All About Cataracts

The use of premium intraocular lenses (IOLs) in cataract surgery performed in the United States is increasing, according to recent surveys.

Premium IOLs include multifocal lens implants and accommodating IOLs. Both types of presbyopia-correcting intraocular lenses give patients a broader range of vision, reducing or eliminating the need for reading glasses after cataract surgery.

According to a recent survey of cataract and refractive surgeons reported by the eyecare industry research firm Market Scope, 71 percent of U.S. eye surgeons offered their patients the option of premium IOLs in 2008, up from approximately 59 percent in 2007. The company also estimates that 210,000 presbyopia-correcting IOLs were implanted during cataract surgery or other vision correction procedures in the U.S. in 2008, up from 153,000 in 2007.

Eye surgeons also say they prefer premium IOLs for the correction of high myopia. In a 2008 member survey of the American Society of Cataract and Refractive Surgery (ASCRS) more eye surgeons responding to the survey reported preferring premium IOLs (40 percent) to LASIK (23 percent) for the correction of large amounts of nearsightedness in patients desiring elective refractive surgery.

Among ASCRS surgeons using presbyopia-correcting premium IOLs, their top three lens choices in 2008 were the AcrySof ReSTOR multifocal IOL (Alcon), the Crystalens accommodating IOL (Bausch & Lomb) and the ReZoom Multifocal IOL (Abbott Medical Optics).

Other premium intraocular lenses include toric IOLs that correct astigmatism and aspheric IOLs designed to reduce glare and improve night vision.

Premium IOLs cost more than standard IOLs, and the added expense of these lenses typically is not covered by vision insurance and must be paid out-of-pocket, increasing your cataract surgery cost. However, most people who choose premium IOLs are very pleased with the added visual benefits the lenses provide, according to eye surgeons who offer them.

Posterior capsule opacification (PCO) is one of the most common cataract surgery complications. It can occur relatively quickly after cataract surgery or months later.

The natural lens inside the eye is surrounded by a clear, membrane-like capsule. The front portion of this capsule is removed during cataract surgery to gain access to the cloudy natural lens and remove it. The posterior portion of the lens capsule is left intact to prevent loss of the gel-like fluid behind it, which would increase the risk of a detached retina from cataract surgery.

Posterior capsule opacification is thought to be caused by lens epithelial cells remaining in the eye after the cloudy lens is removed during cataract surgery. These cells can migrate onto the surface of the posterior capsule, where they undergo cellular changes and form an opaque membrane that decreases vision.

PCO can be successfully treated with a non-invasive outpatient procedure called a neodymium:YAG (Nd:YAG) laser capsulotomy. The procedure uses laser energy to obliterate the opacity, restoring vision.

Researchers at Storm Eye Institute, Medical University of South Carolina (Charleston, SC) recently conducted a retrospective study of 225 eyes that underwent cataract surgery with intraocular lens (IOL) implantation to investigate whether the type of IOL used in the surgery has an effect on the rate of PCO occurrence.

The eyes in the study received one of three IOLs: AcrySof ReSTOR SN60D3 (a spherical multifocal IOL), AcrySof Natural SN60AT (a spherical monofocal IOL), or AcrySof IQ SN60WF (an aspheric monofocal IOL).

All three IOLs are manufactured and marketed by the same company (Alcon, Inc.). Each lens was implanted in 75 study eyes, and mean follow-up time after surgery was 15.9 months.

The researchers found the rate of posterior capsule opacification after surgery was:

• 42.7 percent among eyes receiving the spherical multifocal IOL (ReSTOR)
• 28.0 percent among eyes receiving the spherical monofocal IOL (Natural)
• 14.7 percent among eyes receiving the aspheric monofocal IOL (IQ)

The Nd:YAG laser capsulotomy rate for eyes receiving the IOLs was 25.3 percent, 17.3 percent and 4.0 percent, respectively.

The researchers concluded that IOL design affects the rate of posterior capsule opacification occurring after cataract surgery.

Also, based on the rates of laser capsulotomy procedures performed, PCO appears to be less visually significant in eyes receiving the AcrySof IQ aspheric monofocal IOL, compared with eyes receiving the spherical multifocal IOL (AcrySof ReSTOR) and the spherical monofocal IOL (AcrySof Natural). 

The study was supported in part by Research to Prevent Blindness and the National Institutes of Health.

Source: Comparison of the incidence and visual significance of posterior capsule opacification between multifocal spherical, monofocal spherical, and monofocal aspheric intraocular lenses. Journal of Cataract & Refractive Surgery. July 2009.

The U.S. Food and Drug Administration (FDA) recently approved a new astigmatism-correcting intraocular lens (IOL) for use in cataract surgery. The new lens, called the AcrySof IQ Toric IOL, is manufactured by Alcon and is now available for use by cataract surgeons in the United States.

