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Refractive Cataract Surgery – Premium IOLs Correct Presbyopia

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Refractive cataract surgery is a relatively new term, used to describe the merging or combination of traditional cataract surgery with modern refractive surgery techniques.

In the past, the goal of cataract surgery was more purely medical and restorative. The surgery was performed when it was medically necessary to remove a cloudy lens in order to restore a person's ability to see (usually with the aid of eyeglasses or contact lenses after surgery).

Refractive cataract surgery has a more aggressive goal: To enable the person who has cataracts to regain good vision and to eliminate or greatly reduce their need for corrective eyewear, including reading glasses, after surgery.

Premium IOLs

The introduction of new premium intraocular lenses (IOLs) has been key to the development of refractive cataract surgery. These premium IOLs have the capability of providing good uncorrected visual acuity at all distances after cataract surgery, eliminating or reducing the need for eyeglasses after surgery.

In some cases, a person who has a cataract in one eye may choose to have a premium IOL (also called a refractive IOL) implanted in both eyes. The procedure of replacing a natural lens that does not yet have a cataract with a refractive IOL is called refractive lens exchange, or RLE.

Advantages of combining cataract surgery in one eye and RLE in the other eye include:

  • A better overall refractive result for more comfortable binocular vision
  • Correction of significant nearsightedness, farsightedness or astigmatism in the eye with the clear natural lens (to avoid the need to wear a contact lens on this eye after cataract surgery on the other eye)
  • Correction of presbyopia in the eye with the clear lens to reduce the need for reading glasses
  • Pre-empting the need for cataract surgery at a future date in the eye with the clear natural lens

Types of Premium IOLs

The types of premium IOLs currently used for refractive cataract surgery include:

Toric IOLs

Toric IOLs correct astigmatism. Residual astigmatism is a primary reason why people still need to wear eyeglasses after conventional cataract surgery. With toric IOLs, the surgeon can select a lens power that corrects pre-operative astigmatism for a better chance of 20/20 uncorrected visual acuity after surgery.

Presbyopia-Correcting IOLs

Some time after age 40, nearly everyone loses the ability to see clearly up close due to an aging change in the eye called presbyopia.

Even young people who sustain a cataract before becoming presbyopic lose this near focusing ability after conventional cataract surgery. This is because, unlike a young natural lens, traditional IOLs are inflexible and don't have the ability to change shape to focus light for near vision.

Today, premium IOLs have been developed to correct presbyopia and restore near vision. There currently are two types of presbyopia-correcting IOLs: accommodating IOLs (Bausch & Lomb's Crystalens) and multifocal IOLs (Alcon's AcrySof ReSTOR diffractive IOL and AMO's ReZoom multifocal refractive IOL).

Laser Cataract Surgery

Considerable research is underway to study the use of laser technology to perform the cataract surgery procedure. Research studies suggest that laser cataract surgery may provide an additional measure of stability and accuracy, and thus has the potential to improve the visual outcome and reduce recovery time for refractive cataract surgery.

Corneal Refractive Surgery after Cataract Surgery

In addition to premium IOLs, refractive cataract surgery may involve the use of LASIK surgery, PRK, conductive keratoplasty (CK) or other corneal refractive procedures after cataract surgery to provide greater independence from eyeglasses.

If some nearsightedness, farsightedness or astigmatism remains after cataract procedures, one of these refractive procedures performed on the cornea can improve uncorrected visual acuity. For the correction of presbyopia after cataract surgery with conventional (monofocal) IOLs, a multi-focal LASIK procedure, such as PresbyLASIK is one way to reduce the need for reading glasses.

Consult With a Refractive Cataract Surgeon

The field of refractive and cataract surgery is changing rapidly. To get the latest information about your options — in both premium IOLs and refractive cataract surgery — have a thorough pre-operative consultation with a cataract surgeon who also performs refractive surgery.

Refractive cataract surgery involving the use of premium IOLs such as toric IOLs and presbyopia-correcting IOLs requires special expertise. Be sure to ask your surgeon how many procedures they have performed with these advanced lenses and techniques, and what the outcomes were.

Refractive Cataract Surgery Cost

Medicare and other insurance policies typically will not cover all costs associated with refractive cataract surgery.

In most cases, insurance policies will provide a certain level of coverage for the costs of traditional cataract surgery,  and you will be responsible for the additional cost of premium IOLs and fees for procedures (such as post-cataract surgery LASIK) that are considered elective and not medically necessary.

Prior to surgery, be sure you get a quote for all aspects of refractive cataract surgery and consult with your insurance company to determine which expenses will be covered by insurance and which will be your "out-of-pocket" responsibility.

Note: This information is for general education purposes only. It is not to be used as a substitute for medical advice from your eye doctor or refractive surgeon.

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