Refractive Cataract Surgery

What is Refractive Cataract Surgery?

Refractive eye surgery is any eye surgery used to decrease or eliminate dependency on glasses or contact lenses. This can include various methods of surgical remodeling of the cornea or cataract surgery. The most common methods today use excimer lasers to reshape the curvature of the cornea. Successful refractive eye surgery can reduce or cure common vision disorders such as nearsigntedness, farsightedness, and astigmatism.

The objective of basic cataract surgery is to simply restore your best-corrected vision to its pre-cataract status, which may involve glasses. In basic cataract surgery, most patients’ vision is improved with a monofocal intraocular lens (IOL) focused at distance. The power of the lens you require is typically determined by a separate keratometer and ultrasound device.While results are generally excellent, any preexisting astigmatism and any postoperative farsightedness or nearsightedness is corrected with glasses. If the lens is focused at distance, you will need to wear reading glasses or bifocals for near vision and some intermediate vision.

In contrast, the goal of refractive cataract surgery is not only to restore your pre-cataract vision, but also to minimize your dependence on glasses.

First, we use an instrument such as the Humphrey-Zeiss IOL Master in addition to ultrasound to perform your eye’s measurements, which increases the accuracy of the measurements to minimize significant farsightedness or nearsightedness after cataract surgery.

Then, we augment your preoperative measurements with corneal topography, a computerized three-dimensional mapping of your eye’s surface. This allows us to assessment  any astigmatism and plan the appropriate treatment.

Lastly, you may consider a premium toric or multifocal IOL as opposed to a traditional spherical IOL.

What are the lens options?

We give our patients three lens options:

Monofocal IOL.

We use the “new technology” new aspheric monofocals, which are designed to give patients without astigmatism the clearest distortion-free vision within a set range, usually distance. We use the AcrySof IQ and TECNIS 1-Piece New Technology IOLs.

Premium Astigmatism Correcting Monofocal IOL.

This advanced technology lens is a variation of the traditional monofocal lens. As the name implies, this lens gives patients with astigmatism the clearest, distortion-free vision, again within a set range, usually distance. We use the AcrySof Toric Advanced Technology IOL.

The Premium Multifocal IOL.

Our most innovative lens is considered an “advanced technology” IOL and uses highly specialized optics to focus images over a wide range of distances from near to far. Our favorite is the TECNIS Multifocal, which provides pupil-independent reading and distance vision.

Can Monofocal IOLs help me read without glasses?

The most popular option is monovision, or blended vision, which focuses your dominant eye for distance and your non-dominant for near vision. Although near-depth perception and night driving without glasses might be compromised, monovision it is a good option for many people, especially those experienced with blended vision via contact lenses.

A much less popular option is to focus both of your eyes for near vision. This obviously requires you to wear glasses for all distance-related visual tasks, but it is an excellent option for avid readers or hobby enthusiasts who do a lot of close work.

If I have astigmatism can I have the TECNIS Multifocal?

To do so, we must treat your astigmatism. This may involve a simple extra incision or two (corneal relaxing incisions), typically performed with the LenSx laser or might involve more elaborate reshaping a later date with the excimer laser that is used in the popular LASIK and PRK procedures.

Am I settling if I don’t choose the AcrySof Toric or TECNIS Multifocal lenses?

Absolutely not. First, if you do not have astigmatism, the AcrySof Toric is not indicated. Second, the TECNIS Multifocal may not be an appropriate choice for you. Third, you benefit from the technology and skills we use to perfect the premium lenses even if you do not choose the Toric or Multifocal.

All of our lenses are state-of-the-art. “Premium” simply describes lenses with additional features considered above and beyond the what insurance carriers consider standard.

Are there other new technologies?

Yes. The WaveTec Optiwave Refractive Analysis System (ORA), a revolutionary diagnostic device, provides real time refractions of your eye that are performed during surgery to fine tune your proper lens implant power. This extra attention to detail is particularly important if you seek true visual freedom from glasses for any of your activities. It gives you the very best potential unaided vision and is therefore included in all of our refractive cataract surgery procedures.

ORA is critical if you have had previous vision correction such as LASIK, PRK, and RK. These procedures decrease the accuracy of our lens power formulas, so we adjust our calculations to compensate for this. Fortunately, ORA dramatically improves our ability to predict the required power in challenging situations. In fact, many consider ORA the standard of care for all post-refractive patients.

It is also important to note that while ORA typically benefits all of our patients, it is especially helpful if you have unusually long or short eyes. The on-demand wavefront refraction and optimized algorithms of ORA can often be the key to your best result.

This is all a bit overwhelming. Help!

We understand. That’s why our extensive preoperative consultations are far from ordinary. We block an entire hour for every preoperative work-up to gather all the information we need, and to ensure that you have the information you need to make the very best decision.

While we ask that you prepare for the consultation by becoming familiar with our educational literature, we do not expect you to arrive with a decision. Only after a thorough discussion of the best options for you will you be asked to finalize our plan. Of course, we will guide your decision based on our experience and professional judgment.

The Bottom Line.

Current technologies for cataract surgery or refractive lens have made a giant leap forward. The synergy of our laser precision and accuracy coupled with our premium lenses offers the opportunity to not only restore but truly enhance your vision.