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I'm looking forward to getting rid of my reading glasses. Plus, I’ll never need cataract surgery!”

Surgery Options

Presbyopia Lens Replacement Surgery

About


If you have developed noticeable presbyopia symptoms and don’t want to wear reading glasses, bifocals or contact lenses anymore and if your are over age 45 or have begun to develop cataracts, presbyopia lens replacement surgery (also called refractive lens exchange) may be a good option to consider. Talk with your doctor about whether presbyopia lens replacement surgery is right for you.

Presbyopia lens replacement surgery is based on cataract surgery, one of the safest and most effective procedures practiced today. During the procedure, the natural lens in your eye is replaced with an advanced artificial lens, called an intraocular lens or IOLs.

The surgery is a presbyopia treatment but it also addresses cataracts at the same time, so you won’t have to have another surgery later in life. You can often also correct nearsightedness, farsightedness or astigmatism at the same time, as well, so that you will have excellent vision at all distances-even without glasses or contacts.

There are a few options for presbyopia lens replacement surgery. Which approach is right for you depends on your lifestyle as well as your medical needs. Your ophthalmologist will help you choose:

How presbyopia lens replacement surgery works

    Presbyopia lens replacement surgery typically takes 30 to 45 minutes, although you should plan to be at the doctor’s office for two to three hours total. Most patients experience little or no pain or discomfort and do not see the procedure taking place.

    These days, virtually all lens replacements surgeries performed in the U.S. remove the natural lens using a technique called phacoemulsification. First the surgeon makes a tiny incision at or near the cornea. A very small ultrasound device then removes the natural lens, and a new intraocular lens (IOL) is inserted. Because of the size and location of the incision, few (if any) stitches are needed, and the eye heals rapidly.

    With phacoemulsification, more than 97% of patients are restored to their everyday activities with significantly improved vision and without any complications.

Choosing your intraocular lenses

    Many important factors will affect which intraocular lenses are the right choice for you, including:

    • How do you feel about continuing to wear glasses or contact lenses after your lens replacement surgery? Would you prefer not to need glasses or contacts?
    • Do you have an astigmatism?
    • How important is good night vision to your lifestyle?
    • In general, how well do you adjust to changes and learn new skills?

    Your doctor may also ask you:

    • What activities or tasks are necessary to your daily life? To your job?
    • What hobbies do you currently enjoy or would like to engage in most often?
    • During which activities would you find glasses the most inconvenient or aggravating?

    Read more about each type of lens to understand how your answers to these questions will affect your choice of IOL.

Multifocal intraocular lenses

    Multifocal intraocular lenses have special features that give you good near, intermediate and distance vision-all in one lens. Multifocal intraocular lenses give you a good chance of living glasses-free for the majority of your activities after surgery.

    A multifocal IOL resembles a bulls-eye target, with concentric circles for near, intermediate and distance vision. Your brain automatically zeros in on the range of vision you need-so you can see objects well at all distances.

    Multifocal intraocular lenses are an excellent choice if you:

    • Want to reduce your dependence on glasses or contacts as much as possible.
    • Do not have astigmatism, do not mind wearing corrective lenses for your astigmatism or are willing to consider additional surgeries such as LASIK or limbal relaxing incisions.
    • Are less comfortable adapting to change and learning new skills.
    • Are willing to risk having some minor night vision symptoms (see outcomes for more information.)

    If you wish to reduce your dependence on glasses or contacts but also feel that good night vision is extremely important and adapt more easily to change, you might consider accommodative intraocular lenses or IOL monovision (see below).

Accommodative intraocular lenses

    Accommodative lenses can move in response to your eye muscles, similar to the way the natural eye lens does, providing excellent distance and intermediate vision and functional near vision.

    When you look at something far away, the muscles in your eye relax and allow the IOL to assume a flat position. When you shift your gaze to something up close, the muscles push on the lens, which causes it to move or flex so you can see well at close range.

    Accommodative intraocular lenses are an excellent choice if you:

    • Want to reduce your dependence on glasses or contacts.
    • Do not have astigmatism, do not mind wearing corrective lenses for your astigmatism or are willing to consider additional surgeries such as LASIK or limbal relaxing incisions.
    • Are comfortable adapting to change and learn new skills easily.
    • Feel that good night vision is very important to you.

IOL monovision

    With IOL monovision, one eye receives a lens for distance vision, while the other receives a lens for near vision. Once you’ve adjusted to monovision, your brain effortlessly selects the image you want at each moment, so you see well at near and far distances.

    This techniques uses monofocal lenses, rather than a multifocal or accommodative lens. Monofocal lenses provide clear vision at one distance-near, intermediate or long distance. Usually, when you have monofocal lenses, you have to wear glasses for any distance other than the distance for which your lens is designed. However, monovision combines lenses focused for different distances to give you clear vision without corrective lenses at any distance.

    There are two types of monofocal lens-standard intraocular lenses and toric intraocular lenses. Until fairly recently, everyone who had lens replacement surgery received a standard IOL because it was the first type of artificial lens created. Toric IOLs are similar to standard IOLs in that they only give clear focus at one distance, but toric IOLs can also correct astigmatism.

    IOL monovision is an excellent choice if you:

    • Want to reduce your dependence on glasses or contacts as much as possible.
    • Would prefer not to have an additional surgery to correct your astigmatism or do not have astigmatism.
    • Are comfortable adapting to change and learn new skills easily.
    • Feel that good night vision is very important to you.

