Multifocal Lenses in Izmir, Turkey

The refractive errors of the eye are MYOPIA, HYPERMETROPIA and ASTIGMATISM. The number of the artificial lens to be placed in the eye is determined in the sensitive measurements made before the Izmir Cataract surgery.

The aim here is to get the number as close to zero as possible after the surgery and to reduce the addiction to glasses or to get rid of glasses if possible.

Myopia and hyperopia of the patient can be eliminated to a great extent with the standard artificial lens placed in the eye according to precise measurements.

Standard lenses are monofocal and usually focus only on distance vision. These lenses do not have the ability to see near. Although the patient can see at a distance clearly without glasses, his near vision is impaired and he must use close glasses.

This is a very natural result of surgery. However, if full information is not given by the ophthalmologist before the operation, it may be perceived as an incomplete intervention by the patient. However, the patient has become a healthy individual who does not use remote glasses at the end of this surgery.

Every healthy individual starts to use close glasses from the age of 40-45. This is not a disease condition, it is a natural consequence of aging (like graying of hair). In summary, this is the result to be obtained with standard single vision lenses.
However, thanks to the technologies developed in recent years, it is possible for the patient to see both far and near without the need for glasses after cataract surgery.

There are different methods for this purpose. One of them is the MONOVISION technique. For this, the dominant eye of the patient is reset by cataract surgery, while the non-dominant eye is left slightly myopic (about 1.0-1.5D).

In this way, the patient’s dominant eye sees the distance clearly, while the non-dominant eye sees the near better. With this technique, the patient can do most of his daily work without the need for glasses (such as using a mobile phone, reading labels in the market). However, there will still be a need for glasses for very clear and sharp vision both far and near.

Another method is the placement of a MULTIFOCAL INTRA Ocular LENS in the eye during cataract surgery. Multifocal intraocular lenses consist of interlocking rings of different refraction, focused at close range such as reading distance, medium distance such as computer distance, and far away, such as television distance.

It is aimed to see all distances with the same lens. The cataract surgery technique is the same in multifocal lenses, just like standard lenses. Only the type of lens placed in the eye is different.

Prof. Dr. Tansu Erakgün
Retina Diseases and Vitreoretinal Surgery Specialist

Born on March 20, 1968, in İzmir, Prof. Dr. Tansu Erakgün completed his middle education at Saint Joseph College and his high school education at Karşıyaka Gazi High School. After graduating from Ege University Faculty of Medicine in 1992, which he entered in 1986, he began his residency training in the Department of Ophthalmology at Ege University Faculty of Medicine Hospital in the same year. In 1997, he became a specialist...

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How is the Lens to be Used for Surgery Decided?

The selection of the lens to be used for eye surgery is based on the data and results obtained as a result of the eye examination. During an eye exam, your doctor examines your eye and determines the type and severity of vision defect in your eye. Your doctor will evaluate the vision defect in your eye and other factors in your eye to determine which lens to use for surgery. For example, factors such as other health problems in your eye and the condition of other tissues in your eye are also taken into account when choosing the lens to be used for surgery. The selection of the lens to be used for the surgery is based on the data obtained as a result of the eye examination and is made by your doctor.

Which patients are suitable for a multifocal lens?

Although multifocal lenses seem very advantageous in theory, they may not be suitable for every patient. After surgery, halo formations around point lights (such as lamps), compatibility problems at intermediate distances, scattering and glare may occur in lights such as sunlight or car headlights.

These complaints are mostly temporary and are expected to regress within 3 to 6 months. In some patients, these complaints may be permanent. It is reported that with the trifocal lenses developed in recent years, these complaints are alleviated and especially the distance problems are reduced.

The most important issue with multifocal lenses is patient selection.

Appropriate patient criteria for multifocal lens (patients with better results, although there is no definite indication):

– Those who have a strong desire to get rid of glasses
– Less critical, more ‘carefree’ people
– Those who do not expect to see very sharp near and far
– Those with hyperopia or very high myopic refractive error

Negative patient criteria for the multifocal lens (patients who may be dissatisfied, although not certain)

– Patients who do not worry much about using glasses after surgery and do not aim to get rid of glasses
– People who are overly critical and have unrealistic expectations
– Those with very keen near and far vision expectations
– People who were previously myopic (these patients’ near vision is usually extremely good and the quality of vision with a multifocal lens may be below expectation)
– Those who have to drive at night, who work in jobs that require a lot of computer work
– Patients with problems in the visual center (such as yellow spot disease, macular edema due to diabetes)

Cataract surgery with a multifocal/trifocal lens is an extremely useful method with high patient satisfaction if the appropriate patient is selected. However, patient selection is an important factor here.