In addition to having a toric design to correct astigmatism, the new premium IOL also has aspheric curves to reduce a common post-surgical optical error called spherical aberration. By reducing spherical aberration, the AcrySof IQ Toric IOL is designed to improve image quality and contrast sensitivity for better night driving vision and sharper vision overall.

In a clinical trial required by the FDA prior to approval, among 37 patients who had the IOL implanted bilaterally for the treatment of cataracts and astigmatism, 98 percent did not need prescription eyeglasses for distance vision six months after surgery. Also, the lens continued to show good rotational stability when checked one year after surgery. 

According to Alcon, the AcrySof IQ Toric IOL is a good choice for any patient undergoing cataract surgery who has 0.75 diopter (D) or more corneal astigmatism prior to surgery. The IOL corrects up to 2.50 D of astigmatism, and it can be combined with a procedure called limbal relaxing incisions to correct even higher amounts of astigmatism.

Like other premium IOLs, the AcrySof IQ Toric IOL costs more than a conventional monofocal intraocular lens and will increase your cataract surgery cost. For details, consult a cataract surgeon near you.

Advances in cataract surgery are occurring every year, making the procedure safer and more effective than ever.

A number of the key advances in cataract surgery took place in 2008. Among the new technology and techniques:

New Phacoemulsification Technology

Phacoemulsification (or “phaco”) is a cataract surgery technique in which the cataract is broken up into small pieces with a small, hand-held probe that has a vibrating tip. The small pieces are then removed from the eye with suction. Phaco is currently the most common technique used for cataract surgery in the United States.

Manufacturers of phaco equipment for cataract surgery introduced several advances in 2008, including probes that allow the procedure to be performed with smaller incisions. This reduces the risk of unwanted astigmatism after cataract surgery. Other advances include new microsurgical tools to help break up very dense cataracts more effectively during phaco cataract surgery.

New Lens Implants

New intraocular lenses (IOLs) introduced or in development in 2008 include presbyopia-correcting IOLs, aspheric IOLs and toric IOLs.

Presbyopia-correcting IOLs

These innovative lenses help restore a person’s ability to see well up close as well as far away, thereby reducing the need for reading glasses and computer glasses after cataract surgery.

The Crystalens HD (Bausch & Lomb) presbyopia-correcting lens that was introduced in 2008 works by having the ability to change position slightly within the eye in response to focusing effort. This type of presbyopia-correcting IOL is also called an “accommodating” IOL. Other brands of accommodating IOLs are currently in development.

Another type of presbyopia-correcting intraocular lens is the multifocal IOL. Multifocal IOLs are similar in design to multifocal contact lenses, containing separate lens powers for seeing distant, intermediate and near objects simultaneously. Examples of multifocal IOLs include The AcrySof ReSTOR IOL (Alcon Laboratories) and the ReZoom Multifocal Lens (Advanced Medical Optics).

Accommodating and multifocal IOLs can be implanted in both eyes, or in one eye only for a “monovision” effect. Some surgeons feel a monovision correction provides better distance vision than having presbyopia-correcting IOLs implanted in both eyes.

Aspheric IOLs

Aspheric IOLs are specially designed to more closely mimic the shape of the eye’s natural lens, which changes in curvature from its center to its periphery. This characteristic of possessing a gradually changing curve is called asphericity (meaning “not spherical,” or “not of the same curve”).

Because they are more similar in shape to the eye’s natural lens, aspheric IOLs are designed to provide sharper vision and reduce higher-order aberrations (HOAs) caused by traditional spherical IOLs. HOAs contribute to glare and reduced contrast sensitivity, especially at night and in other low-light conditions.

Many cataract surgeons appear to believe in the benefits of aspheric IOLs, as the use of thes premium IOLs grew rapidly in 2008.

Examples of aspheric IOLs include the Tecnis IOL (Advanced Medical Optics) and the AcrySof IQ IOL (Alcon Laboratories).

Toric IOLs

Toric IOLs are a new type of premium intraocular lenses that correct astigmatism.

In the past, people who had astigmatism and cataracts had to wear eyeglasses or have an additional surgical procedure to correct their astigmatism after cataract surgery. With toric IOLs, many of these people can see clearly after cataract surgery without the need for full-time glasses or additional surgery.

Use of toric IOLs increased significantly in 2008 and continued future growth is expected. Examples of toric IOLs include the AcrySof Toric IOL (Alcon Laboratories) and the STAAR Toric IOL (STAAR Surgical Co.)

More Advances on the Horizon

As the aging of the U.S. population continues, more and more Americans are having cataract surgery. And more advances in cataract surgery technology are occurring every year, including techniques for smaller incisions and faster recovery time.

To stay up-to-date on the latest news about cataracts and cataract surgery, return to AllAboutCataracts.com often. Or browse AllAboutVision.com’s Cataract Surgeon Directory to find a cataract surgeon near you.