Refractive cataract surgery vs traditional cataract surgery
Posted , 6 users are following.
Hello, Can someone explain the difference between refractive cataract surgery vs traditional cataract surgery? Many thanks.
0 likes, 35 replies
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Notes on Refractive cataract surgery vs traditional cataract surgery
maura04015 judith93585
Edited
These paragraphs from the ucf article make it sound to me as if they're talking about multi-focal toric lenses:
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"This is why refractive cataract surgery is such a groundbreaking advancement. This procedure utilizes complex, multifocal IOLs to replace the natural lens and restore the eye’s ability to perceive nearby and far-away objects—without the need for glasses or toric contact lenses.
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*** to be an eligible candidate, the patient has to have an eyeglass or toric contact lens prescription that falls within a certain range to mitigate potential risks and reduce the chances of poor refractive outcomes."
Guest maura04015
Posted
There is nothing new or groundbreaking about multifocal IOLs. Yes they continue to evolve and improve but they have been around for a long time. What the website doesn't seem to mention is that there are pros and cons to ALL IOLs, including multifocal IOLs. You trade off image quality for focus range. Yes, Mutifocal IOLs will give you a wide range of functional vision without glasses but vision quality is not as good as with a monofocal. And they have side effects at night like halos around lights. And they have contrast loss. And you may still need readers in low light. Monofocal IOLs on the other hand have great image quality and contrast but it's only optimized for one distance so you will need glasses a lot more. Unfortunately there is no free lunch.
RonAKA Guest
Posted
" Monofocal IOLs on the other hand have great image quality and contrast but it's only optimized for one distance so you will need glasses a lot more."
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That is why mini-monovision is used. You get the advantages of monofocal lenses and the depth of focus if each eye is optimized differently.
maura04015 Guest
Edited
Yup. I didn't say I agree with the article, just that that seems to be what they mean when they talk about refractive cataract surgery. The one firm decision I made early on was no multi-focals for me. I'm just too risk averse.
RonAKA judith93585
Edited
After doing some reading on the use of the term "Refractive Cataract Surgery" I think I now understand better what it is about. It seems to be a collective term for additional services and higher cost IOLs that promise eyeglass free vision. Unfortunately it is not that simple there is a whole range of options you can get when it comes to cataract surgery. The most basic lens is a monofocal, and it certainly provides refractive correction which is optimum at the preselected distance. The most basic version which I believe is still available is a hard lens that cannot be folded for insertion. It requires a larger incision which takes longer to heal and may require a stitch.
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The first step up from this hard lens is a foldable lens, which requires a smaller incision and heals faster. Some of these lenses are non aspherical and some are aspherical. The theoretical best vision is with the aspherical corrected lenses. Examples would be the Tecnis 1 or Clareon. Some jurisdictions or insurance companies will charge a small premium to get the aspheric version. It is probably worth it. It is certainly worth it to get the soft foldable style.
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The next issue is astigmatism. If you want to be eyeglasses free for at least some distances you should consider a toric lens to correct astigmatism if it is significant. When they measure your eyes they should tell you what the residual astigmatism will be. Generally if it is over 0.75 D cylinder it is worthwhile. But, on the other hand if you plan to wear glasses, astigmatism can be better corrected with the eyeglass lens. Where I am a toric lens costs $1,100 more per lens, so it is worth considering whether you would benefit from it or not.
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The next issue is presbyopia which means having distance vision but not near vision. As we age this is common. The standard solution which about 95% of people select is to use a monofocal lens which gives vision at distance and down to about 2-3 feet. Then they use reading glasses to correct the presbyopia. The down side is that you have to keep putting them on and taking them off. Or, if you get progressive glasses you can correct all the residual refraction error including astigmatism, plus get near vision out the bottom of the lens. Other options are to target near vision with the IOLs in both eyes. Then of course you need glasses, most likely progressives to get distance vision. And the third option that many do not consider is to get the dominant eye corrected for distance, and the non dominant eye corrected for close vision. This is called mini-monovision. All of these options use standard (non premium) lenses unless you get a toric to correct astigmatism. This means there should be no additional costs for lenses (except the toric).
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The last option is to go for an extended depth of focus (EDOF) lens like the Vivity which gives you some closer vision but not a lot. You will get more with mini-monovision at no extra cost. The Vivity can be in the order of $2+K per eye or more. Or for better near vision plus distance vision but with potential side effects like halos around lights and reduced contrast sensitivity in dimmer light, you can select a multifocal lens which will also be 2+K per eye. An example would be the PanOptix.
