Mr. Jain, aged 62 years visited our clinic at Shreeji Eye clinic &Palak’s Glaucoma Care Centre, Andheri East. He complained of seeing hazy and glare around car head-lights especially at night time. He also had difficulty in reading fine letters on his mobile or on television. On examination he was found to have cataract in both eyes which was causing all the problems. As he led very active life and he required good near vision for reading fine letters on mobile and also good intermediate vision for reading fine letters on Computer Screen, he was advised trifocal intraocular lens. He underwent cataract surgery with implantation of trifocal lens in both the eyes at Shreeji eye Institute & Palak’s Glaucoma Care Centre and today he is happily leading spectacle free life andcarries out his all routine work.
As cataract surgery at our clinic is done with latest phacoemulsification technology, it helps patients to see immediately after surgery. He is allowed to carry out his routine work from day one after surgery. Choosing the intraocular lens wisely,after detailed discussion with patient regarding his occupation and his requirements, is also helping our patients to lead highly active, fulfilling and satisfied life.
Who are the Candidate for multifocal/ trifocal IOLs?
Virtually everyone who has cataracts and is in good general health may be candidate for cataract surgery with this kind of IOLs. If a patient has significant astigmatism (that is cylinder power in one axis), they may be a candidate for a TORIC lens implant. Only after a thorough examination, we are able to advise patient whether if he can qualify for multifocal/ trifocal IOLs.
Premium Lens Implants offer a new alternative for cataract patients seeking a broader range of vision than the vision provided by traditional “mono focal” lens implants. Recent technological breakthroughs have led to the development of several exciting new options for cataract patients, which can provide a broader range of vision, greatly reduce dependence on glasses and correct for presbyopia. These lenses are called “accommodating” or “multifocal” intraocular lenses because they allow the eye to accommodate a greater range of vision (from near to far vision) than the traditional “mono focal” implant, which typically can only correct for distance vision.
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Who are the Candidate for EDOF (extended Depth of Focus) multifocal/ trifocal IOLs?
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1.Monofocal IOL has a simple optic with almost a single power along the entire surface of IOL. Aspheric design monofocal IOL reduces the higher order aberration induced by the the peripheral part of the lens and also corrects spherical aberration induced by the cornea. This helps in achieving better quality of vision due to improved contrast sensitivity.
2.Multifocal lens have different powers for distance and near. These lenses have diffractive gratings in the form of rings on the IOL optic. Older multifocal lenses had 2 powers one for distance other for near.
3.Trifocal lenses have 3 powers, one for distance and second one for near for reading and third for intermediate distance for computer working distance. These diffractive gratings on the IOL split certain proportion of light for distance, intermediate and near. This enables the person to work on distance, intermediate and near without needing to wear glasses. The presence of rings on the lens can produce haloes and glare while looking at the light source. This can bother people who have to driving at night time and have to face headlights while driving at night time. Multifocal and trifocal lens also comes in toric form to correct astigmatism ( cylindrical power).
4.EDOF (Extended Depth of Focus IOL) EDOF Is an acronym for Enhanced Depth Of Field. These lens provide good distance and intermediate but only fair near vision. Person implanted with EDOF lens will be able to work on intermediate distance without glasses but still may need glasses for reading small print at near distance.
5.Toric IOL incorporates cylindrical power in addition to spherical power to correct astigmatism induced by the corneal curvature. Toric monofocal IOLs are used to correct cylindrical power induced by the cornea and hence improve distance vision without glasses after surgery. The need for toric IOL is decided only after taking corneal measurement.
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Symptoms of cataract
Hazy or foggy vision for distance or near, seeing glare around car headlights especially at night time, headache due to less vision, frequent change of spectacles are few symptoms which usually patient face due to cataract. As symptoms worsens, the surgeon will recommend cataract surgery, usually phaco, to restore clear vision. With advancements in cataract surgery such as the IOL patients can sometimes experience dramatic vision improvement.
The most common form of cataract in India is age related cataract. More than 40,00,000 cataract surgeries are performed in the India each year. Cataract surgery is one of the most common surgeries performed, and also one of the safest and most effective. Phaco is currently the most popular version of cataract surgery.
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Tips to decide for type of IOL
• Always discuss with your doctor regarding your needs
• Always discuss nature of your occupation with doctor. It helps your doctor to decide for right lens for your eyes. Ex. Diamond worker would want better near vision without glasses
• If you have cylinder power in your eyes, doctor may advise for TORIC lens.
• Options of cataract surgeries available:
◦ Cataract Surgery with monofocal lens (Indian & Imported)
◦ Cataract Surgery with monofocalToric lens (Indian & Imported)
◦ Cataract Surgery with extended Depth of Focus (EDOF)lens (Indian & Imported)
◦ Cataract Surgery with extended Depth of Focus (EDOF) TORIC lens (Indian & Imported)
◦ Cataract Surgery with Multifocal/ Trifocal lens (Indian & Imported)
◦ Cataract Surgery with Multifocal/ Trifocal Toric lens (Indian & Imported)
Post-surgery care
• Immediately following surgery, the patient is monitored in an outpatient recovery area. The patient is advised to returns to the clinic for follow-up after 4-6 hours. The surgeon will remove the eye shield and prescribe eye drops to prevent infections and inflammation. Patients are advised to wear an eye shield while sleeping, and refrain from rubbing the eye for at least two weeks. During that time, the doctor will give the patient special tinted sunglasses or request that he or she wear current prescription eyeglasses to prevent possible eye trauma from accidental rubbing or bumping. Unlike other types of cataract extraction, patients can resume normal activity almost immediately after phaco.
• Subsequent exams are usually at one week, three weeks following surgery. This can change, however, depending on any complications or any unusual postoperative symptoms. After the healing process, the patient will probably need new corrective lenses, at least for close vision. While IOLs can remove the need for myopic correction, patients will probably need new lenses for close work unless they had multifocal IOL.
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