Clear lens replacement

For individuals over 40 who are considering refractive surgery to decrease dependence on glasses and contact lenses, clear lens replacement (CLR) is an exciting option. In essence, this procedure entails removing the natural lens of the eye and replacing it with an intraocular lens (IOL) implant. The procedure is essentially the same as a cataract operation with lens implant, however, in this case, the procedure is completed prior to cataract development for the refractive advantage. With the benefit of powerful ultrasonic instrumentation to measure the length of the eye to within 100ths of a millimeter, and sophisticated IOL formulas, ophthalmologists have become very accurate at determining the proper IOL power to decrease post-operative dependence on eyewear.

CLR is a procedure that is more invasive than LASIK, PRK, and Intacs, with consequent greater potential risks. However, CLR may be an excellent alternative to these procedures for people already wearing bifocals or for those who do not qualify for other refractive procedures due to extremes of refractive error. Because CLR requires entering the eye to place the lens implant, the patient has a small risk of infection inside the eye (endophthalmitis) that is not present in the other, above mentioned, refractive procedures (LASIK, PRK, and Intacs). Unlike these procedures, however, CLR avoids any treatment of the cornea and instead changes the refractive power of the eye in a potentially more natural position (i.e., natural lens of the eye). CLR, thus, avoids any significant risk of reduction of contrast acuity.

Because CLR requires removal of the natural lens of the eye, the patient is subsequently unable to focus at near (accommodate). This is why CLR is best suited for patients over 40 who are already wearing bifocals. One potential solution to this problem of accommodative loss is implantation of the Array multifocal IOL implant. This implant allows focusing at both near and far, allowing most patients to read small size print and drive a car without glasses, following implantation of the lens in both eyes. A total of 41% of patients implanted with the Array multifocal lens in both eyes reported that they never wore glasses post-operatively. The drawback of this lens is that approximately 15% of patients have severe difficulty with halos and 11% have severe difficulty with glare. Less than 1% of patients have had such severe visual difficulties following implantation of the Array lens, that they have requested removal of the lens.

A second alternative for patients who are considering CLR, but who do not embrace the notion of wearing reading glasses following surgery, is monovision. With monovision, the traditional monofocal IOL implant is inserted bilaterally, however, the patient's dominant eye is corrected for distance and the non-dominant eye is corrected for near. This choice is also an excellent one, but not necessarily an option that would be tolerated by everyone. An excellent method to determine whether this is a viable option is to correct the eyes in monovision fashion as a trial, prior to consideration of surgery. Those patients that tolerate monovision with contact lenses (or perhaps glasses), will likely tolerate and enjoy this visual solution following surgery with lens implants.

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