Achieving spectacle independence or reducing spectacle dependence is a goal for many of our patients undergoing cataract surgery and it is almost always the goal with refractive lens exchange. At FendaltonEye Clinic we have been offering this service since the late 1990s. There is no intraocular lens that can perform like a 20 year old natural human lens and with every option there are some compromises or side effects.
Each patient is different in what they would like to achieve and which compromises might suit their individual life style.
Fendalton Eye Clinic offers two methods of reducing dependence on near vision spectacles after cataract surgery or refractive lens exchange with intraocular lenses (IOLs).
These IOLs have three focal points for distance, intermediate and near vision. They split light rays to the three focal points using diffraction grating technology. Trifocal IOLs are best suited to people who want the maximum possible freedom from spectacles but are prepared to tolerate night vision disturbances including halos around lights and starburst (a light looks like a large star). I’ve found a high level of patient satisfaction with the Zeiss trifocal IOL in patients who want to be able to see all distances without glasses and are happy to tolerate or adapt to night time halos.
Zeiss AT LISA trifocal IOL (Currently use)
With a unique asymmetrical light distribution of 50 %, 20 % and 30 % between far, intermediate and near foci, AT LISA trifocal is able to provide more satisfying and predictable visual outcomes across three areas rather than the traditional 2 zone focusing multifocal (like the two zone ReSTOR multifocal and Tecnis Multifocal). The Zeiss trifocal IOL has three focal points – infinity, 80cm and 40cm. The Zeiss trifocal is currently the most popular trifocal IOL used world-wide.
FineVision Physiol trifocal IOL (Currently use)
This IOL is very similar in design to the Zeiss trifocal IOL and the intermediate and near focal points are at similar distances. There is very little to choose between the FineVision trifocal IOL and the Zeiss trifocal IOL according to European eye surgeons that have used both IOLs.
Alcon AcrySof IQ Panoptix trifocal IOL (Currently use)
This trifocal IOL was released in 2015 and is based on the Alcon AcrySof IOL platform. The main difference compared to the Zeiss and FineVision trifocal IOLs is that the intermediate focal point is closer at 60cm rather than 80cm. I’m not convinced that this closer intermediate focal point is any particular advantage in real life situations and it appears to function much like the Zeiss and FineVision trifocal IOLs. I first used the AcrySof IOL in 1995.
Zeiss AT LARA extended-depth-of-focus trifocal IOL
Introduced in 2017 by Zeiss, the AT LARA trifocal IOL is designed to provide good far distance and intermediate distance vision with fewer issues for night driving than the three trifocal IOLs listed above. While it still causes some night time halos around lights, the halos are less marked and therefore easier to adapt to. The disadvantage of the AT LARA is that the reading focal distance is further away and so reading glasses are more likely to be required.
Monovision is where one eye can see clearly in the distance and the other eye is intentionally made short-sighted so that it has either near reading vision (full monovision) or intermediate (arms-length) distance vision (limited monovision). It is a good option for those who have successfully practiced monovision with contact lenses and are happy with it. If you have higher amounts of astigmatism then monovision can be achieved using toric IOLs that correct astigmatism.
Monovision does focus your two eyes at difference distances and this may affect binocularity or the ability to judge depth or distances.
Monovision is a compromise because the distance eye does not read without glasses and the near eye cannot see in the distance. There may still be times when top-up glasses will be required such as:
• Driving a car in poor light conditions, particularly when it is raining.
• Prolonged reading, as it can be tiring to read with only one eye.
The main advantages of monovision are that using modern aspheric monofocal IOLs or toric IOLs usually gives good optical quality without halos, ghosting or glare. With monovision you can still wear glasses that correct both eyes for distance or both eyes for near vision and achieve good optical quality. Achieving monovision with monofocal IOLs or toric IOLs is less costly than using either multifocal, segmented asymmetric Oculentis IOL’s or any type of accommodating IOLs.
I hope this outlines the options that you have to achieve maximum spectacle independence using modern intraocular surgery and intraocular lens technology.
Monofocal IOLs for emmetropia
Clear distance vision, no significant halos or glare. Safest option if there is other eye disease.
Total presbyopia, glasses required for intermediate and near vision
Monofocal IOL monovision
Can see distance with one eye and near with the other. Can be corrected for distance or near with spectacles. Safe if there is any other eye disease.
Reduced binocular vision. Adaptation to monovision may not happen in some, reading speed is slower than bilateral multifocal IOLs. Most end up needing glasses for some tasks.
Zeiss trifocal FineVision trifocal
Alcon trifocal IOL
Good unaided distance, intermediate and near vision. Best option for complete spectacle independence.
Halos around lights at night time. Starburst may also occur. Some patients experience mild glare but it usually resolves.
Zeiss AT LARA
Good unaided distance and intermediate vision. Less noticeable halos and/or starburst than the other trifocal IOLs.
Not as good for near vision as the other trifocal IOLs. There still are some night time halos.