Prior to about the age of 40, the natural lens of the eye can change its shape in order to focus at all different ranges: distance, intermediate and near. This change in lens shape is called accommodation. After the age of 40, a person experiences presbyopia- the permanent age-associated loss of accommodation. This is the reason that most people require reading glasses after this age. Astigmatism refers to uneven focusing in the eye. All eyes have some degree of astigmatism, and it usually due to how the cornea is shaped. Astigmatism is normally corrected with eyeglasses or contact lenses.
A variety of IOLs are considered Premium IOLs because they can increase the range of focus and/or correct astigmatism.
Conventional IOLs provide a fixed range of focus. If a conventional IOL is selected to give good distance vison, the patient will require glasses for reading. If a conventional IOL allows for good near vison, the patient will require glasses to see at distance. Conventional IOLs do not correct astigmatism.
Premium Multifocal IOLs can allow patients to see all distances clearly after cataract surgery.
Toric IOLs are designed to correct astigmatism so the eye focuses sharply.
A Variety of Premium IOLs are both multifocal and astigmatism-correcting.
It is the design of the Premium IOL, and not the surgery itself, which allows a premium IOL to give more of a range of focus and/or correct astigmatism.
Types of Premium Intraocular Lens Implants
Of note, there is an increased cost associated with premium IOLs because of the specialized designs, and because of the additional testing and calculations required to determine the appropriate IOL to use. This cost is not covered by a patient’s insurance, which usually only covers only the cost of the surgical procedure itself.
Cataract and Glaucoma Surgery are often performed together as combined procedures. This is because there is significant overlap between cataracts and glaucoma.
The lens of the eye, because of its position and size, can have significant effects on the fluid flow in the eye, causing the eye pressure to increase. Some glaucoma conditions, such as angle closure glaucoma, are the result of an enlarging cataract. Other conditions, such as steroid use or diabetes, can cause both cataracts and glaucoma. Secondary glaucoma, such as exfoliation glaucoma, are associated with both complex glaucoma and cataracts, each of which more difficult to treat.
As a result, in these and other situations, it is often more efficient to combine the glaucoma and cataract surgeries. The combined surgery can simultaneously achieve both improved vision and a lowering of the eye pressure. In addition, it is more convenient for the patient to have both types of surgery completed at the same time.
In cases where the glaucoma is mild and there is a coexisting cataract, combining cataract surgery with a MIGS procedure can reduce or eliminate the number of glaucoma drops that need to be used. In more severe glaucoma cases, the cataract surgery can be combined with a glaucoma drainage implant.
In certain situations, it is best to perform sequential procedures. This often depends on the relative complexity and severity of the cataract or the glaucoma. Either the glaucoma surgery or the cataract surgery is performed first, followed by the second type of procedure. The time between the procedures can be anywhere from weeks to months. This is to allow the eye to recover from the first procedure.
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