For the 60 percent of Americans older than 60 who will be affected by cataracts – a disease in which the eye’s clear lens becomes clouded, requiring surgical removal – an increasing number of options are available in the form of intraocular lens (IOL) implants.
Hundreds of IOLs are now on the market, notes Kevin M. Miller, M.D , Kolokotrones Professor of Clinical Ophthalmology at UCLA’s Jules Stein Eye Institute. While all IOLs improve vision, eligible patients willing to pay out-of-pocket costs for certain “premium” lenses may be able to avoid the need for glasses completely. When planning cataract surgery, patients should discuss their options with their ophthalmologist, Dr. Miller says.
Before IOLs came of age in the 1980s, patients who had cataracts removed were left with a condition called aphakia (absence of a lens in the eye) and needed to wear thick “Coke bottle” glasses or special contact lenses in order to see. With the advent of lens designs that provide far better optical results than could ever be obtained with the special glasses or contact lenses, implanting a lens at the time of cataract removal has become the norm.
“The lens implants were initially designed simply to rectify the aphakia problem, knowing that glasses or contact lenses would take care of the rest of the optical error,” Dr. Miller explains. “But starting in the 1990s, the emphasis has been on trying to get the best possible vision without glasses, both from better surgery and the type of lens we implant.” In recent years, design innovations have improved night vision through aspheric optics and filtered potentially damaging ultraviolet and high-frequency visible blue light, he notes.
More recently, so-called premium IOLs have in some cases moved from monofocal to multifocal – potentially enabling the individual to see well, without glasses or contacts, at both near and far distances. But, while Medicare insurance covers cataract surgery and the implantation of a lens to correct aphakia and restore function, extra costs associated with premium lenses must be paid out of pocket, and these can amount to as much as $1,500-$2,500 per eye.
Premium IOLs fall into two categories at this time. Toric lenses are designed to correct a significant level of astigmatism – in which vision is blurred because of an irregularly shaped cornea – and thus reduce dependence on glasses for distance vision (reading glasses are still needed). Presbyopia-correcting lenses come in two types - multifocal and accommodating. Unlike toric lenses, presbyopia-correcting lenses aim to achieve both distance and near vision without the need for glasses. Many patients don’t qualify for presbyopia-correcting lenses, including patients with macular degeneration.
“With any of the premium lenses, you’re paying for the increased likelihood that you won’t need glasses to watch television or a movie, recognize people coming in from across the room or drive a car,” Dr. Miller explains. “With toric lenses, you might only have to wear drug store-style reading glasses, and with the presbyopia-correcting lenses, you have increased odds of being able to read without glasses as well. But if that convenience isn’t worth the out-of-pocket cost, then the premium lenses aren’t needed.”