Until recently, life without reading glasses or bifocals was not an option for most cataract patients. You now have an option. The multifocal IOL is a unique technological innovation that can provide you with quality vision throughout the entire visual spectrum – near through distance – with increased potential independence from reading glasses or bifocals!

As we perform daily activities such as reading, watching television or working at the computer, our eyes are constantly focusing on objects at varying distances – up close, far away and everything in-between. The ability to quickly change focus throughout this range of vision is called accommodation. Unfortunately, this ability diminishes as we grow older¹, causing us to become dependent on bifocals or reading glasses. However, the multifocal IOL was designed to provide quality near to distance vision by combining the strengths of apodized diffractive and refractive technologies. Similar technology has been used for years in microscopes and telescopes to improve image quality, and has now been patented for use in intraocular lenses.

Apodized Diffractive Technology

Apodization is the gradual tapering of the diffractive steps from the center to the outside edge of a lens to create a smooth transition of light between the distance, intermediate and near focal points. Diffraction involves the bending or spreading of light to multiple focal points as it passes through the lens. On the multifocal IOL, the center of the lens surface consists of an apodized diffractive optic. This means that the series of tiny steps in that center area work together to focus light for near through distance vision.

Refraction involves the redirection of light passing through the lens, to focus on the retina. The refractive region of the multifocal IOL bends light as it passes through the lens to a focal point on the retina. This outer ring of the multifocal IOL surrounds the apodized diffractive region and is dedicated to focusing light for distance vision.
For most patients, the multifocal IOL delivers excellent near and distance vision, and good intermediate vision without reading glasses or bifocals. In fact, with this increase in vision quality, multifocal IOL patients would be able to pass the visual acuity portion of the driver’s license exam in most states.

Finally, quality vision and true freedom from glasses for 80% of patients

During the Amultifocal IOL clinical studies, patients experienced life style enhancement through quality vision, and greater freedom from reading glasses and bifocals. In fact, according to the multifocal IOL clinical studies, four out of five patients with the multifocal IOL reported never wearing glasses following cataract surgery in both eyes, compared to only 1 out of 10 patients with monofocal lenses. This is the highest level of freedom from glasses ever demonstrated in an IOL clinical trial.

During the Amultifocal IOL clinical studies, patients experienced life style enhancement through quality vision, and greater freedom from reading glasses and bifocals. In fact, according to the multifocal IOL clinical studies, four out of five patients with the multifocal IOL reported never wearing glasses following cataract surgery in both eyes, compared to only 1 out of 10 patients with monofocal lenses. This is the highest level of freedom from glasses ever demonstrated in an IOL clinical trial.

Additionally, multifocal IOL clinical studies indicated that nearly 94% of the study subjects were so satisfied with their new quality vision that they would have the multifocal IOL implanted again.

As with any surgical procedure there are inherent risks, and your results cannot be guaranteed. Your doctor will provide you with more detailed information about the potential risks and benefits to help decide whether cataract surgery and the multifocal IOL is right for you. For additional details, please contact Tukel Eye Center.

Warnings

You may have some visual effects when several images are being focused at the same time. These may include rings or circles around lights at night.

You may have some difficulty in your ability to distinguish an object from a dark background. This may be more noticeable in areas with less light. Therefore, you should take extra care when driving at night.

Your eye doctor should consider the following points before implanting the multifocal IOL:

To achieve your best vision after cataract surgery, your doctor must determine the lens power best suited for your needs.

The front surface of your eye may be irregular in shape (astigmatism) before and after cataract surgery. The amount of astigmatism you have may affect your results after surgery.

Consult your doctor for more information concerning cataract surgery and the multifocal IOL lens.

Multifocal IOL Brief Statement

CAUTION: Federal law restricts this device to sale by or on the order of a physician.

