Advanced Technology Intraocular Lens - crystalens® & ReSTOR®, ReZOOM® Presbyopic Lens
Washington Eye surgeons are the first in the Washington DC - Maryland, MD, region to implant the latest breakthrough in vision correction, the full vision Crystalens, ReSTOR and ReZOOM presbyopic lens technologies. These are the first eye surgery procedures that can restore clear vision for reading, computer, and distance in both eyes without glasses. Washington Eye surgeon Dr. Neil Martin has recently been interviewed about his experience with crystalens® – a major advance in vision correction
– by the Washington Post, NBC TV, Parade Magazine, AARP, and Business Week.
What are advanced technology intraocular lenses?
There are now two advanced technology intraocular lenses (IOLs) available from our Washington DC-area eye center in Chevy Chase – crystalens®, ReSTOR® and ReZOOM®. All are exciting new FDA-approved vision correction technologies that permit boomers and seniors to experience natural, seamless distance, intermediate, and near vision. The advanced Technology IOL is a space-age plastic lens that is surgically implanted to permanently replace the old, hard natural lens of the eye. These technologies have been demonstrated to have the same safety as decades old traditional lens implants, but can also provide what many of our patients say they really want: greater freedom from glasses – not just distance glasses, but readers too. This surgery can allow many people in their late forties and older (with or without cataracts) to return to the vision they had when they were younger and did not need glasses. The world renowned surgeons of Washington Eye Physicians and Surgeons have corrected the vision of thousands of cataract patients from DC, Virginia (VA) and Maryland (MD) through advanced cataract surgery.
The crystalens® combines the distance vision of a traditional lens implant with a flexible hinge that can provide patients of our Washington DC-area center seamless, natural intermediate and near vision as well. The lens builds on over 30 years of experience with cataract lens implant technology to improve and rejuvenate vision so that patients can accomplish most, and frequently, all of their visual needs without glasses.
The ReSTOR® lens uses a new strategy for collecting and distributing light and doesn't rely on the focusing muscles, which can lose effectiveness with age. Surgical techniques using the ReSTOR® lens can fix farsightedness and nearsightedness for patients of our Washington DC-area practice, and improve vision for computer and reading distances, as well.
The ReZOOM® lens, like ReSTOR®, does not rely on the focusing muscles to change focusing power. This lens is a second-generation refractive multifocal IOL (intraocular lens) and uses special optics to capture and focus the light rays. ReZOOM® uses advanced technology optics to provide 5 different focusing zones. The central part of the lens is used for distance vision in bright conditions, when the pupil is small. The other zones provide for a range of focusing power from distance vision in dim light to intermediate vision (computer distance) to near vision (reading distance).
Who can have advanced technology intraocular lenses?
Only an experienced eye surgeon can determine if a patient is a good candidate for these procedures. The best candidate is over 50, has pupils that are not too large, little astigmatism, and eyes that are healthy, other than having cataracts. Although the lens is FDA approved in patients with cataracts for the correction of presbyopia (loss of the eye's flexibility to change focus), some of our Chevy Chase eye center vision correction candidates without cataracts may be candidates for the advanced technology lens implant. These lenses can correct most degrees of near- and farsightedness (generally, myopia and hyperopia from –10.00 to +7.00). Astigmatism may be corrected at the time of implantation with "relaxing incisions," or after the implantation, by performing a LASIK procedure. Patients with glaucoma, inside-the-eye inflammation (iritis or uveitis), diabetic retinopathy, macular disease, or other active eye disease may not be candidates for the lens. Prior LASIK does not necessarily exclude a patient from being a candidate for an advanced technology lens implant procedure. In view of the fact that prior vision correction surgery makes the calculation of an implant's power much less exact, these patients require a case-by-case determination of individual concerns. Patients who already have a lens implant may not have an advanced technology lens in that eye, but some may be candidates for this treatment in the other eye.
What is the cost of the procedure?
For our Chevy Chase eye center patients with cataracts, insurance will generally cover the cataract part of the procedure and the elective advanced technology upgrade will be patient's financial responsibility. This covers the surgeon and anesthesiologist's fees, the cost of the eye surgery center, the cost of the lens, and 90 days' postoperative care. The patient is responsible for any co-pays or deductibles.
For patients who have no cataract and seek crystalens®, ReSTOR® or ReZOOM® vision restoration at our Washington DC-area center for cosmetic (or refractive) reasons, the procedure is considered cosmetic and is the full financial responsibility of the patient.
Some patients' eyes may change over time and these patients may eventually elect to have LASIK or other forms of vision correction at additional cost.
For patients who have had LASIK, PRK, or RK, additional fees may be required. Prior vision correction procedures decrease the accuracy of preoperative lens power determination and significantly increase the possibility that a lens exchange or further LASIK or PRK may be needed after the crystalens®, ReSTOR® or ReZOOM® surgery.
