What Are Intraocular Lens Implants?
The intraocular lens implants (IOL) used by the physicians of Roholt Vision Institute are high-tech, FDA approved designs. The most common material for intraocular lens implants since 1953 is derived from a hard plastic called polymethylmethacrylate (PMMA). Now foldable PMMA (or acrylic) implants are used. Foldable silicone intraocular lens implants are also used and are safe and effective (this is not the same type of silicone used in breast implants). The doctors will take various factors into consideration when deciding which implant to place in your eye. All the implants are non-reactive with human tissue and hypoallergenic.
Roholt Vision Institute uses the Humphrey-Zeiss IOLMaster™ , Lenstar™ and the iTrace™ eye analyzer, (a first in NE Ohio) and the Pentacam™ . These technologies enable eye measurements for intraocular lens implants more accurate than those used previously. For more information, visit the Zeiss, Haag-Streit, Tracey, or Oculus website.
What Are My IOL Implant Options?
Now you must consider your choices for your intraocular lens implants. To help in your decision, ask yourself two questions:
- Am I interested in the latest technology for my eyes, to get the best visual result?
- Do I want to be less dependent upon glasses or is wearing glasses ok?
Other than Basic Cataract Surgery, services may include the use of Zepto™ to produce a stronger, more central lens opening to help in implant centration, or Laser Cataract Surgery (LCS) if the surgeon feels it will help and patient agrees.
1. Basic Cataract Surgery
This lens uses a single vision intraocular lens, which gives good vision. You will need reading glasses and possibly distance glasses. Medicare and insurance pay for basic intraocular lens implant surgery subject to coinsurance and deductible.
2. CustomCorrection™ I
Advanced techniques such as Zepto™ , LCS, LASIK, or PRK may be used in this refractive package. This option corrects low degrees of astigmatism and refractive error allowing patients less dependence upon glasses after cataract surgery. Generally, excellent uncorrected distance vision is obtained (requiring only reading glasses), or Blended Monovision (dominant eye distance with non-dominant eye blended for near vision). Superior quality monofocal lenses are implanted, usually chosen for asphericity (corneal curvature) factors. An added benefit can be the use of the Raynor EMV (Extended Monofocal Vision) RayOne EMV – Rayner : Global or J&J Eyhance IOL for increased performance compared to basic IOLs. TECNIS Eyhance™ IOL | Johnson & Johnson Vision (jnjvisionpro.com)
3. CustomCorrection™ II – Multifocal Lens Implants
We offer several multifocal lens implants, and call this procedure CustomCorrection™ II The lenses are: Panoptics™ , Vivity™ , Symfony™ , and Odyssey™ . These intraocular lens implants usually allow patients to achieve both distant and near vision without eyeglasses. Each type has unique characteristics, and the doctors at Roholt Vision Institute are skilled at implanting all. Dr. Roholt was one of the first implant surgeons in the Midwest involved in multifocal lens implant research in the early 90’s as an investigator in the Storz TruVista™ .
Now the new advanced designs offer opportunities for glasses-free vision, and these advanced lenses even correct for astigmatism. The disadvantage of the multifocal lens is a possible slight decrease of clarity in low contrast, or haloes with night driving, compared to single vision implants. For more information on these lenses visit: Clareon™ Intraocular Lens (IOL) Family | Alcon (myalcon.com), IOLs & Implants | Johnson & Johnson Vision (jnjvisionpro.com)
4. CustomCorrection™ A
For individuals who have moderate to severe astigmatism, a special “Toric” or astigmatism-correcting intraocular lens implant (Clareon™ or Tecnis™ ) is used to achieve the same results as in CustomCorrection™ I. The CustomCorrection™ II option, using the Vivity™ , PanOptyx™ , Symfony™ , or Odyssey™ Multifocal lenses also correct astigmatism, in addition to the multifocal optics.
5. CustomCorrection™ – Light Adjustable Lens (LAL)
The RxSight Light adjustable Lens™ (LAL) IOL is the newest (FDA and clinically approved) lens capable or giving you the sharpest, HD vision without glasses. Night vision is excellent and Astigmatism can even be accurately reduced or eliminated. It is adjustable after a 2-4 week period of healing during which UV blocking glasses are worn, followed by 2-3 adjustments with a Light Delivery System, after which the desired vision is “locked-in.”
The LAL is especially useful if you have had LASIK, PRK, RK, or other refractive procedures previously.
6. CustomCorrection™ BlendVision
Patients sometimes prefer a BlendVision, in which the dominant eye is focused for distance, the other eye for near. The ocular system “neuro-adapts” to this in a week or two for most people. This is usually combined with the CustomCorrection™ A or CustomCorrection™ I procedure, since it is less expensive than CustomCorrection™ II, or RxSight LAL™ multifocal lens.
All the above CustomCorrection™ options are non covered services with Medicare and Commercial Insurance payors.
What is the Light Adjustable Lens™?
Roholt Vision Institute is one of the first centers in the Midwest to provide the RxSight Light Adjustable Lens™ (LAL) for their patients. Originally developed for post-refractive (RK, PRK, or LASIK) patients, this amazing technology offers the opportunity to achieve clear, uncorrected HD vision, minimizing the use of spectacles or contact lens. Astigmatism can be more accurately treated with the LAL. This lens has been in development for over 20 years, and can be used for treatment of cataracts, or in the case of refractive errors such as high myopia, hyperopia or astigmatism. It is an excellent choice for those with high visual demands, such as law enforcement, marksmen, pilots, athletes or those desiring precise vision. Click here to learn more.
