Ophthalmologist
SPECIAL LENS DESIGN: NON-MSP COVERED
All intraocular lenses, whether covered by MSP or not, are soft foldable lenses with a wound size of about 2.75mm. You may choose either a basic monofocal lens covered by MSP or a Special Design lens.
These advanced technology lenses are “convenience items” that are not medically necessary and can be purchased by patients. They are not covered by MSP. The optional non-MSP covered items are paid by the patient and cost can vary with each specialist depending on business overhead.
We often recommend a style of lens that will fit patient’s requirements. It is the doctor’s duty to help patients make their choice. Keep in mind, not all lenses are suitable for every patient. Some compromises must be made based on your lifestyle in order to select the best lens design for you. There is no perfect lens but patient opportunities leads to better results in an era of personalized visual care. How much your vision improves is based on having accurate mathematical measurements for surgical planning and performing excellent surgery.
The important requirement is to be on the public waitlist as soon as possible if you desire improved vision. Other choices can be finalized later as we clarify options for you and your family. In surgical planning monovision is a plan discussed in the previous General Information Package. It can be used for basic lenses or special design lenses.
Be safe, be hopeful and trust in our team.
MONOFOCAL LENSES (Non-MSP Lens)
Clareon (Alcon)
Envista (Bausch & Lomb)
Tecnis Eyhance (Johnson & Johnson)
Clareon (Alcon) A single power monofocal lens not covered by MSP (no Toric version available) that provide 100% of light at a fixed distance. It has a yellow-filter that “protects” the eye from harmful effects of the invisible ultraviolet light. This is a new biomaterial that is glistening-free. It is delivered into the eye using a preloaded automated disposable cartridge and is unique in that regard. Dysphotopsia may be less.
Envista (Bausch & Lomb) A one power, soft foldable intraocular lens that is not covered by MSP. Monofocal lenses provide 100% of light at a fixed distance. Non-Toric and Toric version available.
Tecnis Eyhance: Modified Monofocal (Johnson & Johnson)Tecnis Eyhance is Monofocal lens that works like a bifocal lens. It provides distance and arms-length vision with minimal intermediate vision without distortion in day and night.
· The interest in improving intermediate vision after cataract surgery is growing.
· New IOL designs can extend the range of vision after cataract surgery.
· Improved intermediate vision can be achieved with small yet innovative changes in the superficial profile of new-generation IOLs.
(Volume 46 Issue 6. June 2020. Journal of Cataract & Refractive Surgery)
DIFFRACTIVE OPTICS (Multifocal Lenses)
PanOptix Trifocal (Alcon)
Synergy Trifocal Tecnis (Johnson&Johnson)
Fine Lens (Baush& Lomb)
Diffractive Optics: Please refer to Wikipedia definition.
Unlike the basic Monofocal lens, it has more than one focal point.
“These IOLs use diffractive optics and split light into far and near foci, thereby creating peaks at individual focal points that the patient can focus on. However, blurry vision in between the two foci and glare and halos from the other images are disadvantages.” (EuroTimes Feb 2019 - Dr. Soosan Jacob).
Realistic expectations mean a reasonably but not completely glasses-free lifestyle. Although there is no guarantee that you will be “glasses-free” after cataract surgery, multi-focal lenses give the best opportunity to reduce your dependency on glasses. The main benefit of this is to try to reduce the need for reading glasses. These lenses divide light into different parts, a portion for distance, middle, and near range.
These lifestyle lenses are not recommended for high performance night activities (i.e.a pilot flying an airplane at night). Approximately 2% of the patients who have a diffractive multifocal lens find their vision bothersome at night and less than 1% of patients will require a lens exchange. Trifocal lenses generally give the best reading at a close range.
All patients will experience glare and halos, but most people can learn to ignore them. Patients undergo neural adaptation usually within 3 to 6 months. In other words, your brain will adapt, and your symptoms will reduce. If a patient finds the first eye (with a multi-focal diffractive lens implant) bothersome from glare or halo, he or she may choose a different design, perhaps a refractive bifocal lens (i.e.Oculentis Comfort Lens or a Monofocal) as an option for surgery in the other eye.
