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Foldable Intraocular Lens Implants
and Small Incision Cataract Surgery

Intraocular lens implant. Cutaway view of eye, with intraocular lens in place.

New Technology Aids Post-Cataract Surgery Patients

A cataract is a clouding or discoloration of the eye's lens. Thus when a cataract is removed, the surgeon is actually removing the lens of the eye. After the cataract is removed, the surgeon places an artificial lens into the eye to help it focus; this is called an intraocular lens implant (most often simply referred to as an "implant"). Implants have become the standard of care and they are placed in all cataract patients unless there is some unusual reason an implant cannot be used.

The Eye MDs is pleased to offer IOL Master Technology, which provides extremely accurate measurement of the axial length used for intraocular lens power calculations.

Years ago, before implants were used, patients had to wear very strong glasses or even contact lenses after cataract surgery. This is because the eye was left without any lens and all of the focusing had to be done with the glasses or contacts. Without these visual aids, the patient would be legally blind.

Implants now can provide most of the focusing power for the patient's eye. Patients with implants can see well enough to get around without glasses; some see extremely well in the distance without glasses. Glasses are still needed by the majority of patients with implants to read and to provide their very best vision. New Deluxe implant technology can even provide a wider range of focus after cataract surgery to include distant, intermediate and near vision; and thus reduce dependency on glasses after cataract surgery.

Normal lens, top, and cataract lens, which will inhibit flow of light.

Implants have changed over time. For many years, implants have been made of solid pieces of plastic called PMMA. The cataract incision had to be at least as big as the implant's optic lens as it is not flexible. The common size for these rigid lenses today would be 5.5 to 6.0 mm (note this central optic lens is suspended in its position by arms called haptics which give the implant an overall diameter of 12 to 14mm). A cataract incision of this size usually requires stitches to obtain a water tight seal.

Over the past several years, foldable implants have gained popularity as they can be placed into the eye through a much smaller incision. These implants have flexible optic lenses made of acrylic or solid silicone. They can be placed into the eye through a self sealing incision as small as 1/8th of an inch. Sutures are not usually required due to the small size of the incision and its self sealing design. These small foldable implants also enable the surgeon to perform topical cataract surgery eliminating needle injections, patches and shields.

The foldable implant enables the surgeon to use a very small incision. These small incisions do not induce significant changes in the patient's astigmatism thus enabling predictable results. With predictable outcomes, the surgeon can consider special corneal incisions to reduce significant pre-existing astigmatism. These astigmatic corrections are done at the time of surgery and can often enable patients with significant astigmatism to enjoy an astigmatic reduction after cataract surgery (not all patients benefit by astigmatic incisions). Reduction in astigmatism reduces the patient's need for glasses to correct their vision. This new technology simply reduces dependency on glasses for many daily activities (it does not necessarily eliminate the need for glasses in all situations).

Recent technology has improved the intraocular lens (IOL) implant so that it has an increased range of focus and thus better mimics the natural human eye. These new “Deluxe” IOLs can provide distant, intermediate and near vision thus reducing dependency on glasses. The Deluxe IOLs are small and foldable but have the added advantage of focusing distant and near. There are currently three major technologies for Deluxe implants. The ReStor and ReZoom Deluxe implants split the light entering the eye to focus distant, intermediate and near images on the retina simultaneously; this is done by diffraction or refraction of the light rays, respectively. The Crystalens intraocular lens changes focus by shifting its position when the eye’s natural muscle attempts to focus, a process called accommodation. All of these Deluxe IOL technologies provide a wider range of focus and thus greater freedom from glasses.

Dr. David George, Dr. Scott Strickler and Dr. Zane Lazer pioneered small incision cataract surgery with foldable implants here in the mid-Ohio Valley. They are also experienced in doing astigmatic reductions for patients who would benefit by such a reduction in astigmatism.