What Is ORA™ & How Is It Used In Cataract Surgery?
ORA™ is WaveTec’s “Intraoperative Wavefront Analyzer.” Some surgeons use this device during cataract surgery to estimate the intraocular lens(IOL) power. Although in some cases this may be helpful, the variables in surgery result in different positions of the IOL compared to the post-op, healed position. The RxSight LAL™ has eliminated the need for this technology.
What Is ZEPTO™ Precision Pulse?
A new benefit in conjunction with ultrasonic cataract surgery method is the ability to use Zepto™ Precision Pulse Capsulotomy. One of the most important steps in cataract surgery or lens replacement surgery is the capsulotomy or capsulorrhexis. The natural human lens, or cataract, is enclosed by a thin, saran-like sac. This “capsular bag” must be entered and peeled away to remove the lens. Currently, there are three ways to accomplish this: the traditional cataract surgery method uses small instruments to peel it open; the Laser Cataract Surgery (LCS) capsulotomy, and the latest innovation, the Zepto™ Precision Pulse Capsulotomy.
Zepto™ uses an electronic pulse to instantly create a perfectly round capsulotomy. This is the ONLY method which uses the patient’s visual axis for centration, which helps intra-ocular alignment and accuracy. The edge of the capsule is congealed for increased strength, which to avoid complications such as tearing of the capsule edge. The Zepto™is even stronger than the traditional method, which itself is stronger than a LCS capsulotomy (created by multiple rapid pulsations which cause an easily torn, serrated edge to the capsular opening). Zepto™ is also less costly to the patient than LCS. Go here for more information.
What Is Refractive Lens Exchange (RLE)?
Patients who desire to reduce or eliminate dependence on contacts or glasses, or with high degrees of myopia, hyperopia and/or astigmatism may not be candidates for LASIK, SMILE, PRK or the Evo ICL™. Sometimes presbyopia (inability to see near) has occurred. Additionally, some people may have incipient or minor degree of lens opacity (early cataract) but don’t qualify for insurance coverage and can’t wait years for the cataract to develop. In these cases, an excellent, accurate solution is CustomCorrection™ Refractive Lens Exchange also known as Refractive Lensectomy. This is a gentle eye procedure performed at the ambulatory center, which gives rapid visual recovery, most often without the use of glasses for either distance or near vision. RLE uses advanced intraocular lens such as the Panoptics™, Vivity™, Symfony™, and Odyssey™ or the RxSight™ Light-adjustible Lens (Clareon™ Intraocular Lens (IOL) Family | Alcon (myalcon.com), IOLs & Implants | Johnson & Johnson Vision (jnjvisionpro.com), Frequently Asked Questions | The Light Adjustable Lens from RxSight
Refractive Lens Exchange is a non-covered, self-pay procedure.
What Happens If I Get Secondary Or “After-Cataracts” Following My Lens Implant?
A secondary cataract, or cataract re-growth, is a frequent occurrence after lens implant, lensectomy, or cataract surgery, and can occur within weeks after the original operation. This occurs even with perfectly performed cataract eye surgery. A YAG laser (Yttrium-Aluminum-Garnet) is used to open the wrinkled or fogged membrane behind the intraocular lens implant. This laser procedure takes five minutes and is painless. The secondary cataract will usually not recur. Performance of a YAG laser is more common with Multifocal implants (CustomCorrection™ II). With CC™-II the YAG may be performed prior to a focusing procedure such as LASIK, PRK, or CK. Dr. Roholt’s practice was the first in NE Ohio to use the YAG laser.
This treatment is billed separately to insurance or Medicare.
Does Cataract Surgery Require Stitches?
The incision into the eye is generally very small and is self-sealing, creating a “No-Stitch” incision. However, sometimes for safety’s sake, one or more sutures are placed to close the incision and, therefore, the “One-Stitch” procedure is used. In general, the cataract surgery is tailored to the individual.
What Type Of Anesthesia Is Used For Cataract Surgery?
The cataract surgery / lensectomy surgery is performed using anesthetic placed around the eye area and/or adjacent eyelids, or strong eyedrop “topical” anesthesia which causes complete loss of pain sensation. A short-acting sedative is also used to eliminate anxiety or discomfort.
Can Lens Implant Surgery Help With Focus Defects?
Myopia (nearsightedness), hyperopia (farsightedness) and astigmatism (warped cornea) are all focus defects that can be improved by lens implant surgery with CustomCorrection™. The eyeglass lens power needed for the eye is incorporated into the lens implant. Astigmatism is caused by a distorted “spoon shaped” cornea. This visual defect can be reduced or eliminated using the RxSight LAL, or a toric lens implants as in CustomCorrection™ A, or through LASIK or other CustomCorrection™ techniques. As physicians specializing in refractive surgery (correction of focus defects), the doctors at Roholt Vision Institute are uniquely qualified to help you attain the best vision possible.
Is There Any Post-Care Required After Cataract Surgery?
Roholt Vision Institute is one of the first centers in Ohio to offer the EZ-Drop™ method of antibiotic/steroid prophylaxis after cataract surgery. This greatly reduces the number of drops that need to be instilled. The risk of infection is also reduced compared to the conventional methods of multiple eyedrops.