As we age, our chances of developing a cataract become greater, but newer implantable lenses restore vision with less need for glasses afterward.
A cataract is a cloudy patch in the lens of the eye that blocks light. The lens, a normally transparent structure behind the iris and pupil, relaxes and contracts in order to focus light reaching the retina. A cataract can result in blurred vision and eventually blindness.
When a cataract is severe enough that eyeglasses and other vision aids cannot restore sight, surgery can be a good option. This surgery removes the cloudy lens and a clear, artificial lens called an intraocular lens (IOL) is implanted in its place.
IOLs help focus light coming into the eye and have a prescription tailored to patients’ needs. Prescriptions can restore near, far, intermediate vision.
The original type, called monofocal IOLs, correct vision for only one distance, and patients usually still need to wear glasses for various activities—such as reading (near vision) or driving (distance vision).
Dr. Mark Hornfeld, a board-certified ophthalmologist in Manhattan who has been performing cataract surgery and implanting IOLs for the past 20 years, says that with the newer multifocal IOLs, patients have less need for eyeglasses.
This is because multifocal IOLs are designed so that different distances simultaneously come into focus. This design allows patients to focus clearly at different distances.
However, you usually cannot restore near, distance, and intermediate vision with a single lens. Dr. Hornfeld says there are multifocal IOLs that improve distance and close-up vision, and others that improve distance and intermediate vision.
Patients choose the one that best fits their lifestyle.
“If they read a lot, then we put in a reading lens; if they do a lot of computer work, we'll put in the intermediate lens,” he said.
Usually, patients with multifocal IOLs don’t need to wear glasses, Dr. Hornfeld said, but this is not always the case. For example, if someone has an IOL that fixes near and distance vision, but they want to read a computer screen, they might need glasses.
Multifocal IOLs were first approved by the FDA several years ago, Dr. Hornfeld said. Since then, technology has advanced, and outcomes have improved. IOLs are now the best option for many people to regain youthful vision.
“People who get these lenses are very happy,” Dr. Hornfeld said. “This is like bringing them back to the way they used to see when they were much younger.”
He said that after 60, patients are more likely to be diagnosed with a cataract that requires a lens replacement. But Dr. Hornfeld says that in certain cases, replacements are possible for patients in their 40s and 50s who don’t like to wear glasses, have an early cataract, and want to reduce their need for glasses.
For some patients, implanting a multifocal IOL can also give them a better range of vision than LASIK surgery can, especially over the long term because patients can still get a cataract after LASIK, but not with an IOL.
This procedure, called a clear lensectomy, is cataract surgery on a patient who doesn’t have cataracts. In this case, just as with LASIK, the procedure is not covered by most insurance plans.
“So you’re removing the natural lens and replacing it with this lens implant. Then it’s better than LASIK because it gives them distance and near [vision], and it also preempts the cataract because they’re never going to get cataracts,” Dr. Hornfeld said.
However, Dr. Hornfeld recommends careful screening of patients for the clear lensectomy to maximize results and minimize adverse outcomes.
The Procedure
Replacing a lens usually takes about five minutes. Dr. Hornfeld first numbs the eye with anesthetic eye drops, then uses special tools or lasers designed for cataract surgery to make a very small incision in the side of the cornea, the transparent layer that covers the front of the eye. He then removes the damaged lens through this incision.
Dr. Hornfeld then rolls up the replacement IOL “like a taco” and inserts it through the incision where “it unrolls into place,” he said.
The procedure is then over.
“The incision is self-sealing, which means we generally don’t need to use sutures afterward,” he said.
Recovery and Side Effects
Recovery times differ depending on the patients’ response to the surgery. According to the American Academy of Opthalmology, you may have blurry vision for a few days or up to weeks.
Although rare, the most common risks include inflammation, infection, swelling, and IOL prescription error. The nationwide rate of infection (known as endophthalmitis) after cataract surgery is about one per thousand cases.
If you have astigmatism (warping of the cornea), this issue should be addressed as part of the planning for a multifocal lens implant. People with high astigmatism are not good candidates for this technology, as there are better alternatives available.
Common side effects of multifocal IOL implants are seeing glare or halos around lights and decreased sharpness of vision. Dr. Hornfeld said about 10 percent of his patients experience glare at some point, but for most of them, it is only temporary.
“There might be 1 percent where it doesn’t go away,” he said. “Then we have to replace the lens.”
Dr. Hornfeld doesn’t recommend multifocal lenses to people who frequently drive at night. “If there’s a 10 percent chance that there’s night glare, then why take the chance?” he said. But when a patient is a good fit for a multifocal IOL, it can make a world of difference.
“This technology can provide the ability to see far and near without glasses and has resulted in very high satisfaction rates among my patients,” he said.
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