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Correcting presbyopia with new generation intraocular lenses: Which is the right IOL for me?

Cataract surgery is the most common elective surgical procedure worldwide. Depending on the premium intraocular lenses used, one could also be free of one's glasses permanently.
Cataract surgery is the most common elective surgical procedure worldwide. Depending on the premium intraocular lenses used, one could also be free of one's glasses permanently.PHOTO: ISTOCK

Consider these new-generation lenses for your cataract surgery

Cataract surgery patients often have high expectations for their post-operative vision, with many wanting to be free of their glasses permanently. If you’re wondering how this can be done, look no further.

Dr David Goh, medical director and senior consultant ophthalmologist at Novena Bladeless Cataract Surgery & Eye Specialist Centre, answers some common questions about how the latest lens implants options can help achieve this during cataract surgery.

Q: I am planning to have my cataracts removed. With so many lens implants in the market, I'm not sure which to choose. What are some of the latest and more advanced types that I can consider?

A: Intraocular lenses (IOLs) are implants that replace the eye’s natural lenses when they are removed during cataract surgery. In the last decade, premium IOLs can also correct presbyopia, myopia and astigmatism.

Surgeons can now achieve optimal vision with presbyopia-correcting IOLs by matching available technologies with your visual needs in order to modify the degree of your eyes post-operation.

New technologies such as bladeless laser cataract surgery and computer-guided IOL implantation also help enable greater precision.

Share the specifics of your lifestyle with the surgeon. For instance, how do you use your eyes on a daily basis? What special interests do you have? It is important because your surgeon can set your vision where you want it.

For freedom from spectacles and good vision at all distances


Multifocal IOL. PHOTO: NOVENA BLADELESS CATARACT SURGERY & EYE SPECIALIST CENTRE


Trifocal IOL. PHOTO: NOVENA BLADELESS CATARACT SURGERY & EYE SPECIALIST CENTRE

In our daily lives, we need three distances for visual function: 35cm for reading, 66cm for intermediate vision and distance vision.

Pros: In order to achieve vision at all distances without spectacles, multifocal IOLs or trifocal IOLs are commonly used.

Cons: These IOLs may cause night-time glare and haloes during the first few months.

For less glare and haloes at night, with occasional need for reading glasses when tackling very fine prints


Extended Depth of Focus (EDOF) IOL. PHOTO: NOVENA BLADELESS CATARACT SURGERY & EYE SPECIALIST CENTRE

If you do not want to risk night-time glare and haloes, opt for the Extended Depth of Focus (EDOF) IOLs.

Pros: These lenses have an elongated focal area that offer an extended depth of focus, and therefore clear far and intermediate vision.

Cons: Near vision is reasonably clear, however you may need reading glasses occasionally for prolonged reading.

For good far and near vision at a lower cost, with the occasional need for night driving glasses


Monofocal IOL. PHOTO: NOVENA BLADELESS CATARACT SURGERY & EYE SPECIALIST CENTRE

If you find that you are not suitable for multifocal IOLs after discussing with your doctor — whether due to your occupation or corneal quality amongst other reasons — you can consider monofocal IOLs.

Pros: It is possible to achieve freedom from spectacles with the monovision strategy for monofocal IOLs. The monovision strategy fully corrects the dominant eye to zero dioptres (D) for distance, while the non-dominant eye is made -1.75D for reading.

Monovision offers good far and near vision, and monofocal IOLs are also cheaper than multifocal, trifocal or EDOF multifocal IOLs.

Cons: Intermediate vision may not be as good when compared to the intermediate vision offered by multifocal, trifocal or EDOF multifocal IOLs.

For better intermediate vision with monovision IOLs

To address the issue of poorer intermediate vision, which is the limitation with traditional monofocal IOLs, the monofocal plus IOL is a new-generation monofocal IOL to look out for in the market.

Pros: Monofocal plus IOLs offer better binocular intermediate vision than standard monofocal IOLs, without the glare and haloes associated with multifocal IOLs.

Q: How can these procedures be done?

A: The advanced bladeless femtosecond (FS) laser cataract surgery was approved by United States Food and Drug Administration (FDA) in 2010. FS laser replaces the manual process of cutting a cataract by hand using blades and sharp surgical instruments.

The biggest advantage is that the computer-guided FS laser allows the IOL to be perfectly positioned at the centre of your visual axis, which improves your post-operative visual quality.

3D scans and laser precision create perfectly sized and perfectly circular capsule openings for IOLs.

These capsule openings have reproducible, uniformly circular and precise diameters compared to manually created ones. This improves refractive outcomes and increases a patient’s chances of not having to wear spectacles permanently.

In summary...

Multifocal, trifocal IOLs: Provides vision at all distances, but can be associated with glare and haloes at night

EDOF IOLs: Causes less glare and haloes at night, but the patient may have to wear glasses for very fine prints and prolonged reading

Monofocal IOLs: The monovision strategy offers cost advantages, as well as good near and far performances, but the intermediate vision is not as good

Monofocal plus IOLs: Enhances vision at 66cm, providing better intermediate vision for monovision patients

For more information, visit drdavidgoh.com.sg.

Dr David Goh
Medical director and senior consultant ophthalmologist
Novena Bladeless Cataract Surgery & Eye Specialist Centre