    If you haven’t tried monovision before but are interested in this approach, your doctor can help you try monovision in advance using specialized contact lenses. This is an important step to confirm you would be able to adjust easily.

Learn more about typical outcomes of presbyopia lens replacement surgery with all types of IOLs.

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Glossary

Not sure what a particular term means? Click on words in bold to pull up the glossary tab.

FAQ

Is presbyopia related to cataracts?

    Presbyopia and cataracts are separate conditions. However, both conditions occur slowly over time, so many people develop both conditions as they get older.

What is the lifespan of an IOL? Can an IOL ever "go bad?"

    As a general matter, IOLs do not expire or "go bad." While some patients have experienced problems with individual lenses, IOLs are made of durable materials and you can reasonably expect your new lenses to last throughout your lifetime.

Glossary Entries

Accommodative lens
A type of intraocular lens (artificial lens implanted in the eye in place of or in front of the natural lens to improve focus and correct vision problems). Has a fixed focal point but physically changes shape inside the eye in response to eye muscle movements to adjust for clear vision at near, intermediate or far distances.

Astigmatism
Common vision problem and type of refractive error. Caused by either irregularity in the curvature of the cornea or the lens of the eye. People with astigmatism generally have difficulty seeing fine details at all distances. Treated with corrective lenses, laser vision correction or toric IOLs.

Bifocals
Eye glasses that combine two lenses made for focusing at different distances. Typically the upper lens provides clear distance vision and the lower lens clear close vision for reading and seeing fine details.

Close or near vision
Vision that allows you to see objects close up well, sometimes called “reading vision.”

Cataract
Clouding of the eye's lens that blocks passage of light to the retina, resulting in impaired vision. Often a result of normal aging, cataracts form when protein clumps cloud areas of the eye's lens. As the cataract progresses, vision worsens and often requires surgical replacement of the damaged lens with an artificial one.

Cornea
Clear, curved surface at the front of the eye through which light enters the eye. Along with the sclera (the white part of the eye), provides external protection for the eye. Often called the window of the eye. During many types of vision correction surgery, such as LASIK, the cornea is reshaped to reduce or eliminate the main types of refractive error - nearsightedness, farsightedness and astigmatism.

Distance vision
Vision that allows you to see objects far away.

Farsighted, farsightedness (or hyperopia)
Common vision problem and type of refractive error. Caused by too little curvature of the cornea or too little distance between the front of the eye and the retina at the back. Both structural defects cause light entering the eye to focus incorrectly on the retina, resulting in blurred close-up vision. Treated with corrective lenses, laser vision correction or multifocal or accommodative IOLs.

Intermediate vision
Vision that allows you to see objects at arms-length well, including computer screens and car dashboards.

Intraocular lens (IOL)
Artificial lens made of plastic, silicone or acrylic. Designed to be implanted in the eye in place of or in front of the natural lens to improve focus and correct vision problems, such as cataracts and presbyopia.

Lens
The transparent disc behind the pupil that brings light into focus on the retina. As the eye ages, the lens often becomes cloudy and is called a cataract.

Monofocal (or "standard") intraocular lens
Type of intraocular lens (artificial lens implanted in the eye in place of or in front of the natural lens to improve focus and correct vision problems) designed to provide clear vision at one fixed focal point (usually for clear distance vision).

Monovision
Vision correction that eliminates need for bifocals or reading glasses by correcting one eye for clear distance vision and the other for clear up-close vision. The brain combines the two images to create clear vision at all distances.

Multifocal intraocular lens
Type of intraocular lens (artificial lens implanted in the eye in place of or in front of the natural lens to improve focus and correct vision problems) designed to include corrections for near, intermediate and distance vision in the same lens.

Nearsighted, nearsightedness (or myopia)
Common vision problem and type of refractive error. Caused by either too much curvature of the cornea or too much distance between the front of the eye and the retina at the back. Both structural defects cause light entering the eye to focus incorrectly on the retina, resulting in blurred distance vision. Treated with corrective lenses, laser vision correction or multifocal or accommodative IOLs.

Ophthalmologist
Doctor of medicine (M.D.) or doctor of osteopathy (D.O.) who is qualified to diagnose, manage and treat all eye and visual system disorders. An ophthalmologist is trained to render total eye care, including vision services, contact lenses, eye examinations, medical eye care and surgical eye care.

Phacoemulsification
Also known as "small incision cataract surgery" or "phaco." Used in the majority of cataract surgeries performed today. Involves making a small incision on the side of the cornea and inserting a tiny probe that emits ultrasound waves to soften and break the lens of the eye into pieces, which are then suctioned out.

Presbyopia
Also called age-related focus dysfunction. Common vision problem that develops naturally over time. Characterized by loss of the eye's ability to focus at close distances or on fine details. Treated with reading glasses, contact lenses, presbyopia laser vision correction (also called LASIK monovision) or presbyopia lens replacement surgery.

Toric lens
Type of intraocular lens (artificial lens implanted in the eye in place of or in front of the natural lens to improve focus and correct vision problems) designed to correct moderate to severe astigmatism.

Ultrasound, ultrasonic energy
High frequency sound waves used during cataract surgery to break up the eye's natural lens so that it can be easily removed and replaced with an intraocular lens (artificial lens implanted in the eye in place of or in front of the natural lens to improve focus and correct vision problems).

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