, the patient basically has a small pupil at all times. Even in dim light when their pupil may be a little bit larger, this lens has a small pupil built in.
“The patient can see both distance and close fairly well but neither one is as perfectly crystal clear as with a dedicated lens. Because it has a small aperture and you are looking through a small pupil at all times, if it’s put in both eyes, it can affect vision a very low light. That’s why it is only put in one eye and the other one is usually an eye dedicated for distance and it can be matched up with a light adjustable lens.
“That way, you have a light adjustable lens in one eye that’s dedicated for high quality vision and an Apthera Pinhole lens in the other eye for a nice blend of both distance and up close.”
Different eye irregularities play an integral role in determining which lens to implant. Someone with macular degeneration, for example, will still have their central vision affected, decreasing their ability to see properly even with glasses, so it may not be worth the added expense and commitment that comes with the specialty implants. No implant is going to cure the disease.
“Don’t think of the different lenses as low-end, mid-tier and high-end,” Dr. Tate cautioned. “They are best thought of as different tools to achieve whatever goal the patient is looking to achieve.
Just because a lens is covered by Medicare doesn’t mean that it’s inferior. It’s just a different lens.
All of them are high quality. It’s often nice for somebody who has a compromised retina to just stick with the very clean, simple, fixed-focus lens.”
Consulting with an ophthalmologist is the best way to determine which lens will provide the greatest benefits for your unique eye health and vision goals.
Dr. Stephen Tate received his medical degree from West Virginia University School of Medicine and completed his internship at Riverside Methodist Hospital in Columbus, Ohio. He returned to the West Virginia University Eye Institute to complete his training in ophthalmology. He is an expert in cataract and lens implant surgery. He can be reached at New Vision Eye Center, 1055 37th Place, Vero Beach, 772-257-8700.