Who can not apply multifocal lenses?

Since the treatments generally have certain conditions, the question of whom multifocal lenses are not applied is important for treatment. Multifocal lenses are artificial lenses that replace the natural lens during cataract surgery. These lenses are lenses with different focal points to see near and far clearly. Multifocal lenses may be a viable option for many people who have had cataract surgery, but these lenses are not recommended for some people. Multifocal lenses should not be applied to people with certain eye problems as they interfere with the eye’s ability to focus. In particular, multifocal lenses are not recommended for people with eye problems such as retinal diseases, glaucoma or dry eye.

The application of multifocal lenses may not be appropriate in people with high degree of astigmatism. On the other hand, for people who have cataract problems that increase with age, multifocal lenses can provide a better vision with a single lens that allows them to see near and far, but it is important to talk to the doctor and have an eye examination to decide which lens is suitable for the person. In summary, although multifocal lenses are generally a suitable option for people who have had cataract surgery, these lenses may not be suitable for people with certain eye problems. Therefore, it is important to pay attention to the recommendations of the specialist doctor and eye examinations.

Cataract and astigmatism

The transparent glass part of the eye called the cornea (like a watch glass) is the eye’s most important refractive medium. It is spherical in structure (similar to the surface of a soccer ball). If one axis is flatter than the other, astigmatism occurs (similar to an American football).

In fact, almost every eye has varying degrees of astigmatism, no cornea is like a perfectly spherical surface. It may be necessary to use glasses for astigmatism above a certain degree.

In a cataract patient with an astigmatism of roughly 0.75D (diopter), the standard intraocular lenses placed in surgery do not provide a complete astigmatism correction. A certain amount of astigmatism remains after the surgery.

If the patient does not want to use distance glasses, the standard lens fitted may not satisfy the patient. For this, it is necessary to use an astigmatic lens called a toric lens.

These lenses are specially produced considering the patient’s eye measurements. For this, the doctor needs to discuss all possible alternatives with the patient.

A cataract patient fitted with a toric lens should know that he or she will be exempt from distance glasses, but will use near glasses.

The issue of astigmatism is also a problem for multifocal lenses. If there is an astigmatism above 0.75D, the visual performance will not be good with flat multifocal lenses. Both multifocal and toric (astigmatic) lenses should be preferred.

As you can see, it is possible to live without glasses after cataract surgery, but there are many different conditions and methods.

First of all, the patient should have realistic expectations and know what he wants. The doctor also needs to inform the patient about the possible outcomes and expectations.

F.A.Q.

Do multifocal lenses have numbers?

Multifocal lenses are special lenses that can be placed inside the eye and these lenses help the eyes to see objects at close, intermediate and far distances clearly. In multifocal lenses, when the appropriate number of lenses is placed in the eye, the amount of correction required for proper focusing of the eyes is determined by the doctor. Multifocal lenses help the eyes to see objects at different distances clearly and therefore allow the eyes to see objects at different distances clearly without the need for glasses or contact lenses.

How long does multifocal lens surgery take?

Multifocal lens surgery takes about 10-20 minutes and is performed under drop anesthesia. During multifocal lens surgery, the ophthalmologist selects and inserts multifocal lenses into the eye. These lenses help the eyes to see objects at different distances clearly and therefore allow the eyes to see objects at different distances clearly without the need for glasses or contact lenses.

What should be considered after the multifocal lens?

Some precautions and considerations after multifocal lens surgery may be: Following the doctor: The instructions and recommendations given by the doctor should be taken into account. Use of sunglasses: Sunglasses should be used to protect the eyes against sunlight. Use of artificial tears: Artificial tear drops can be used to moisten the eyes. Smoking: Smoking should be carefully reduced after surgery.

References:

https://en.wikipedia.org/wiki/Progressive_lens

Alio, J. L., Plaza-Puche, A. B., Férnandez-Buenaga, R., Pikkel, J., & Maldonado, M. (2017). Multifocal intraocular lenses: an overview. Survey of ophthalmology, 62(5), 611-634.