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There can be some extra services that are offered too. I would go for an optical measurement system like the IOLMaster 700 over the more basic ultrasonic A-Scan method. There may be a Pentacam extra cost if they measure for a toric lens. Worthwhile if you want toric correction.
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ORA is final power measurement in the eye after the natural lens is removed. I would suggest it is only necessary if you have difficult eyes: Very high myopia, very high hyperopia, or prior Lasik surgery.
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Your clinic, or surgeon should have handouts explaining these options along with prices, and should also be willing to discuss them with you.
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Hope that helps some. Ask if you have further questions. But, bottom line is that I would not just sign up for "Refractive Cataract Surgery". It is a step by step process where you select what you want and what you don't want, kind of like buying a new car.
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If you care to say what your objectives are with your vision, I could be more specific as to what the options may be.
judith93585
Edited
Thanks very much for your clear explanation of the various options! I am near sighted and have been wearing glasses or contacts full time since childhood. My most recent thought has been to have both IOLs set to near vision. Seeing clearly for near (reading) or intermediate (computer) vision suits my lifestyle. Wearing glasses for distance (walking and driving) would not be a problem. I have been told by cataract surgeons that I need toric IOLs.
Since I am risk averse, my current preference is for Clareon toric monofocal IOLs due to the potentially lower risk of rotation and PCO.
With regard to mini-monovision, several years ago when wearing contacts, my LE was mildly undercorrected ( mini-monovision by +0.75 diopter). I did not notice the difference in general but decided it might be safest when driving to see optimally with both eyes. It occurs to me that wearing glasses for distance might make that a mute point?
Lynda111 judith93585
Posted
If you are "risk averse," and you want to keep your surgery as simple as possible, skip the toric and wear eyeglasses to correct astigmatism and use the Clareon monofocal set for near, or better yet, intermediate. That is just my opinion. There is no one right way to have cataract surgery done. It is an individual choice.
judith93585 Lynda111
Posted
Thanks Lynda, what is the risk using toric?
RonAKA judith93585
Edited
I'm not Lynda, but I would suggest the risk of using a toric monofocal is about the same as a monofocal only. There are no optical side effects with using a toric lens like there can be with an EDOF or MF lens. The only issue besides cost is getting the lens installed in the correct angular position. I recall that if they are off by only 5 degrees the benefit is significantly reduced. That said toric lenses are very commonly used, and surgeons should be skilled at implanting them in the correct position. It is important to be sure to get an exam 1 day after implantation where the surgeon checks the position to see if it needs to be adjusted.
judith93585 RonAKA
Posted
Thank you!
Lynda111
Posted
What Ron said is correct. The surgeon's skill is especially important here both in marking the eye prior to surgery and centering the toric iol properly. If you have a serious problem with dry eyes that can be a contraindication.
You can Google "toric marking & alignment " for more information.
judith93585
Posted
My most current glasses prescription:
sphere RE -4.75
sphere LE -5.00
cylinder RD +1.00
cylinder LE +1.25
axis RE 007
axis LE 170
Add RE +3.00
Add LE +3.00
I see nothing about an angle...
My plan to have have the IOLs set to near rather than distance. Would glasses still provide the same or better correction when worn for intermediate and distance rather than near?
RonAKA judith93585
Edited
The Axis is the angle. Your prescription has been written in ophthalmologist format with + cylinder. To get it to a normal optometrist format requires some conversion. The conversion would be to:
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RE: Sphere -3.75 D, Cylinder -1.00 D @ 97 degrees
LE: Sphere -3.75 D, Cylinder -1.25 D @ 80 degrees
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The Add is just the addition for reading with a bifocal or progressive eyeglass lens. The +3.0 D is like putting on some +3.0 D readers.
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Your eyes are very similar with moderate myopia, and mild astigmatism. I think your odds are fairly good that you will not need a toric lens. But, you never know for sure until after they are measured, and you get the predicted residual astigmatism from the surgeon.
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If you have the IOLs set for near vision you will need prescription glasses for distance. They will correct for any residual astigmatism. And if you get progressive glasses the astigmatism correction will also be made for near too. However, if you want to be eyeglasses free for near vision then a toric may possibly be needed, although my guess based on your prescription above is that it is likely not necessary. Some astigmatism can actually help with reading.
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Your big question when getting measured for an IOL is to ask what the predicted residual astigmatism will be. If less than -0.75 D then a toric is not justified. Even if it is a bit higher it still may not be justified for reading vision only. I recall @Lynda111 has some significant residual astigmatism and it is giving her some unexpectedly good reading vision with monofocal lenses.