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REFRACTIVE LENSECTOMY
Also called refractive lens exchange and clear lens
extraction, this is a variation on cataract surgery
where the natural crystalline lens is removed and replaced
with an implant. The only difference between traditional
cataract surgery and refractive lensectomy is that one
does not wait for the lens to become cloudy and cataractous;
one removes the lens while it is still clear and functional.
The patient’s prescription is corrected by selecting
and inserting an implant of specific focusing power.
Technically, this type of surgery is not significantly
more challenging than currently available cataract surgery
(which, it must be emphasized, is technically more challenging
than Lasik).
The potential disadvantages of this type of procedure
include:
1) once the natural lens is removed, a patient, if less
than 40 years of age, loses the ability to read without
glasses;
2) this is more invasive surgery, with more risk; in
particular,
3) the increased risk of retinal detachment in nearsighted
patients (which is not as much of a concern for farsighted
patients).
The pseudoaccommodating IOLs have a multi-focusing
surface, much like bifocals in glasses. One such pseudoaccommodating
IOL is the ReSTOR® implant. For
the well-motivated patient, this can be an excellent
option
The true accommodating IOL works by mimicking the young,
natural crystalline lens; it flexes and moves forward
with near or reading effort, generating more focusing
power. The Crystalens is the first
approved accommodating IOL in the U.S. Three years out
of the original FDA study of this lens, patients are
still enjoying distance, intermediate, and near vision,
the vast majority without any glasses. This
is another excellent implant option for the motivated
patient.
There are a slew of pseudoaccommodating and accommodating
IOLs in the research pipeline, which may eventually
reach the U.S.
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