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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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