Cataract surgery and specialized lenses
Therapy: The only effective treatment for cataracts is surgery, during which the clouded lens is removed and replaced with an artificial lens. There are currently no effective medications or other measures that can prevent or slow down the onset or progression of cataracts. Cataract surgery is a well-established procedure in modern ophthalmology. In a typically short, outpatient procedure, the clouded lens is removed and replaced with an artificial lens (intraocular lens).
The pre-operative examination includes a precise, computer-assisted measurement of your eyes to determine the correct strength of the artificial lens. Your doctor will also explain the suitable procedures for you and whether you are a candidate for the CATALYS Precision Laser System. During this consultation, you will be informed about the potential benefits and risks. At the end of the pre-operative examination, a specific treatment plan will be proposed, and your surgery date will be scheduled. For an artificial lens implant, you should not have any acute inflammations (e.g., purulent conjunctivitis, acute herpes infections), systemic infections, or an acute rheumatic attack.
Cataract surgery is the most common surgical procedure worldwide. It’s a routine, precisely planned, and painless intervention. Stitches are no longer necessary, and often, patients can see clearly again on the very first day after surgery. The procedure involves removing the natural but clouded lens of the eye and replacing it with an intraocular lens (IOL, standard or premium lens) to restore clear vision.
During the procedure, the cloudy, natural lens is broken up using an ultrasound probe and carefully removed through a small, approximately 2mm incision at the edge of the cornea—outside the patient’s field of vision. A folded, tiny artificial lens made of acrylic is inserted through this incision and precisely placed where the old lens was. The procedure is performed on an outpatient basis under local anesthesia and usually takes no longer than 20 minutes. Additionally, the surgery generally doesn’t require any stitches, promoting faster healing.
Only one eye is treated on the day of surgery and is then covered with a bandage overnight for protection. The local anesthesia works for several hours, so you will usually not experience any wound pain.
Regensburg Eye Clinic utilizes world-leading laser technology specifically designed for cataract treatment. Many of the steps involved in traditional cataract surgery are performed with laser assistance. The laser treatment is precise and customized to each individual patient.
Even the opening of the cornea can be performed blade-free with the CATALYS Precision Laser System. The laser enables the creation of a perfectly circular opening in the capsular bag, with the desired diameter and exact centering. This precise opening helps to position the artificial lens exactly in the center, ensuring that the lens optics are circularly overlapped and secured by the lens capsule. The laser divides and fragments the lens nucleus into many small cubes, which can then be easily aspirated. This requires very little ultrasound energy. The laser-assisted surgical procedure is particularly gentle, which is especially beneficial for patients with very hard nuclei or those with concomitant corneal diseases.
Intraocular lenses (IOLs)
Standard intraocular lenses (IOLs)
They are implanted into the eye during cataract surgery to replace the patient’s own clouded lens. In some cases, this can also correct existing nearsightedness or farsightedness. However, a standard lens cannot correct astigmatism or presbyopia (age-related farsightedness). Therefore, complete freedom from glasses cannot be achieved with a standard lens.
Premium intraocular lenses (IOLs)
Unlike standard lenses, premium intraocular lenses offer additional optical features. They can improve image quality and night vision (aspheric IOLs), reduce corneal astigmatism (toric IOLs), or enable clear vision at various distances without the need for glasses (EDOF or multifocal IOLs). Additionally, there are blue light filtering lenses designed to protect the retina. However, it is important to understand that even the most advanced premium lens cannot perfectly replicate the properties and capabilities of a young, natural lens.
The following lens types are available for the treatment of cataracts:
Monofocal lenses
Monofocal lenses allow for clear vision at a predetermined distance, such as for faraway objects. For reading and intermediate distances, you would then need reading glasses. Alternatively, it is possible to use monofocal lenses that enable reading without glasses. In this case, you would need to wear glasses for distance vision (driving, watching TV).
Aspheric intraocular lenses
Aspheric intraocular lenses correct a higher-order aberration known as ‘spherical aberration’. This can cause slight irritations in contrast or night vision for patients after cataract surgery. Aspheric premium lenses correct this aberration and enable clearer vision, especially in dim light.
Toric intraocular lenses
Toric intraocular lenses can be used when, in addition to cataracts, there is also an astigmatism. These lenses are sometimes custom-made for individual patients and, in many cases, eliminate the need for glasses to correct astigmatism after surgery.
Blue light filtering lenses
Similar to the natural lens in the elderly, so-called yellow blue-blocking lenses reduce the entry of high-energy blue light into the eye. This blue light is suspected of causing damage to the sensitive light receptors of the retina. The benefits of these lenses have not yet been definitively proven in studies.
Multifocal lenses
Multifocal lenses, similar to progressive addition lenses (PALs), combine different corrective powers. They can correct both nearsightedness and farsightedness, as well as presbyopia.
Very strict anatomical requirements apply to these premium multifocal lenses, which is why not all patients are suitable for them. Since a portion of the incoming light is lost due to scattering effects, night vision with these lenses can be impaired by halos around light sources.
Lenses with extended depth of focus (EDOF, etc..)
New specialized types of multifocal lenses are implants that, in addition to providing good distance vision, also offer clear vision at intermediate distances (e.g., for computer work). However, near vision may be slightly less sharp compared to traditional multifocal lenses, sometimes necessitating the use of reading glasses. The optical side effects in low-light conditions are, however, less pronounced than with classic multifocal lenses.
The basis for selecting an intraocular lens, in addition to a thorough eye examination, is a detailed discussion about the patient's specific needs and expectations.
Premium intraocular lenses offer many advantages, but their costs are not covered by statutory health insurance. While statutory health insurance covers the basic costs of cataract surgery, it does not cover comfort-oriented procedures such as premium lenses or surgery using a femtosecond laser.