Dr. Iskander specializes in custom refractive cataract surgery. This means minimizing preexisting refractive error (i.e. prescription) as much as possible during cataract surgery, lessening our patients’ dependence on glasses after surgery. Besides Dr. Iskander’s surgical skills, this also requires attention to details during the preoperative assessment. Your particular goals and lifestyle are major factors of which intraocular lens will best suit you. Intraocular lenses are measured using laser interferometry with the Carl Zeiss IOL master. In dense cataracts, immersion A-Scan ultrasonography is also used to confirm the intraocular lens implant measurements.
There are many types of IOLs on the market now and new ones are still under development, including lenses to correct for astigmatism, block UV light, and a range of other specific characteristics. Very few insurance carriers cover specialty lenses. Each of these lenses require specific training and certification for implantation.
A monofocal IOL is the traditional IOL approved by the FDA in 1981. It is a single focus lens that generally provides good distance vision, requiring the recipient to wear glasses or bifocals to have good near and intermediate vision. When cataracts are present in both eyes, patients may elect to have both eyes implanted with IOL’s that correct for distance. This provides good distance vision, but patients will require reading glasses for up close functions. Patients may elect to have one eye implanted with a near lens and the other with a far lens, a technique called Monovision, which many contact lens wearers are already familiar with. Dr. Iskander uses the most advanced monofocal intraocular lenses available, the wavefront optimized lenses, whenever possible. These intraocular lenses have the best potential for visual quality and for better night vision.
These are newer IOLs that allow for greater range of vision and decreased dependency on glasses or contacts. The best part of these accommodating lenses is that they correct for presbyopia, which is the stiffening of the eye’s lens and superciliary ligaments that occurs for everyone as they age. These lenses work in different ways. Depending on your visual needs and characteristics, Dr. Iskander will make sure you understand the options and help you make the most informed decision possible. It is important to understand that although these lenses give more ranges of vision, the visual outcome cannot be compared to the natural lens of a perfectly seeing eye at a young age where the eye has perfect ranges of vision. Patients may be spectacle free for most of the time, however, they may still need glasses for some hard visual tasks like night driving or reading, especially in dim illumination or reading very fine print. Here is a very general overview of some of the lenses Dr. Iskander prefers.
Tecnis Multifocal Lens
The Tecnis® multifocal lens is designed to help correct astigmatism and/or presbyopia during cataract surgery. Like other IOLs, this lens makes the recipient more independent by reducing or eliminating his or her dependence on spectacles. Patients who spend a lot of time indoors will find that they can see better in dim light, and those who spend more time outdoors will find that their visual acuity is improved. Tecnis® Multifocal provides good vision in low light environments, a greater range of good vision (near, far, etc.), and has a very high rate of patient satisfaction. About nine out of ten Tecnis® patients report never needing to wear glasses for any activities.
Tecnis Symfony IOL
The Tecnis Symfony® Lens is designed to reduce or eliminate the need for reading glasses or bifocals after undergoing cataract surgery. The Tecnis Symfony® lens is comprised of a multifocal lens design, which has multiple power rings that help patients see at various distances. The Symfony IOL also is designed to reduce glare and halos, especially while driving at night. The Tecnis Symfony® design allows for an extended range of vision, providing a new option for patients that may result in better vision across a broader range of distances. This new lens significantly reduces any glare and halo effect, producing approximately the same amount of night vision issues as monofocal lenses, which is close to zero.
Abbott Pharmaceuticals also developed the Symfony® Toric lens, which can help patients with astigmatism reduce or eliminate their need for reading glasses or bifocals after cataract surgery.
Click HERE to learn more about the Symfony Lens.
ReSTOR Multifocal IOL
An apodized diffractive lens with multiple zones, which responds to the way light is focused in the eye at various distances – the center is optimized for near vision, with a gradual tapering to the outer edge of the lens that is optimized for distance. The ReSTOR lens provides excellent far away and close-up vision. It provides reasonable intermediate vision (computer distance). It functions almost like glasses with bifocals. AcrySof ReSTOR was approved by the FDA in 2005. Dr. Iskander uses the latest generation, the ReSTOR aspheric IOL. This is a wavefront optimized intraocular lens that improves on the previous generation. The ReSTOR IQ currently comes in 2 versions, for maximum optimization of near vision.