Frequently Asked Questions About the Accommodating Lens
Q: What is the Accommodating Lens?A: The Accommodating Lens is a relatively new technology that is designed to mimic the eye's natural ability to focus on distant, middle and near objects. Used in conjunction with highly effective cataract extraction methods (with or without the presence of a cataract), the Accommodating Lens can restore a full range of functional vision, from distance to reading vision without total dependence on glasses or contact lenses.
Q: What makes the Accommodating Lens different from other intraocular lenses?
A: The Accommodating Lens has the unique ability to focus on objects at varying distances using the eye's natural muscle. This means that the Accommodating Lens can provide sharper vision, without corrective lenses, throughout a full range of vision from near to far and everything in between.
Standard (single vision) lens implants do not have the ability to provide a full range of vision. Most people who have single vision lens implants MUST wear glasses for middle and near vision.
Q: Can my vision be corrected to 20/20, for both reading & distance?
A: The Accommodating Lens has been designed to focus your eyes at all distances after cataract surgery. While virtually everyone will experience a significant improvement in their uncorrected vision after surgery, some people will not see 20/20 at all distances.
It is interesting to note that many people, who have not had surgery, are not able to see 20/20 at both near and far even with glasses or contact lenses. This is due to a variety of ocular and physiological problems as well as lifestyle preferences, yet most of these people function quite normally although their vision is reduced.
The Accommodating Lens FDA two-year clinical study results indicate that 92% of the people enrolled in the study (implanted bilaterally) could see 20/25 or better at distance, 96% could see 20/20 at arm's length and 73% could see 20/25 at near without glasses or contact lenses.
What is more exciting is that 98% of these people could pass their drivers test, 100% could see their computer and dashboard, read the prices in the supermarket or put on their makeup, and 98% could read the telephone book or newspaper, all without glasses or contact lenses.
Q: What about my middle vision like working on the computer. Will it be like wearing trifocals?
A: Your ability to see at approximately arm's length (middle vision) will be greatly enhanced with the Accommodating Lens. Over 96% of people enrolled in the clinical study were able to see 20/20 at arm's length without correction.
In addition, the quality of vision compared to wearing trifocals is significantly improved. You will have a full range of vision, without having to tilt your head to find that portion of your glasses that allows you to see clearly. You simply look at something and the Accommodating Lens will automatically focus your eye at near, arm's length, or distance. The Accommodating Lens mimics the natural focusing ability of your eye.
Q: Will I be able to read in all light conditions?
A: The Accommodating Lens functions very much like the normal human lens. It is important to remember that reading vision in low light is also influenced by the overall health of your eye and by the condition of the light sensors in the retina. As we get older our ability to see in low light conditions may start to decrease. It is always best to read in good light conditions.
Q: How do I know if I am a good candidate for Accommodating Lens implantation?
A: Singer Eye Center will perform a thorough examination and advise you of a customized treatment plan for effectively correcting your vision.
Virtually everyone with good general health is a candidate for implant surgery, but people with chronic infections, uncontrolled diabetes, or other health problems may have to wait until these conditions are under control prior to surgery.
People who have had prior corneal refractive surgery are acceptable candidates for Accommodating Lens implantation as long as their eye is in good health.
If you have already had cataract surgery, you are not a candidate for the Accommodating Lens procedure.
Q: Should I have the Accommodating Lens implant put in both eyes?
A: Both eyes work together when focusing on near objects and the Accommodating Lens will be more effective when used in both eyes. However, it is possible to benefit from the focusing abilities of the Accommodating Lens when implanted in only one eye.
Dr. Singer will look at a number of factors in deciding which eye to implant first and when, if necessary, to implant the other eye. We prefer to wait two to three weeks between surgeries, but this may vary based on how well the first eye is healing and the visual outcome.
Q: How long with the surgery take? Will I feel anything?
A: Dr. Singer performs the Accommodating Lens procedure in the Ambulatory Care Center at Gifford Medical Center, in Randolph, Vermont. You will arrive about an hour before the procedure. A number of topical drops will be placed in your eye and oral medications may be administered to help you relax. The eye drops anesthetize your eye and dilate your pupil.
Once in the surgery suite, you will lie down on a comfortable bed, a microscope will be positioned over your eye and you will be asked to look up into the light of the microscope.
The actual surgery usually takes around 20-25 minutes. Dr. Singer will stabilize your eye with a device that gently holds your eyelids open, so you won't have to worry about blinking during the procedure. You will feel no pain, only slight pressure on your eye. Many patients see beautiful colors during the surgery.
Once the surgery is complete, additional drops will be placed in your eye to prevent infection, decrease inflammation, and keep your pupil dilated. Someone will need to drive you home. Once at home, you should rest for the remainder of the day. You should avoid any strenuous activities on the day of surgery. Dr. Singer will see you the day after surgery to examine your eye. You will use eyedrops for the next 6 weeks. These drugs help the eye heal leaving no residual effects.
Q: What are the chances that something could go wrong with the surgery? What would they be?
A: The medical procedure to implant the Accommodating Lens is the same safe, proven cataract surgery performed annually on over 7 million eyes globally. The Accommodating Lens represents the state-of-the-art in artificial lens design and is the result of over 50 years' evolution in the treatment of cataracts. Over 40 million procedures have been done in the last 25 years. But because it is surgery, it is not completely risk-free.