INDICATIONS: The multifocal IOL Apodized Diffractive Optic Posterior Chamber Intraocular Lens (IOL) is intended for primary implantation for the visual correction of aphakia secondary to removal of a cataractous lens in adult patients with or without presbyopia, who desire near, intermediate and distance vision with increased spectacle independence. The lens is intended to be placed in the capsular bag.

WARNINGS: Careful preoperative evaluation and sound clinical judgment should be used by the surgeon to decide the risk/benefit ratio before implanting a lens in a patient with any of the conditions described in the Directions for Use labeling. Some adverse reactions that have been associated with the implantation of intraocular lenses are: hypopyon, intraocular infection, acute corneal decompensation, macular edema, pupillary block, retinal detachment, and secondary surgical intervention (including but not limited to lens repositioning, biometry error, visual disturbances or patient dissatisfaction). As a result of the multifocality, some visual effects (halos or radial lines around point sources of light at night) may also be expected due to the superposition of focused and unfocused multiple images. A reduction in contrast sensitivity may also be experienced by some patients, especially in low lighting conditions such as driving at night. In order to achieve optimal visual performance with this lens, emmetropia must be targeted. Patients with significant preoperative or expected postoperative astigmatism >1.0D may not achieve optimal visual outcomes. Care should be taken to achieve IOL centration, as lens decentration may result in a patient experiencing visual disturbances under certain lighting conditions.

PRECAUTIONS: Do not resterilize. Do not store over 45° C. Use only sterile irrigating solutions such as BSS® or BSS PLUS® Sterile Intraocular Irrigating Solution. Clinical studies with the multifocal IOL indicated that posterior capsule opacification (PCO), when present, developed earlier into clinically significant PCO. Studies have shown that color vision discrimination is not adversely affected in individuals with the Natural IOL and normal color vision. The effect on vision of the multifocal IOL in subjects with hereditary color vision defects and acquired color vision defects secondary to ocular disease (eg,glaucoma, diabetic retinopathy, chronic uveitis, and other retinal or optic nerve diseases) has not been studied. The long-term effects of filtering blue light and the clinical efficacy of that filtering on the retina have not been conclusively established.

ATTENTION: Reference the Physician Labeling/Directions for Use for a complete listing of indications, warnings, and precautions.

For us to see clearly, light rays enter our eyes through the clear cornea, pupil and lens. These light rays are focused directly onto the retina, the light-sensitive tissue lining the back of our eyes.

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The retina converts light rays into impulses that are sent through the optic nerve to our brain, where they are recognized as images. Seventy percent of the eye’s focusing power comes from the cornea and 30% from the lens. While problems with the cornea (the clear front window of your eye) or the lens may prevent light from focusing properly on the retina, a refractive error may prevent us from seeing clearly in certain situations, despite having a clear cornea an lens.

Today, many people are choosing to correct their refractive errors with options other than eyeglasses or contacts.

Various forms of refractive surgery-such as LASIK – improve vision by permanently changing the shape of the cornea to redirect how light is focused onto the retina. In some cases, instead of reshaping the cornea, the eye’s natural lens is either replaced or enhanced by an implanted intra ocular lens (IOL) that helps correct vision.

The eye’s lens, which contributes to your focusing power, has four primary functions:

  • Transparency: to provide a clear medium through which light rays from an object can reach your retina;
  • Optical: To focus a sharp image of an object onto the retina;
  • Anatomic: To create a functional barrier between the front (anterior) and back (posterior) segments of the eye;
  • Accommodation: To vary the eye’s refractive power, providing clear images of objects over a wide range of near, far and intermediate distances.

For People with cataracts, the lens of the eye becomes cloudy. Light cannot pass through it easily, and their vision is blurred. Cataract surgery is used to remove the cloudy lens and replace it with a clear IOL.

In some cases, people without cataracts who want to reduce or eliminate their need for glasses and who may not be candidates for LASIK may choose to an IOL implanted in a procedure called Refractive Lens Exchange (RLE). This procedure may be used to correct moderate to high degrees of myopia (nearsightedness), hyperopia (farsightedness) and presbyopia (the inability to focus at near distances with age).