For more information about advanced technology intraocular lenses, refer to our frequently asked questions. If you have a question not listed in our FAQs, or to make an appointment, please contact Washington Eye Physicians & Surgeons.
Advanced Technology Intraocular Lens (IOL) Vision Enhancement Frequently Asked Questions
- What is advanced technology intraocular lens (IOL) vision enhancement?
- What makes advanced technology IOLs different from ordinary intraocular lenses?
- Do advanced technology IOLs provide 20/20 vision for both reading and distance?
- How do advanced technology IOLs affect middle vision for tasks such as working on the computer? How does it compare to trifocals?
- How do advanced technology IOLs affect low-light vision?
- Am I a good candidate for advanced technology IOL vision enhancement?
- Will the doctor implant advanced technology IOLs in both eyes at the same time?
- How long does the procedure last? Is it painful?
- What is the likelihood of complications, and what might they be?
- How does vision improve after surgery?
- Will lens implant surgery cause glare, night driving problems, and light sensitivity?
- How soon after lens implant surgery will I be able to resume normal activities?
- How often do I need to have my eyes checked after surgery?
- Can I go to any eye doctor for check-ups after the surgery?
- Will I have to have cataract surgery again?
- What happens if my eye is injured some time in the future?
- Does the presence of an advanced technology IOL rule out other eye surgery?
- Does rosacea on the face require any special preparation for eye surgery, or create a higher risk of infection?
- Will lens implantation have any effect on dry eye syndrome?
- Does lens implantation have any effect on chronic red and irritated eyes or headaches from eyestrain?
- Will security eye scanning still work after advanced technology lens implantation?
- Is advanced technology IOL implantation covered by insurance?
- How can I be sure an advanced technology IOL implant surgeon is qualified?
What is advanced technology intraocular lens (IOL) vision enhancement?
The advanced technology IOL is a new, state-of-the-art type of intraocular lens that can provide a full range of vision, from near to distance, in most patients. The procedure for removing the natural lens and implanting the advanced technology IOL is the same that's been used for years in cataract surgery, but the result is a full range of vision, significantly reducing or eliminating the need for glasses or contact lenses.
What makes advanced technology IOLs different from ordinary intraocular lenses?
Unlike an ordinary IOL, the advanced technology IOL can focus on objects near and far. The crystalens® is designed to be focused by the eye's natural muscle; the ReSTOR® lens has special surface design that brings near and distant objects into focus without muscle assistance. Both are intended to provide most patients a full range of vision without the need for corrective lenses. With ordinary IOLs, most people MUST rely on glasses or contact lenses for middle and near vision.
Do advanced technology IOLs provide 20/20 vision for both reading and distance?
Advanced technology IOLs were created to provide a full range of vision, near to distance. Nearly everyone will find their uncorrected vision significantly better after surgery, but some will not see 20/20 through the full range of vision.
Pre-existing ocular and physiological factors may prevent full range 20/20 vision. Your doctor will advise you of any conditions which may affect the outcome of your individual surgery.
In a two-year FDA clinical study, 92 percent of participants with crystalens® in both eyes achieved 20/25 or better distance vision, 96 percent achieved 20/20 at arm's length (middle vision), and 73 percent achieved 20/25 near vision without glasses or contact lenses.
To apply the study results to real life, 98 percent of participants were able to pass driver's license eye exams, and read newspapers and phone books. All of them could read a computer screen, dashboard instruments, and supermarket price stickers; all the female participants could apply makeup.
In FDA clinical studies of ReSTOR®, 80 percent of participants with replacement lenses in both eyes did not use glasses or contact lenses after the procedure; 84 percent achieved 20/25 or better distance vision and 20/30 or better near vision and could read small stock quotes in a newspaper.
How do a dvanced technology IOLs affect middle vision for tasks such as working on the computer? How does it compare to trifocals?
Advanced technology IOLs will greatly enhance middle vision, roughly arm's length, used for tasks such as using a computer, viewing dashboard instruments, or reading supermarket price stickers.
There is no comparison to the hassle of trifocals. No matter the distance, near, middle, or far, your advanced technology IOLs can put your view in focus without the annoyance of tilting your head to see clearly.
How do advanced technology IOLs affect low-light vision?
Since the lens implant procedure replaces the cloudy natural lens with a crystal-clear IOL, the transmission of light to the retina should be enhanced. However, low-light vision is influenced by other factors, including the health of the eye in general and of the retina in particular. With time, it is normal for low-light vision to decrease. Adequate lighting is always beneficial, especially when reading.
Am I a good candidate for advanced technology IOL vision enhancement?
Only an experienced eye doctor can evaluate your vision care needs and recommend a customized course of treatment.