Patients who have two different styles of lenses will often prefer one eye, when tested individually. However, with both eyes open, the ultimate result will be the fusion of images (blended image).
“A mix-and match policy can help expand the range of vision offered by different multi-focals. Newer rotationally asymmetric segmented bifocal IOLS with sector-shaped near vision segment give far and near (+3D add) focus zones for better depth of focus and include Oculentis”. (EuroTimes Feb 2019 - Dr. Soosan Jacob).
Not all patients are suitable candidates for multi-focal lenses. The measurements obtained will help the doctor to make that recommendation.
Some patients may have blurred vision that may require glasses for certain activities such as driving at night. This is due to the pupil size which dilates at night. Minor refractive errors may manifest more at night. This may be due to an uncorrected refractive error that requires glasses, contact lenses, or corneal refractive laser surgery. Occasionally, topical eyedrops can be given to shrink the pupil and to improve vision at night.
PanOptixTrifocal Lens (Alcon)
This lens has a yellow filter that blocks invisible ultraviolet light and acts like a blue light blocker. Some studies indicate it may be beneficial in macular degeneration patients. A clear lens version has become available after April 1, 2021. European studies led by Dr. Kohnen say, “Trifocal IOLs give good VA at far, intermediate and near distance, and patient satisfaction is high despite some optical phenomenon… my patients are satisfied with these lenses. (kohnen@em.uni-frankfurt.de)
Refer to: www.PanOptix.ca and www.myalcon.com
Tecnis Design Lenses (Johnson & Johnson) (No Toric version available)
Synergy(Clear plastic, trifocal)
“TECNIS Synergy IOL combines diffractive technology from TECNIS Multifocal and TECNIS Symfony IOLs to deliver continuous high-contrast vision across the range” (also blocks ultraviolet light)
Finevision Lens Trifocal Lens (Bausch & Lomb)
Oculentis Lens (Clarion)
Vivity (Alcon
Refractive Optics: Please refer to Wikipedia definition.
Oculentis Comfort Lens: Multi-focal Lens (Clarion)
The Oculentis IOLs are refractive and thereby allow more light (~96%) to enter into the eye giving good vision in low light conditions. Also, the optics and lens design cause less halos or optic phenomena than other specialty multifocal lenses (diffractive).
This particular lens comes in 3 different kinds of add powers. It comes in non-Toric and Toric versions
For higher add power to read closer, a lens can be custom ordered and can take up to six weeks to make from Europe.
Refer to: https://www.clarionmedical.com/en-CA/vision/iols/lentis-comfort-extended-depth-of-focus-iol
Vivity: EDOF, Extended Depth of Function (Alcon)
"The Vivity®Extended Vision IOL is a first-of-its-kind, non-diffractive, presbyopia-correcting IOL, with Wavefront-Shaping technology, delivering a AcrySof® IQ monofocal visual disturbance profile and an extended focal range from distance through functional near.”
“You can expect a continuous range of vision for distant and intermediate tasks, while also providing you with functional near visual acuity. Functional near visual acuity reduced your need for glasses when performing up-close tasks such as using your smartphone or reading a menu in adequate light, compared to the basic monofocal intraocular lens.” (Alcon promotional brochure)
It is a yellow-tinted lens with a blue-light blocker which some studies indicate can be beneficial in macular degeneration patients (similar to the Panoptic and Clareon monofocal Alcon lens). Clinical experience indicated this lens functions well in mesopic conditions (dim light) although bench studies (modulation transfer function) suggest it may not perform as well as clear lenses. A clear version has become available after April 1, 2021. This lens may read at a closer range than many modified monofocal designs.
Refer to: www.vivity.ca and www.myalcon.com
THE FUTURE IN IOLS·
These create a pinhole-effect and can affect spherical aberration to reduce distortions from corneal disease but will have limitations for accurate retinal review once implanted.