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Cataract patients now have the option to have their vision corrected to allow them to see at both near and far distances after cataract surgery! These lens implants provide significantly reduced dependence on glasses for all tasks of daily living, providing a range of focus that laser vision correction cannot achieve. Individuals with visual impairment suffering from cataracts previously had only a mono-focal lens implant option after surgery.

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Multifocal Lens Implants

Multifocal Lens Implants

Some people mistakenly believe that having cataract surgery will enable them to see perfectly without glasses. Having the eye’s natural cataract-clouded lens removed and replaced with a clear artificial lens implant should certainly improve your vision. However, the basic artificial lens is a single, fixed focus lens. It cannot give distance focus one moment and near focus the next (like the eye’s natural lens does in a young person). Thus, even after cataract surgery, eyeglasses are still needed in order to shift the focus of your eye.

You may also need eyeglasses to correct your far distance vision following cataract surgery. There is no guarantee that perfect distance focus will be achieved with surgery. Astigmatism is another reason that distance glasses may be needed at times. The basic lens implant does not correct astigmatism, which is a natural blur resulting from the shape of the cornea. Fortunately, eyeglasses can be used to optimize distance focus just as they do for anyone whose eyes are not in perfect focus naturally.

There is one special type of lens implant- the multifocal- that provides both near and far focus simultaneously and can significantly reduce your dependence on reading glasses. Standard lens implants are called monofocal lenses because they are set to focus at a single location and cannot provide the ability to see at multiple different distances without glasses.

Multifocal lens implants are designed to produce a dual focus. Part of the lens is set for distance focus, and part of the lens is set for near. The design is entirely different from bifocal eyeglasses where you look through the top portion for distance and the bottom area for near. With a multifocal lens implant the brain automatically finds the correct focus.

Like the basic lens implant, the multifocal is safe. However, compared to a standard lens implant set for distance focus only, a multifocal improves your ability to see up close without glasses. Not everyone with a multifocal lens implant can read equally well without glasses. There are many factors that cause this individual variability. The ability to read without glasses is certainly better if both eyes have a multifocal lens. The younger and healthier the retina is, the better the reading ability will be. Interestingly, the ability to read without glasses improves over time for most patients.

Because the lens implant does not correct it, any astigmatism you have will reduce your ability to see both far and near without glasses. While there is no guarantee that you will read as well without glasses as you desire, multifocal lenses give you much better odds of doing so, compared to standard lens implants.

Is the Multifocal lens implant right for you?

While the multifocal lens implant should reduce your dependence on eyeglasses, there are some tradeoffs. The different focal zones of the lens can create the appearance of halos or ghost images around lights at night.

Fortunately, seeing halos is a distraction that doesn’t obscure the focus, and the vast majority of patients grade them as being “minor” or “minimal”. The halos will become much less noticeable over time as your brain gradually adapts to them. However, not everyone can adapt as easily as others. In the rare event that the haloes are too bothersome, the multifocal lens can be surgically removed. Because this entails risk, this is more of a last resort.

Reducing the need to wear glasses is not a priority for everyone, and since there are some tradeoffs and added costs, the multifocal lens implant would not be important for these individuals.

Can the multifocal lens be implanted in just one eye?

Yes, this is possible when the other eye already has a standard implant, or when there is no cataract in the opposite eye. However, the ability to see both far and near without glasses is better when you have a multifocal lens in both eyes. With a multifocal lens implant in one eye, the brain simply integrates all of the vision that you get with both eyes open. For this reason, you shouldn’t constantly compare one eye to the other. Some individuals may take longer than others to adapt to this situation. With a multifocal lens in one eye, you should still have more ability to see things close up, as compared to if you had received a standard single-focus lens implant.

Can patients without cataracts have multifocal lens implants?

Many people are interested in surgical methods to reduce their dependence upon eyeglasses and contact lenses. Laser eye surgery, such as Lasik, is the most common way to correct nearsightedness if one is under the age of 40. However, for patients over the age of 50, laser surgery by itself is less advantageous. By this time of life, any method that corrects your distance vision (including contact lenses, Lasik, or a standard lens implant) will not work for reading up close without glasses.

The multifocal lens implant is the only technology that can allow a 50+ year old eye to have focus both far and near without glasses. For this reason, people over the age of 50 wearing strong prescription glasses may elect to have multifocal lens implants in order to see much better without glasses. However, with no cataract present, health insurance covers none of the costs. Because the natural lens must still be removed before implanting a multifocal lens, the procedure is performed in the same way as for cataract surgery. Thus, patients electing to have lens implant surgery to reduce their need for glasses will never have to worry about developing cataracts later in life.

Who might need a Lasik “enhancement” after a multifocal lens implant?

For a multifocal lens implant to work well, it is very important for the selected lens power to match your individual eye. Despite flawless surgery, some patients with multifocal lens implants are still not able to see as well without glasses as they would like. If this is due to the lens power being “off”, what can be done? One option is to wear glasses or contact lenses. A theoretical solution might be to exchange the multifocal lens implant for another with a different power. However, because of the risks involved with removing a lens implant, it is usually safer to “enhance” or fine-tune any residual prescriptions with an external Lasik procedure on the cornea instead. Lasik can also correct any remaining astigmatism from your cornea.

Likewise, it is possible that either the standard or multifocal lens implant that has been selected may not adequately correct your distance prescription. Depending upon how far off the artificial lens is, laser enhancement can be a good option. The odds that this would need to be done with a multifocal lens are usually less than 10%. The changes are greater in patients with high astigmatism or requiring very strong prescription glasses to begin with.

Multifocal Summary

If you are a patient with cataracts, you are considering surgery because your cataracts prevent you from seeing well with your corrective eyeglasses. After cataract surgery you should be able to see well for both far and near distances with your new eyeglasses (assuming no other eye health problems exist). The decision about which type of artificial lens implant to have will only affect your ability to see without glasses following cataract surgery. Multifocal lens implants will provide the added convenience of being able to read many things without glasses.

No current technology can eliminate glasses, and how well you will perform with multifocal lens implants can vary because of individual factors. Nevertheless, they are an excellent option for patients who already need cataract surgery who want to decrease their reliance upon glasses. While multifocal implants carry no guarantees, they should greatly improve the odds that you will be able to read and see better overall without glasses.

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