For patients who are over 45 years of age and are starting to experience the aforementioned normal aging process of the eye called presbyopia, LASIK/ PRK may not be the best refractive option. Depending on the ultimate goal of having surgery, a refractive lensectomy might be a better choice. Commonwealth Eye Surgery became the first practice in Kentucky to provide refractive lensectomies on a routine basis in 1988.
A refractive lensectomy involves the removal of the natural crystalline lens of the eye and replacement with an intraocular lens implant, or IOL. It is identical to cataract surgery with the exception that the lens has not yet clouded to become a cataract. The benefit of going the route of the refractive lensectomy is that it will negate the need for future cataract surgery since the natural lens will already be removed.
For those who choose to have a refractive lensectomy, there are several lens implant options available, depending on the specific needs and wants of each patient. Each implant is briefly described below.
Monofocal: Standard Implants are monofocal. They give good vision at only one distance, either far vision or near vision, but not both. They do not correct for astigmatism. For patients who don’t mind wearing glasses all the time, the standard IOL is the best option.
Crystalens: Crystalens implants are for BOTH Distance and NEAR Vision. Crystalens IOLs are specialty IOLs that will provide good distance, intermediate and near vision in each eye. However, patients may still require glasses to see small print or to read at very close distances. One would expect to see well enough to drive, work on a computer, and read most newspaper sized print without glasses. The Crystalens does not correct astigmatism, and this must be addressed to achieve maximal benefits of this implant. Fortunately, laser astigmatic correction is available for those with astigmatism.
TORIC: TORIC Implants are also a monofocal IOL, but they correct for astigmatism. Patients who have astigmatism and want the best vision possible without glasses should consider a TORIC IOL. Because they are monofocal, patients will still need to decide whether to have the IOL set for distance vision or for near vision.
Monovision: “Monovision” may allow you to avoid reading glasses as one eye is focused for distance and the other for near. Your local Optometrist can best determine your ability to adapt to “monovision” pre-operatively with a contact lens trial.
Blended Vision: Blended Vision is what we call monovision. Monovision is having one eye focused at distance and the other eye focused at near. Blended vision works best for patients who have been successful monovision contact lens wearers and want to minimize their dependence on glasses after surgery. Blended Vision may be obtained with aspheric monofocal IOLs and/or TORIC IOLs. It includes excimer laser touch –ups if needed to fine tune vision after cataract surgery.