Most people in good general health are good candidates for advanced technology IOLs. Exceptions include those who have already had cataract surgery. Those who have had corneal refractive surgery may be good candidates, if approved by a doctor. They may require an enhancement procedure to achieve the best result. Those with uncontrolled diabetes, chronic infections, and certain other health problems should not have lens replacement surgery until these conditions are under control.
Will the doctor implant advanced technology IOLs in both eyes at the same time?
For the best result, advanced technology IOLs should be implanted in both eyes. Cataracts normally develop in both eyes at the same time. In the instance of only one clouded lens, only that lens needs to be replaced. For the typical patient, although both lenses need replacement, most surgeons prefer not to do them at the same time.
The normal procedure is to replace the lens that is most clouded first. If both are equally clouded, the doctor will usually replace the lens in the non-dominant eye first. The interval between surgeries depends on the healing of the first eye and the vision results; two to three weeks is typical.
How long does the procedure last? Is it painful?
The actual implanting of the advanced technology IOL takes about 20 minutes; the whole visit to the surgical center usually takes less than two hours.
The patient arrives about an hour before the procedure and is given oral medication to induce relaxation and eye drops to anesthetize the eye and dilate the pupil.
Once the patient is on the surgical bed and the eyelid is secured, the old lens is removed and the replacement inserted through a tiny incision. There is a sensation of pressure on the eye, but no pain.
After surgery, more eye drops are applied to prevent infection, decrease inflammation, and keep the pupil dilated. A protective patch is usually placed over the eye. Once home, the patient should rest and avoid any strenuous activities. The doctor will examine the eye the next day and advise the patient on the appropriate course of recovery, which will include continuing eye drops for a week or two and avoiding strain on the eye until it is thoroughly healed.
Be sure to arrange for some one to drive you home after the procedure.
What is the likelihood of complications, and what might they be?
Advanced technology IOLs are revolutionary, because, unlike ordinary IOLs, they provide multifocal vision. They are also evolutionary, since the actual procedure for implantation is the same as the regular cataract lens replacement surgery, which has been practiced for decades. The basic procedure is performed on more than seven million eyes each year, and has proven extremely safe; however, there is always a chance of complication with even the most routine surgery.
Most complications, such as minor infections, inflammation, and irritation, are temporary and easily treated. Serious sight-threatening complications, such as serious infection, hemorrhaging, or retinal detachment, are extremely rare, but are more likely in patients with diabetes and high blood pressure, and those who suffer from chronic inflammation and infections. About 98 percent of cataract surgery patients experience no complications and more than 95 percent achieve improved vision.
As with all surgical procedures, the eye surgeon will perform a thorough examination and provide a complete evaluation of expected results and possible complications.
How does vision improve after surgery?
After surgery, vision improves gradually, as the eye first heals, then adapts to the advanced technology IOL. Distance will usually be very good within a day or two after surgery. With the ReSTOR® lens, you will see an improvement in near vision in usually the first several days, though some patients may take longer. With the crystalens®, return of near vision may take longer, as it requires the use of focusing muscles which may not have been used for years.
To promote proper alignment of the crystalens® as the eye heals, drops are applied after surgery to prevent the eye muscles from moving the lens. These also dilate the pupil, causing light sensitivity. The effects of these drops will gradually lessen over the course of a week or two, during which time reading glasses may be required.
For patients with crystalens® implants, improvement of middle and near vision usually begins about two weeks after surgery. Reading glasses should be discontinued at this point, to promote strengthening of the eye muscle and training it to focus in a new way. Achieving full focusing potential may take several months. The more you try to read without reading glasses, the quicker your eyes will be trained to get along without them. After healing, some patients may experience slightly different vision in each eye. A little difference is normal, but, if the difference is significant, corneal refractive surgery may be recommended; it may also be recommended to correct astigmatism.
Although results vary from patient to patient, most achieve excellent near and distance vision, and very good middle vision. Some patients still require glasses or contact lenses with a mild prescription for optimal vision in extreme situations. Some patients achieve better vision improvement than others, but virtually all will see better with lens replacement than without.
Implant surgery is intended to correct deficiencies in the eye's lens, and will not help with vision problems related to other parts of the eye, such as floaters, flashes, or visual field loss.
This information is general and not intended to apply completely and specifically to any individual patient. Only a consultation with an experienced eye surgery professional can disclose all circumstances applicable to the individual patient.
The long-term safety and effectiveness of this lens has not been established.
Will lens implant surgery cause glare, night driving problems, and light sensitivity?
Glare, night driving problems, and light sensitivity can occur with both traditional and advanced technology lens implants. Night vision problems are usually much less severe than before cataract surgery. These phenomena are usually temporary and diminish as the brain and eyes adjust.
Light sensitivity is usually temporary. The crystal-clear material of the advanced technology IOL nearly always permits more light to pass through than the natural lens it replaces, so that some patients might have to adjust to seeing vivid colors and brighter lights than before surgery.
