Intraocular Lens Gives Cataract Surgery Patients Near, Intermediate and Distance Vision
The AcrySof ReSTOR intraocular lens, approved by the U.S. Food and Drug Administration in March 2005, uses new apodized diffractive technology to give cataract surgery patients quality near, intermediate and distance vision. In clinical trials, 80 percent of patients who underwent cataract surgery and received the AcrySof ReSTOR lens in both eyes reported that afterwards they did not need reading glasses or bifocals, compared to only 8 percent of cataract surgery patients who received monofocal intraocular (IOL) lenses.
The AcrySof ReSTOR lens does not rely on the ciliary muscle to enable the eye to quickly change focus to see objects at various distances. Instead, it uses an apodized diffractive optic design. Apodization improves image quality by tapering the surface of the lens in a way that optimizes light energy delivered to the retina by distributing appropriate amounts of light from distant, intermediate and near focal points.
Multi-center clinical studies were conducted to compare AcrySof ReSTOR lens to the monofocal IOLs that have been the standard of care in recent years. In these studies, 99 percent of the patients who received the AcrySof ReSTOR in both eyes and 98 percent of patients who received the monofocal IOL achieved distance visual acuity of 20/40 or better, without correction by glasses or contacts. However, for near vision 74 percent of patients receiving the AcrySof ReSTOR achieved a near visual acuity of 20/25 or better without contacts or glasses, while only 14 percent of those who received monofocal lenses achieved this level of acuity. For intermediate vision, 85 percent of the AcrySof ReSTOR IOL patients achieved binocular uncorrected intermediate vision of 20/40 or better, compared to 67 percent of those who received monofocal lenses.
A recent ruling by the U.S. Centers for Medicare and Medicaid Services (CMS) gives patients the choice to receive advanced technology lenses such as the AcrySof ReSTOR. Under the CMS ruling, Medicare will continue existing reimbursement amounts for cataract surgery, and patients may elect to pay out-of-pocket any additional charges beyond the cost of a standard IOL.
Caveats for physicians and patients to consider when choosing the type of IOL to use: The AcrySof ReSTOR lens provides three vision segments -- the outer rim of the lens for distance, the center for intermediate and for reading. If the lenses in both eyes are not lined up, the patient could potentially have double vision. Also, the manufacturers do not discuss using the AcrySof ReSTOR lens in one eye when a patient already has a standard IOL in the other. All of the statistics are based on binocular lens implants. Most patients report that they are satisfied with traditional IOLs: Surgeons often implant monofocal IOLs that make patients slightly myopic in each eye, with the result that most achieve good binocular vision at all distances. Some may need reading glasses for extended reading.
The AcrySof ReSTOR lens may be most appropriate for individuals, such as artists, who need particularly sharp vision at all ranges, or for individuals who are particularly anxious to avoid wearing glasses. Side effects that were reported for the AcrySof ReSTOR lens occurred mostly under low light conditions, such as driving at night and working at intensive near tasks in low illumination. For an individual for whom these activities are very important, a conventional monofocal lens is preferable.
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