TLDR;
This video explains the different types of intraocular lens implants available for cataract surgery, helping patients make informed decisions based on their visual goals and lifestyle. It covers monofocal, toric, multifocal, and light adjustable lenses, discussing their pros and cons, and provides example scenarios to illustrate how to choose the best option. Key points include understanding your visual priorities (distance, intermediate, near), considering astigmatism, and being aware of any underlying eye conditions that may affect lens suitability.
- Understanding different lens implant options for cataract surgery.
- Considering visual goals, astigmatism, and underlying eye conditions.
- Empowering patients to have informed discussions with their ophthalmologists.
Intro [0:00]
The video introduces the complexities of choosing the right intraocular lens implant for cataract surgery. It emphasizes that the decision is significant because the implant is permanent and will affect vision for the rest of the patient's life. The video aims to simplify the decision-making process by discussing the main categories of lens implants and how to align the choice with individual visual goals and lifestyles.
Medical conditions can limit your cataract surgery choices [2:23]
It's important to know that not every eye is suitable for all lens options due to factors like eyeball anatomy and underlying diseases. Conditions such as uncontrolled diabetes, cardiovascular issues, macular degeneration, and corneal scars can impact post-surgery vision and the suitability of certain lens implants. Candid communication with your ophthalmologist about your medical and ocular history is crucial for making an informed decision.
Ask these THREE questions to determine the best lens option [3:16]
To simplify the lens selection process, consider three main questions:
- Which single distance (far, intermediate, or near) is most important to see clearly without glasses?
- Do you have astigmatism, an imperfection in the cornea's curvature?
- Do you have any other underlying eye abnormalities or diseases that could affect your vision?
Burning Question #1 [3:40]
The first burning question focuses on prioritizing a single distance for clear vision without glasses. The three main distances to consider are: far distance (driving, watching movies), intermediate distance (computer screens), and near distance (phones, books).
Burning Question #2 [4:21]
The second burning question addresses astigmatism, which is an imperfection in the curvature of the cornea. An eye without astigmatism has the same curvature in all directions, like a basketball. An eye with astigmatism has different curvatures, like a football.
Burning Question #3 [5:29]
The third burning question involves identifying any other underlying eye abnormalities or diseases that could affect vision.
Consider your routine daily visual requirements [5:56]
Before consulting with an ophthalmologist, consider your daily visual requirements. Think about whether you drive a lot, especially at night, work on a computer, or engage in hobbies requiring fine vision. The ophthalmologist will assess your vision, refraction, and astigmatism, and conduct a comprehensive eye exam to identify any other potential issues.
Monofocal intraocular implant [6:53]
A monofocal implant provides one focus point, optimizing vision for a single distance (far, intermediate, or near). Most patients choose a distance target because most daily activities involve distance vision.
Distance target [7:27]
Choosing a distance target with a monofocal implant means computer and reading vision will require glasses.
Non-toric monofocal implant [8:00]
If you do not have astigmatism, a non-toric monofocal implant is suitable, allowing clear vision at your chosen distance.
Important considerations for nearsighted patients [8:23]
Nearsighted patients with mild myopia may be accustomed to reading without glasses. Correcting their distance vision with a monofocal lens might make their near vision seem worse, requiring reading glasses.
Near target [9:35]
Some patients prefer a near target with a monofocal lens, especially if they are used to removing glasses to read. This option is suitable for those who are comfortable wearing distance glasses but prefer near vision without them.
Toric intraocular implant [10:10]
A toric lens implant corrects astigmatism by neutralizing it within the lens itself. Not every patient needs a toric lens; it is typically required for those with a significant amount of astigmatism (around 1 to 1.5 diopters).
Why do we need to correct astigmatism? [10:54]
Astigmatism affects vision at all distances by preventing light rays from focusing properly on the retina. Patients with significant astigmatism describe their vision as smeared, blurred, or distorted. Correcting astigmatism with a toric lens implant reduces the need for glasses at all distances.
Multifocal intraocular implant [12:01]
Multifocal lens implants allow clear vision at multiple distances (far, intermediate, and near), potentially providing independence from glasses about 90% of the time. However, backup glasses may still be needed in certain situations. Multifocal lenses are not ideal for patients with significant underlying eye disease.
Glare with multifocal implant [13:10]
Most patients experience some glare and halo around bright lights, especially at night, when using multifocal implants. These effects usually diminish as the brain adapts to the new lens over a few months.
Contrast sensitivity with multifocal implant [14:11]
Multifocal implants can cause a slight decrease in contrast sensitivity, making it harder to see in dim lighting. This is why they are not always suitable for patients with conditions like glaucoma or macular degeneration, which also reduce contrast sensitivity.
How much near vision does a multifocal implant give? [15:06]
Multifocal implants provide functional near vision, suitable for reading texts on a phone or a book in normal lighting. However, they do not provide super close-up vision, so tasks requiring very fine detail work may still require reading glasses or a magnifying lens.
Monovision [16:12]
Monovision involves targeting one eye for distance vision and the other for intermediate or near vision. This strategy provides a broader range of focus but can be difficult for the brain to adapt to. It is generally recommended only for patients who have already experienced and adapted to monovision with contact lenses.
Light Adjustable Lens [18:06]
The light adjustable lens is a customizable lens that allows vision correction after cataract surgery. It contains UV-sensitive polymers that can be adjusted with UV light to change the lens's shape and correct refractive errors. Adjustments are typically made one month after surgery.
Example scenarios [19:07]
The video presents example scenarios with different patients to illustrate how to choose the best lens option based on their visual needs, presence of astigmatism, and any underlying eye conditions. Barbara prioritizes distance vision and has no astigmatism or other eye issues, making a monofocal non-toric lens a good choice. Susan also wants good distance vision but has significant astigmatism, requiring a toric lens. Jim wants good vision at all distances but has macular degeneration, making a multifocal lens potentially unsuitable. Jerry wants a full range of vision and has astigmatism but no other eye diseases, making a multifocal toric lens a good option.
Takeaways [26:45]
The video concludes by encouraging patients to communicate openly with their surgeons, ask questions, and make informed decisions based on their individual needs and lifestyles. It emphasizes that patients should feel empowered and guided throughout the cataract surgery journey.
