"Staged Implants" Becoming More Popular

Presyopia is that middle-aged vision which requires reading glasses, even if your eyes are still 20/20. The lens becomes unable to change its curvature enough, become steep enough, to give clear close vision. As the Baby Boomers age and presbyopia occurs more often in the population, ophthalmologists have correspondingly increased their research and experimentation for how to treat it.

Intraocular Lenses (IOLs)

IOLs are replacements lenses for the eye's natural lens. In a short procedure, the eye surgeon gently disintegrates the natural lens, removes it by suction, and replaces it with an artificial lens which will give clear vision at most distances.

For several years now, we have had three FDA-approved IOLs for treating presbyopia:

• Crystalens -- an accommodating lens which mimics the behavior of the lost natural lens and its power of accommodation. It is attached to the same eye muscles which previously controlled the natural lens curvature; now they move the Crystalens forward or back to give sharp vision at varying distances.
• ReZoom -- a multifocal lens with concentric zones built into it, each reacting differently with incoming light. Between them they give clear vision at most distances.
• ReSTOR -- also a multifocal lens, with concentric steps in its structure. Again they give clear vision at most distances.

These IOLs have been re-issued at various times, with improvements made. In addition, many ophthalmologists have used a fourth IOL that is popular in Europe and still in testing for the U.S. FDA.

• TECNIS -- another multifocal lens with concentric rings, each of which breaks up the incoming light into two parts: one for near vision and one for far vision. It gives good vision in all lighting situations.

What Are "Staged Implants"?

This is a cooperative way of treating presbyopia with IOLs, where only one eye is first treated. The eye surgeon makes a judgment call as to which particular IOL to use, and after he or she has implanted it, waits for patient feedback.

If the patient is happy with the vision improvement in the treated eye, the surgeon implants the same type of lens in the other eye. If the patient is not happy, and would like, for example, better near vision, the surgeon will choose a different type of IOL for the second eye.

Although all the IOLs vastly improve vision at most distances, some perform better for near vision, some for intermediate vision, and others for far vision. Presbyopia is a problem with near vision first, and only as the person ages further becomes more of a problem with intermediate vision and then distance vision. Therefore the TECNIS IOL has been useful, as it delivers clearer near vision than the other IOLs.

Popular combinations for near and intermediate distances are:

• ReSTOR and ReZoom
• TECNIS and ReZoom
• ReSTOR 4.0 and ReSTOR 3.0
• ReSTOR and Crystalens

If presbyopa seems to be catching up with you lately, and you are finding store-bought glasses to be inadequate, the next step in keeping clear vision would be scheduling a consultation with an experienced and fully-qualified eye surgeon.