When the natural lens is removed during cataract surgery, or removed as a form of refractive surgery, IOL’s are inserted to take the place of the natural lens. IOL’s are artificial lenses surgically implanted in the eye, replacing the eye’s natural lens. These lenses help your eye to regain its focusing and refractive ability.

The most common type of implantable lens is the mono focal, or fixed – focus lens, which is intended to give clear vision at one distance. In order to see clearly at all ranges of distances, one is required to wear glasses or contact lenses.

Other types of lenses which are gaining in popularity are the multi focal and accommodative lenses. These IOL’s may be used to treat myopia, hyperopia and prebyopia, and may allow less reliance on glasses and/or contact lenses to see clearly at both distance and near.

A multi focal IOL has several rings of different powers built into the lens. The part of the lens (ring) you look through will determine if you see clearly at a far, near or intermediate distance (this is sometimes called pseudo-accommodation).

 

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Two types of multi focal IOL Lenses

An accommodative IOL is hinged to work in coordination with the eye muscles. The design allows the accommodative lens to move forward as the eye focuses on near objects, and move backward as it focuses on distant objects.

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The IOL is implanted in an outpatient surgical procedure that takes approximately 15 – 20 minutes.

In addition to a pre-operative eye exam, measurements of the eye are taken to give the surgeon the necessary information to perform the procedure. These measurements include:

  • Refractive error measurement;
  • Pupil evaluation and size measurement;
  • Measurement of the curvature (keratometry) and overall shape of the cornea (topography);
  • Measurement of the length of the eye from the cornea to the retina (called an A-scan);
  • Calculations to determine the correct power of lens (IOL) to use.

After the eye is numbed with topical or local anesthesia, one to three small incisions are made close to the edge of the cornea. A tiny, high-frequency ultrasound instrument is inserted into the eye to break up the center of the eye’s natural lens. The natural lens is then gently vacuumed out through one of the incisions. The IOL is folded and inserted through the same incision that was used to extract the natural lens and placed into the “capsular bag” that originally surrounded the natural lens.

 

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After the procedure, these incisions are usually “self-healing,” requiring no stitches. Once the multi focal or accommodative IOL is implanted, your eye can focus on near, intermediate and far distances

It should be noted that the focusing ability of the lens may not be fully realized for six to eight weeks after the procedure. In addition, your eye must re-learn how to focus on objects at various distances in order to see clearly. Patients who are pilots, night drivers or those who spend a lot of time in front of the computer may not be good candidates for the multi focal or accommodative IOL’s. Patients who are intolerant of a small amount of glare and/or halos around lights, especially at night, may not be good candidates for these types of lenses.

Some of the risks and possible side effects of IOL implantation include:

  • Overcorrected or under-correction (with a possible need for a re treatment);
  • Infection;
  • Increased floaters or retinal detachment;
  • Dislocation of implant;
  • Halos and glare;
  • Decreased contrast sensitivity;
  • Clouding or hazing of a portion of the IOL (called posterior capsular opacification);
  • Dry eye;
  • Possible need for additional surgery to fine-tune the IOL prescription;
  • Loss of vision
While multi focal or accommodative IOL’s do offer some people an alternative to dependence on glasses or contact lenses, they are not recommended for everyone. You may not be a good candidate for these IOL’s if you are generally satisfied with glasses or contact lenses and unwilling to accept the uncertainty in the outcome of the surgical procedure. Even after the procedure, certain people may still need to wear glasses or contact.

Surgery, contacts and glasses each have their benefits and drawbacks. The best method of correcting your vision should be decided after a thorough examination and discussion with your ophthalmologist (Eye M.D.) Discuss your needs and lifestyle with your ophthalmologist to determine the best procedure for you.

The American Academy of Ophthalmology is an organization of 25,000 ophthalmologists (Eye M.D.’s) dedicated to preserving eye health and sight.