For the millions of baby boomers who will eventually need cataract surgery, here's some cheering news: New types of implantable lenses promise to restore your youthful vision. Unlike the standard single-power lenses doctors have been implanting for 30 years, the newer multifocal intraocular lenses and accommodating lenses allow patients to see near, far, and in between—and even to shed their glasses. "I can read the computer screen, and fine print is no problem," marvels John Bogushefsky, 68, of Gaithersburg, Md., who opted for multifocal lenses when he had cataract surgery a couple of years ago. Once legally blind, he can now see nearly perfectly without any help.
During cataract surgery, a patient's aging and cloudy natural lens is removed and replaced with a synthetic lens to restore the eye's focusing power. Until recently, the only option was a fixed-focus lens, typically designed for faraway distances, which left the patient needing bifocals or reading glasses to see up close. The new design—concentric circles of different refractive strengths—can "reduce the need for glasses by as much as 92 percent," says Marguerite McDonald, a clinical professor of ophthalmology at New York University and an ophthalmic consultant. Each circular zone is shaped for distance, intermediate, or near vision.
The lenses have been available for a little over two years, and so far doctors and patients are pleased with how well they work. Of the two brands currently on the market, the ReZoom lens from Advanced Medical Optics is considered better at improving intermediate vision, a boon for heavy computer users. The zones in the ReZoom lens also are designed to focus under different light conditions, such as low, moderate, or bright light. For those who want to most easily read small print, at the cost of slightly diminished intermediate vision, the Restor lens from Alcon may be more appropriate, says Roy Rubinfeld, an ophthalmologist in Washington, D.C., and a spokesman for the American Academy of Ophthalmology. In a study published in the September 2006 issue of the Journal of Cataract and Refractive Surgery, researchers in England found that only 2.5 percent of those with the Restor lens in both eyes needed reading glasses, compared with more than 92 percent of people with fixed-focus lens implants.
A third option to consider: the Crystalens accommodating lens from Eyeonics. Instead of featuring varying refractive strengths, it attaches to the eye's ciliary muscles and is designed to adjust its position to handle different distances, much like the auto focus of a camera—or the pliable lens of a younger person. These lenses can be implanted in both eyes or matched with a Restor or ReZoom lens, each combination resulting in different degrees of visual acuity. Researchers compared the performance of the various combinations in a study published in the September issue of the American Journal of Ophthalmology and found that people with a Crystalens in one eye and a Restor in the other "enjoyed the best overall vision for all distances," says lead author Jay Pepose, a professor of clinical ophthalmology at Washington University Medical School in St. Louis and director of the Pepose Vision Institute.
Get checked. Patients in their 40s or 50s who are considering LASIK surgery to improve their vision might want to be evaluated for implantable lenses as well. Early signs of a cataract might argue for surgery and implantation of multifocal lenses instead. "The patient may be underwhelmed by the results of laser surgery," says McDonald, since the presence of a cataract will still cloud vision.
Rubinfeld estimates that about 20 percent of cataract patients nationally are now choosing the multifocal lenses. Some doctors have been hesitant to adopt the new technology, owing to scattered reports of halos, glare, and problems with night vision and blurring. Because the lenses have been available for only a short time, these doctors are waiting for more data on patients' long-term experience. So the fixed-focus version isn't going away anytime soon. And many people over 40, especially those who are used to wearing contact lenses for distance and those who don't mind reading glasses, are perfectly happy with them.
As with any surgery, lens implantation comes with some risk of complication. Infection, retinal detachment, and an increase in eye pressure, while rare, do occur but can almost always be successfully treated. Around 20 percent of patients have to return for a laser "touch up" about six to eight weeks after surgery to ensure optimal distance vision.
While insurers will cover the costs of the tried-and-true fixed-focus lenses, they won't yet pay for multifocal and accommodating implants. And since many practices charge more than $2,000 per eye beyond what Medicare or insurance will cough up for cataract surgery, some may find the price tag too much for their wallets to bear. Not John Bogushefsky. Multifocal lenses were a retirement gift to himself, he says, and they've been worth every penny.