All intraocular lenses can produce glare, light flares, or a halo effect at night, since the pupil is open wider and allows light to reflect off the edge of the implant. Your doctor, through medication or night driving glasses, can usually compensate for these problems.
How soon after lens implant surgery will I be able to resume normal activities?
Most patients require only a few days to resume normal activities, with some limitations and adjustments. Some sensitivity to touch and bright lights should not deter most patients from driving and returning to work.
Patients may be given medication to prevent infection and control inflammation. A protective shield may be advisable while sleeping, and sunglasses can provide protection during the day.
For several days after surgery, patients should avoid any heavy lifting or straining the can increase pressure in the eye. Rubbing or pushing of the eye and any situation that could result in being hit in the eye are also to be avoided.
Careful showering and shampooing are permitted, as long as no soap or shampoo touches the eye. Any makeup around the eye should be avoided for several weeks. Public swimming pools, hot tubs, and other potential sources of bacterial contamination should also be avoided.
When in doubt, the patient should consult the doctor for guidelines regarding post-surgical activities.
How often do I need to have my eyes checked after surgery?
Your doctor will check your eyes the day after surgery, and, depending on your particular case, again after about two to four weeks, and again after about three to six months. After that, annual eye exams are recommended, unless a specific problem develops.
Can I go to any eye doctor for check-ups after the surgery?
The surgeon who did the work, or a member of his or her team should perform the checkup on the day after surgery, as well as the next visit. The surgeon may approve subsequent checkups with another doctor, after a consultation with that doctor to ensure familiarity with your case and appropriate care.
Will I have to have cataract surgery again?
In cataract surgery, natural lenses are removed and replaced with artificial lenses, which are not subject to deterioration and should last a lifetime.
Some patients experience subsequent clouding of the membrane which holds the lens, called the capsular bag. The normal treatment for this is a capsulotomy, in which a laser beam is used to punch a hole through the membrane, allowing a clear path for light. It is a quick and painless procedure.
What happens if my eye is injured some time in the future?
The presence of an advanced technology IOL does not make the eye more susceptible to damage from trauma. Most injuries affect the cornea, the clear front portion of the eye, or the retina, the light sensing lining on the rear of the eye. If anything, the lens implant eliminates the chance of cataract due to eye trauma.
Does the presence of an advanced technology IOL rule out other eye surgery?
The advanced technology IOL takes the place of a natural lens in the capsular bag. Once healing is complete, usually about three months, other eye surgery will be unaffected by the presence of advanced technology IOL; it will be no different from surgery with a natural lens present.
Surgery on or around the eye should also be avoided until the implant procedure is well healed; this includes BOTOX® Cosmetic, plastic surgery, or procedures performed on the surface of the eye. A doctor performing any procedure near the eye should be notified of a patient's eye surgery history.
Does rosacea on the face require any special preparation for eye surgery, or create a higher risk of infection?
Unless rosacea directly affects the eyelid or the eye itself, it should not interfere with eye surgery.
Before performing surgery, the doctor will conduct a thorough examination to identify any conditions requiring treatment, in order to ensure that surgery is safe and successful. Patients with rosacea who are not exhibiting symptoms should inform the doctor.
Will lens implantation have any effect on dry eye syndrome?
Dry eye syndrome is caused by conditions unrelated to the lens, be it natural or artificial, so that implant surgery should have little affect on it. If dry eye syndrome is present, a doctor should be consulted on the appropriate treatment.
Does lens implantation have any effect on chronic red and irritated eyes or headaches from eyestrain?
Red, irritated eyes and eyestrain are often caused by inappropriately wearing contact lenses. Implantation of advanced technology IOLs may help the situation, if it reduces or eliminates the need for contact lenses.
These symptoms can be caused by several other factors, including allergies; consulting a doctor for help with irritated eyes is recommended.
Will security eye scanning still work after advanced technology lens implantation?
Security scanners usually read patterns on the iris or retina, and should not be affected by the presence of an advanced technology IOL.
Is advanced technology IOL implantation covered by insurance?
Most private insurance covers the cataract surgical procedure and the anesthesia, but may cover only a portion of the cost of an advanced technology IOL, since it costs more and is considered non-standard.
Patients should consult with both the doctor and the insurance carrier to determine their best alternatives.
How can I be sure an advanced technology IOL implant surgeon is qualified?
All advanced technology IOL surgeons have been thoroughly trained and tested, and have usually performed cataract surgery for several years, applying the same techniques used to implant the advanced technology IOL.
Starting the search for an implant surgeon on the Internet saves a lot of time and travel, but, once the field has been narrowed, a face-to-face consultation with the finalists is best to facilitate meaningful dialogue.
Direct contact with patients who have had advanced technology IOL implant surgery is also very informative.
Finally, a state or county medical society can provide background information on a particular doctor.