Possible complications range from minor, usually temporary side effects, to sight-threatening complications. Fortunately, significant sight-threatening complications are extremely rare, and include, but are not limited to infection, hemorrhage, and retinal detachment. People with existing medical conditions such as diabetes, high blood pressure, chronic inflammatory conditions and chronic infections are at a higher risk of developing complications. Over 99% of Dr. Singer's patients have no complications after Accommodating Lens surgery and are very satisfied with the improvement in their vision.
Dr. Singer will perform a thorough examination and fully inform you of any increased risk of a complication.
Q: What will my vision be like after surgery?
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Beginning two (2) weeks following your 2nd eye surgery, the more you try to read without glasses, the better your near vision will become. Some people may need to decrease the strength of their reading glasses every month until they are no longer needed. We will give you a near vision restoration chart to help you keep track of your progress. It may take a few months, or longer, to achieve functional near vision following implantation of the Accommodating Lens. In fact, studies have shown that near vision keeps improving over a 7 year period. So, be patient and persistent, and your near vision will improve with age!
Q: What about glare, problems driving at night and sensitivity to light? Can implant surgery create these problems?
Sensitivity to light is often a temporary symptom. The Accommodating Lens optic material is so clear that in some people it takes time to get used to how bright colors are and how intense lights can be, particularly at night. A pair of plastic sunglasses will decrease your sensitivity to light as well as providing protection during the day.
As with any intraocular lens, glare can be a problem at night when the pupil widely dilates and occasionally light can reflect off the edge of the implant and create a flash or halo of light. This typically does not occur in your central field of vision, but rather in the periphery. People who have worn contact lenses in the past may be familiar with this phenomenon.
Again, glare is rarely debilitating and if it does bother you, there are a number of things that your doctor can do to improve your vision at night including medications or night driving glasses.
Q: Will I have to have cataract surgery following Accommodating Lens implantation?
A: Once your eye's lens is removed and replaced with a Accommodating Lens, you will never have to have cataract surgery. Occasionally, several months after the lens has been placed in the eye, the vision may start to become cloudy once again. This is due to the clouding of the membrane that surrounds the implant.
This membrane (the capsular bag) originally surrounded the natural lens. When your eye's lens was removed, all that remained was this membrane into which the Accommodating Lens was implanted. The membrane healed around the Accommodating Lens, securely holding it in place in the eye. Unfortunately, sometimes the same conditions that caused the original cataract will cause the build up of cells on the membrane behind the implant, which can blur your vision.
A laser is used to make an opening in the membrane behind the implant, immediately improving vision. This is done painlessly in Dr. Singer's office and takes just a few minutes. This laser treatment typically needs to be done only once.
Q: What happens if my eye is injured sometime in the future?
A: Eye injury can involve many different parts of the eye. The clear front part of the eye, the cornea, and the back part of the eye, the retina, are most often affected by injury.
The presence of an artificial lens does not make the eye any more vulnerable to trauma. Indeed, once the human lens has been replaced by the Accommodating Lens, eye trauma would not cause a cataract.
Q: What about future eye surgery?
A: Advanced implantation techniques and the biocompatibility of the Accommodating Lens allow the body to treat the implant as a normal part of the eye. This artificial lens is encased in the original membrane that surrounded the natural lens. This membrane, called the capsular bag, traps and holds the Accommodating Lens in the correct anatomical position in the eye.
Since the implant is fixed in the same position as the original lens, any future eye surgery that could be performed in or around the normal eye can be performed in an eye with the Accommodating Lens.
Botox treatments, plastic surgery, pterygium removal and other cosmetic procedures should not be performed until your eye is well healed. Typically this is around 3 months, but your doctor will advise you when it will be safe to undergo these procedures.
Q: I have rosacea on my face, do I need to do anything or take anything before the surgery? Do I run a higher risk of infection after surgery?
A: Rosacea is not generally considered a contraindication for eye surgery unless symptoms are expressly related to the lids or the eye itself. Your doctor will perform a complete examination and if symptoms such as an infection of the eyelids, styes, eye irritation and red eyes are present, he/she may elect to treat these conditions with medication before surgery.
If you have rosacea and are not currently exhibiting significant symptoms, it is wise to inform your doctor of your condition.
Q: I have dry eyes. Will lens implantation help this condition or will I still have to use artificial tears?
A: Implant surgery typically will have very little influence on chronic dry eyes. This condition is related to a variety of internal and external medical conditions and is sometime associated with aging. You should consult your doctor on a therapy that is most suited to the cause and severity of your condition as well as your lifestyle.
Q: Will the Accommodating Lens implant influence chronic red and irritated eyes or headaches from eyestrain?
A: If eye irritation is a result of excessive contact lens wear, sensitivity to cleaning and storage solutions, or what is generally described as ‘eye strain', implant surgery may reduce or eliminate these symptoms. Eye irritation can be caused by a wide variety of internal and external factors including allergies that have nothing to do with the Accommodating Lens implant.
Q: Will insurance cover any of the Accommodating Lens procedure?
A: If a patient has operable cataracts, health insurance may cover the portion attributable to the cataract surgical procedure. Accommodating Lens implantation addresses the correction of presbyopia, which is not covered under most health insurance policies. Therefore, the insured is required to pay the additional costs associated with the treatment of presbyopia at the time of cataract surgery, plus any deductibles and co-pays.
