August 3, 2011

Eliminating or Reducing Your Dependence on Glasses

By Lisa Brothers Arbisser, M.D.
Eye Surgeons Associates

Cataract surgery has reached such a height of perfection and safety that we are now able to offer its benefits to patients who just want to decrease their dependence on glasses. In addition to LASIK, which alters the shape of the cornea, there is also lens-based surgery which is often more appropriate for people over 50 years of age. As we reach an age where we need bifocals or trifocals to focus for distance, near and everything in between, one option to eliminate or reduce your need for glasses is Refractive Lens Exchange. Similar to cataract surgery, we implant an artificial intraocular lens, which can allow focus at distance, intermediate and near without glasses. In other words, we don’t wait for the lens to become cloudy and cataractous, we replace the clear lens, which focuses poorly, with an intraocular lens, which allows clear vision and reduced dependence on glasses. This eliminates the need for cataract surgery in the future and the need for glasses will not change significantly over time. Unlike cataract surgery however, Refractive Lens Exchange is considered an elective
procedure and is not covered by insurance.

Eye Surgeons was among the first to practice refractive surgery to reduce dependence on glasses and contacts, both after cataract surgery and as a refractive technique for older patients without cataracts.

Multifocal and accommodating intraocular lenses (IOLs) provide distance, intermediate and near vision, potentially eliminating one’s dependence on glasses for most activities. There are a number of IOLs available, each having some advantages and disadvantages.

A Multifocal lens implant presents visual information differently than your natural lens. It divides the light energy into more than one image. Your brain will need to learn to tune out the noise and tune in the information. This learning process is called neuroadaptation. Because light is divided between images, there is lower contrast and more light is required for best vision, especially for reading without glasses. Anything that reduces the contrast of the visual system, even a dry eye, can reduce satisfaction with this technology. These multifocal lenses are the most likely to permit people to function without glasses for all their daily activities, from driving to reading fine print.

The accommodative lens implant more closely mimics the function of the younger natural human lens by changing its shape and position within the eye to provide a broader range of focus. The accommodative lens has hinges which allows it to move forward with contraction of the muscle inside the eye causing the effective power to increase. It often requires some effort on your part for best results. Similar to gaining improved arm muscle strength by doing pushups, the accommodative lens patient will be encouraged to “exercise” by progressively looking at smaller and closer objects over time without glasses after the first week of surgery. Almost all patients will succeed in reading moderate size print without help, though many may still need low-powered reading glasses for fine print up close. Focusing speed and ability may continue to improve for three months or more after surgery.

Which IOL is right for you? That will depend on your lifestyle needs and the unique characteristics of your eye, which your doctor should discuss with you. As with any surgery, all risks and benefits must be weighed for each individual. The joy of decreased dependence on glasses need not be reserved for the cataract patient or the young but is available today for the young at heart.

Cofounder of Eye Surgeons Associates, Lisa Brothers Arbisser, M.D., is certified by the American Board of Ophthalmology and the American Board of Eye Surgery in cataract/implant surgery. In addition to her busy private practice, Dr. Lisa is adjunct associate professor at the University of Utah John A. Moran Eye Center. Dr. Lisa sees patients in our Rock Island and Bettendorf offices. Eye Surgeons Associates provides complete eye care for the entire family, for a lifetime from its offices in Bettendorf and Muscatine, Iowa; Rock Island, Silvis and Geneseo, Illinois. For more information visit