Cataract
A cataract is a slow, progressive clouding of the eye’s natural lens. It is caused by a change in the proteins of the lens, which make it less translucent. The cataract interferes with light passing through the eye, resulting in blurred or fuzzy vision. People with advanced cataracts often describe their vision as “looking through a piece of wax paper.” A cataract may make nighttime driving difficult due to glare from oncoming car headlights. Cataracts often make reading more difficult. For the majority of cases, surgery is the only cure.
For the majority of cases, surgery is the only cure. Modern cataract surgery is typically performed through a small incision. High-frequency ultrasound, called phacoemulsification, is used to break up the cloudy lens material, and a micro-vacuum removes it from the eye. A clear, artificial implant lens of appropriate power is placed inside the eye to provide focusing power. Today, no-stitch cataract surgery is performed whenever possible.
Before the procedure can begin the pupil is dilated, and the surgical area is prepared using a sterile cleanser. A topical anesthetic is then administered to the surface of the eye. An incision of 2.5 to 3 millimeters in length is then created at the junction of the cornea (the clear front of the eye) and the sclera (the white part of the eye).
All intraocular procedures utilize implantation of an artificial lens to ideally focus light. The practice of lens implantation was first developed for cataract surgery. Lens implantation has multiple potential advantages over corneal refractive procedures, including:
- accuracy for extreme refractive errors,
- fewer visual side effects, and
- preservation of normal corneal architecture.
Intraocular lenses are now used in conjunction with the patient’s own natural lens (phakic intraocular lens) or as a replacement for it.
Phakic Intraocular Lens
Anterior Chamber
The first intraocular lens (Verisyse™) for use without removal of the crystalline lens gained FDA approval in September 2004. The implant corrects 5 to 20 diopters of myopia by affixing the rigid lens to the anterior iris. Results have been excellent with 85% of participants seeing 20/40 or better (uncorrected) at 6 months postoperatively. Patients retain the ability to accommodate naturally, and some have demonstrated better corrected vision than was possible preoperatively.
Posterior Chamber
Another phakic intraocular lens, the Visian ICL™ (Implantable Collamer Lens), is designed for placement behind the iris. It is inserted with a folding technique that minimizes incision size and potential astigmatism. FDA approval data for myopia between 3 and 20 diopters showed that at 3 years postoperatively 59% had 20/20 or better, and 95% had 20/40 (uncorrected) acuities. Less than 1% lost greater than or equal to 2 lines of best corrected visual acuity.
While phakic intraocular lens technologies have brought surgical vision correction to patients with extreme refractive errors, some important considerations deserve mention. The Verisyse™ requires a peripheral corneal incision of at least 5 millimeters, which is closed with sutures. The incision for the Visian ICL™ is approximately 3 millimeters and does not typically require sutures. Both phakic intraocular lenses necessitate deep anterior chambers and peripheral iridectomies to equalize pressure on both sides of the iris. The complications that can occur with phakic intraocular lenses are similar to those of other intraocular procedures (see below).
Refractive Lens Exchange
With the recent success of smaller incisions, high-frequency ultrasound, and superior lens implants, cataract surgery itself has become a refractive procedure. Some surgeons are now using the sameskills to offer refractive correction through lens removal with implant placement prior to cataract formation. Refractive lens exchange has been especially useful for higher levels of hyperopia. Multiple options exist for the intraocular lens implant, which is selected after careful patient interview, examination, and lens removal.
Monofocal Implant
The vast majority of implants today are monofocal, which allow a clear image to be formed on the retina from a given distance. Most patients choose to have an implant that will correct for distance but will necessitate reading glasses for closer work. Occasionally, monovision or planned myopia is used so that near and intermediate distances are clear without glasses. Monovision may be an option in motivated patients who are likely not to be bothered by a mild decrease in depth perception.
Multifocal Implant
Certain implants contain concentric rings of varying powers along the visual axis, thereby providing excellent near and distance acuities. Newer designs (ReSTOR® and ReZoom™) may create less halo side effect and contrast sensitivity loss, which have limited the use of multifocal lenses in the past.
Accommodating Implant
The Crystalens™ is a silicone monofocal implant with a flexible structure that is believed to allow a forward accommodative motion. FDA approval data at one year postoperatively demonstrated 92% of eyes were 20/25 or better for uncorrected distance, and 89% could read 20/40 at near and intermediate without magnifying spectacles. The implant has shown superb stability for all ranges of vision in patients implanted at least 4 years earlier. Studies are ongoing to verify its intraocular movement with near effort.
Risks of Intraocular Procedures
The complications of intraocular refractive procedures may be uncommon, but their consequences can be devastating. Hemorrhage, infection, retinal detachment, and persistent edema of the cornea or retina are all possible with lens implantation procedures. Phakic intraocular lens procedures carry the additional risk of cataract formation, although this occurred in less than 5% of patients in the respective FDA trials.
Your cornea (the outside part of the eye) and the eye’s natural lens (inside your eye) work together to focus light that comes into your eye. The lens, which is flexible when you are younger, becomes increasingly inflexible as you mature, often after you’ve passed the age of forty. Consequently, you have a difficult time focusing on objects. This condition is known as presbyopia.
The onset of presbyopia has traditionally meant that you are relegated to using glasses for clear vision. What’s more, even those individuals who’ve received laser vision correction will eventually become presbyopic and need glasses or contacts to restore their full range of sight.
PRELEX offers a solution. Unlike procedures that focus on changing the shape of the cornea, PRELEX works on the lens inside the eye. Consequently, your vision after the procedure will be stable and unlikely to change over time. In addition, cataract surgery will not be necessary later in life. The multifocal lens that is used to replace your eye’s natural lens will provide you with clearer vision at all distances, giving you little or no dependence on traditional or progressive bifocal glasses.
If you would like to know more about Prelex in Wisconsin or more specifically about the surgeons doing Prelex in Eau Claire WI. Please fill out our contact form and our certified Prelex surgeon will be happy to answer any questions.
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