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.

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.

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.

In an educational program for cataract surgeons held November 7 in Atlanta, experts described a number of new options for premium cataract surgery. The program was supported by eyecare products manufacturer Bausch & Lomb in association with Ophthalmology Times.

New Cataract Surgery Technologies Promise Safer Outcomes and Better Vision

New technologies for premium cataract surgery discussed during the program included the Stellaris Vision Enhancement System, the Crystalens HD accommodating IOL, and the Akreos aspheric IOL. All these products are produced and marketed by Bausch & Lomb (Rochester, NY).

Stellaris Vision Enhancement System

The Stellaris Vision Enhancement System is a new surgical platform that allows ophthalmologists to perform phacoemulsification cataract surgery with very small incisions (2 mm or smaller). The Stellaris system also has other advanced controls to increase surgical safety and efficiency.

(Phacoemulsification, or “phaco,” is a cataract surgery technique wherein the surgeon uses a small ultrasonic probe to break up the cloudy lens into very small pieces, which are then removed from the eye with suction. Phaco has become the method of choice for most cataract surgeons because it can be performed with much smaller incisions than traditional cataract surgery, speeding recovery time after surgery.)

Crystalens HD Accommodating IOL

The Crystalens HD accommodating IOL is an advanced intraocular lens (IOL) used in cataract surgery. Unlike other IOLs, the Crystalens HD is capable of slight movements within the eye in response to focusing effort. This “accommodation” restores some intermediate and near vision lost to the normal aging change in the eye called presbyopia. The Crystalens HD IOL thereby reduces the need for reading glasses after cataract surgery.

Akreos Aspheric IOL

The Akreos aspheric IOL is a new intraocular lens with advanced optics that recently gained approval by the U.S. Food and Drug Administration (FDA) for use in the United States. The lens is made of a soft, flexible material (the lens is folded for placement inside the eye and unfolds automatically) and protects the eye’s light-sensitive retina from harmful UV rays from sunlight. The aspheric curves of the Akreos IOL more closely mimic the optics of the eye’s natural lens than other IOLs and thereby provides sharper distortion-free vision, according to the manufacturer.

Multiple Techniques and Lenses for Premium Cataract Surgery

The field of cataract surgery is continually changing and many options are now available for “premium” cataract surgery — surgery that is performed with advanced techniques and/or employs the use of advanced intraocular lenses.

If you are considering cataract surgery, be sure to ask your surgeon about the latest premium cataract surgery techniques and products available. Be aware that premium IOLs may increase your cataract surgery cost.