All About Cataracts

Bausch & Lomb today announced the worldwide launch of a new accommodating intraocular lens (IOL) with aspheric optics for use in cataract surgery.

The new IOL, called Crystalens AO, is designed to be free of spherical aberration that affects other IOLs and thereby produce sharper vision after cataract surgery. The announcement follows recent FDA approval of the Crystalens AO for use by cataract surgeons in the United States.

The aspheric optical surfaces of Crystalens AO are designed to improve retinal image quality without compromising depth of field, and therefore the new IOL provides higher quality distance and intermediate vision than other IOLs, according to the company.

“The Crystalens AO has zero spherical aberration, and the combination of the Crystalens platform and AO optics work together to enhance depth of field,” says Andy Corley, president of Bausch & Lomb’s global surgical division in a press release issued today by the company.

The Crystalens AO is the latest addition to the Crystalens line of accommodating IOLs produced by Bausch & Lomb, joining the Crystalens HD and the Crystalens Five-O. Currently, Crystalens is the only brand of accommodating IOL that is FDA-approved for use in cataract surgery performed in the United States.

Unlike conventional IOLs, the optical portion of accommodating IOLs can move slightly within the eye in response to focusing effort, to improve not only distance vision, but intermediate and near vision as well, reducing the need for reading glasses after cataract surgery.

Accommodating IOLs are a premium intraocular lens and therefore will increase your cataract surgery cost.

More information about Crystalens accommodating IOLs is available on Bausch & Lomb’s Crystalens website or by calling the company at 1-877-SEE BETTER.

In its December 15 issue, Ophthalmology Times published a “year in review” feature, highlighting key developments in cataract surgery that took place in 2009.

Advances in cataract surgery technology in 2009 included:

Approval of femtosecond laser technology for cataract surgery

In September, the LenSx laser (LenSx Lasers, Inc., Aliso Viejo, Calif.) became the first femtosecond laser to gain FDA approval for a specific step in the cataract surgery procedure, eliminating the need for a bladed instrument for this step. Proponents say femtosecond laser technology (currently used primarily for LASIK and other laser vision correction procedures) could make a cataract operation even more safe and effective, reducing the risk of certain cataract surgery complications.

New multifocal IOLs

Two new multifocal IOLs were introduced to the U.S. market in 2009: the Tecnis Multifocal IOL (Abbott Medical Optics, Santa Ana, Calif.) and the AcrySof IQ ReSTOR +3.0 D (Alcon Laboratories, Fort Worth, Texas). Both lenses are designed to help patients regain a fuller range of vision after cataract removal and reduce their need for reading glasses. According to preliminary studies, both lenses offer patients a higher degree of freedom from glasses than previous multifocal intraocular lenses.

Investigational IOLs

A number of companies were conducting clinical trials of new premium IOLs not yet approved for use in the United States. These include a “light-adjustable lens” (LAL) being developed by Calhoun Vision (Pasadena, Calif.). The power of this lens can be adjusted by exposing it to a specific wavelength of light 2 to 3 weeks after cataract surgery, depending on the patient’s visual needs.

Another premium IOL under study is an accommodating IOL called the NuLens (NuLens, Ltd., Herzeliya, Israel and Alicante, Spain). Preliminary studies suggest the NuLens can produce significantly greater near focusing power than currently available accommodating IOLs for even greater freedom from reading glasses after surgery.

SOURCE: 2009: A banner year in cataract surgery. Ophthalmology Times. December 15, 2009.

Most people undergoing cataract surgery with implantation of a multifocal intraocular lens (IOL) require approximately six months to fully adapt to the IOL and achieve maximum visual benefit, according to new research from Spain.

Researchers at Hospital Quiron in Madrid evaluated the visual performance of patients receiving the Tecnis Multifocal IOL (Abbott Medical Optics, Santa Ana, Calif.) over time after their cataract surgery. A total of 250 eyes of 137 patients received the multifocal IOL, and patients were evaluated at intervals of one to three days, 30 to 90 days and 150 to 210 days after surgery.

Results of the study revealed that the patients demonstrated a significant improvement in uncorrected and spectacle-corrected visual acuity at both distance and near over the course of the seven-month study period.

At the last follow-up visit (roughly six months after surgery), eye chart testing of the visual acuity (VA) of eyes receiving the multifocal IOL revealed:

• 77.6 percent had uncorrected distance VA of 20/30 or better.
• 98.4 percent had best spectacle-corrected distance VA of 20/30 or better.
• 96.8 percent had uncorrected near VA of 20/25 or better.

More than 90 percent of the patients rated their near, distance and overall vision as good or excellent, and 88.4 percent of the patients did not wear eyeglasses or reading glasses.

Over the course of the study, most patients experienced an improvement in their visual acuity at all distances and a decrease in the intensity of glare and other undesired visual phenomena.

The researchers concluded that the Tecnis Multifocal IOL provides excellent uncorrected near vision and good distance vision when used to treat cataracts. Most patients, however, required an adaptation period of approximately six months to experience the full visual benefits of the lens, they said.

You can learn more about the Tecnis Multifocal IOL by visiting this Abbott Medical Optics website.

Subjects undergoing cataract surgery with implantation of the AcrySof Natural IOL (Alcon Laboratories, Inc., Fort Worth, Tex.) achieved better contrast sensitivity under conditions of veiling glare than subjects receiving a clear IOL, according to a new study.

Researchers at the University of Georgia (Athens, GA) assessed the vision of a total of 58 subjects: 17 with yellow AcrySof Natural IOLs implanted after cataract surgery, 20 with clear IOLs implanted after cataract surgery and 21 control subjects who did not have cataracts.

The yellow-colored AcrySof Natural IOL filters ultraviolet (UV) and high-energy visible light (also called “blue light”), which has been associated with glare.

Two tests were performed:

1. Visual acuity under veiling glare conditions. Subjects watched a contrast sensitivity (CS) target while a circular xenon lamp was directed toward their eyes and the intensity of the light was adjusted until the target was no longer visible.
2. Photostress recovery. The time required to detect a CS target after a 5-second exposure to an intense circular disk of broad-band xenon light.

In the test of visual acuity under veiling glare, eyes with the AcrySof Natural IOL could withstand significantly more light than eyes with a clear intraocular lens and eyes with a natural lens (no cataracts).

In the photostress test, visual recovery was faster in eyes with natural lenses (no cataracts) than eyes with either type of IOL. Photostress recovery times in eyes with the two types of IOLs were similar.

The researchers concluded the blue-filtering AcrySof Natural IOL is associated with reduced glare disability compared with clear IOLs and control eyes without cataracts.

The AcrySof Natural IOL may be considered a premium intraocular lens and may increase your cataract surgery cost if you choose this lens implant.

The full report of the comparison test (”The effect of the AcrySof Natural lens on glare disability and photostress”) is published in the August 2009 issue of the American Journal of Ophthalmology.