Refractive Lens Surgery: Changing the Way You View the World

Not everyone wishes to undergo Laser Vision Correction, nor is every correction well suited for those procedures. Alternatives exist in the form of Refractive Lens Surgery. At his Calgary Centre, prior to recommending Lens Surgery, Dr. Demong will conduct a series of diagnostic tests and an examination to determine which type of surgery is best for your eyes. Laser Eye Surgery and Refractive Lens Surgery present equal benefits for many but the recommendation will be based primarily upon the condition of your individual eyes and what you want to achieve with your procedure.

For instance, if you wish to correct reading vision as well as distance vision, Refractive Lens Exchange, using a ReSTOR multifocal lens, is your option. If you wish to correct a combination of distance vision and astigmatism, Refractive Lens Exchange, using a Toric lens, is your option. Refractive Lens Exchange is also the best option If you are experiencing visual disturbances under dim lighting conditions because of pre-cataract changes in your natural lenses. On the other hand, if you are young and have a very high nearsighted prescription outside the safe range of Laser Vision Correction, Phakic Lens Insertion may be your best option.

1. Refractive Lens Exchange (RLE)

Refractive Lens Exchange is a permanent vision correction solution involving replacement of your natural lens with an artificial lens implant. It builds on the technique that has been developed over decades to treat cataracts.

This surgery requires a fine degree of surgical skill, usually developed by performing cataract surgery. Dr. Demong has performed over 10,000 procedures since 1980. As one of the most respected lens surgeons in Canada, he specializes in the micro-incision, no-stitch technique made possible with the combined technologies of ultrasound and foldable lenses. These innovations mean refractive lens removal surgery can be performed safely and quickly, minimizing the risk of complications and optimizing your visual outcome.

Since 40% of distance vision and almost 100% of the accommodative ability is derived from the natural lens of the eye, removal of your lens results in severe visual hardship unless an artificial lens implant replaces it. Artificial lens implants are available in a wide selection of prescription strengths. Once securely in place, these lenses cannot be felt and require no special care. The lens implants will remain in place for the rest of your life.

Refractive Lens Exchange, then, is a two step process:

Phase 1:
Removal of the natural lens with a specialized ultrasonic device.

Phase 2:
Replacement of the natural lens with an artificial lens implant. The implant chosen will be determined by the amount and type of correction you require.

Your surgical appointment will last about 2 ½ hours. Both eyes may be treated the same day in back to back procedures. Each procedure takes about 20 minutes. All Lens Surgery is performed with anesthetic gel to numb sensation during treatment.

Following Refractive Lens Exchange, you can never develop a cataract as you age. This is because your natural lens, where a cataract develops, has been removed. However, the delicate membrane surrounding the artificial lens implant can cloud from protein deposits, resulting in poor quality vision. A device called a YAG laser is used to treat the cloudiness by creating a small opening in the clouded capsule. A YAG laser is performed in Dr. Demong's office and is a quick and comfortable procedure, restoring visual clarity within 2 - 3 days.

2. Phakic Lens Insertion (Anterior Implantable Contact Lenses)

Phakic Lens Insertion is a reversible vision correction solution involving augmentation of your natural lens with an artificial lens implant positioned inside the eye in front of your iris, also known as Implantable Contact Lens.

This surgery requires a fine degree of surgical skill, transferred from techniques used in both cataract surgery and corneal surgery. Dr. Demong personally has performed over 10,000 such procedures since 1980. As a fellowship trained corneal specialist and one of the most respected corneal surgeons in the country, he specializes in the latest corneal techniques. It was his interest in the effect of Implantable Contact Lenses on the cornea that led to his participation in a five year study of these anterior phakic lens implants, called Cachet Lenses. The results of the study have been overwhelmingly beneficial and the lenses were approved by Health Canada in November, 2009. Effective December, 2009, Dr. Demong became the first surgeon in Canada to be certified to perform Cachet Lens Insertion on the general public. The surgery is performed safely and quickly, minimizing the risk of complications and optimizing your visual outcome.

The Cachet Phakic Lens is a supplemental lens to your natural crystalline lens which is left intact during the procedure. It corrects severe forms of nearsightedness and leaves the natural accommodation of the cystalline lens unimpeded. This makes this lens extremely suitable for those adults between the ages of 18 - 45 whose accommodative reflex has not yet undergone significant change. These lens implants can be removed if desired or when the natural lens begins to undergo cataract changes later in life and cataract surgery can then be performed. This surgery, therefore, is considered reversible.

Your surgical appointment will last 3 1/2 hours. Both eyes are usually treated the same day in back to back procedures. Each procedure takes about 10 minutes. All Lens Surgery is performed with anesthetic gel to numb sensation during treatment.

Your Lens Surgery Experience

1. Refractive Lens Exchange

Your Refractive Lens Surgery will be performed at Dr. Demong's private surgical suite located adjacent to our office in Calgary. A mild sedative and series of eye drops will be administered in preparation for treatment. At the same time, our nurses will describe the anticipated process and answer your questions.

Anesthetic gel will be used to numb your eyes. Your eyelids will be gently parted with a spring-like brace to prevent blinking. You will not feel this, nor will you experience any discomfort throughout your treatment.

Then, Dr. Demong will cover you with surgical drapes, ensuring you can breathe comfortably under them. He'll ask you to look at a bright light above you and you'll need to remain very still. Using a specialized surgical device, he'll remove the natural lens with ultrasound and fine pulses of fluid. Then he'll position the artificial lens in the space the natural lens occupied. Upon completion, the incision will seal without a stitch and the eye will require no patch.

If both eyes undergo the procedure the same day, Dr. Demong will change gloves, instruments and drapes while the anesthetist instills anesthetic gel into the other eye. Then the entire procedure will be repeated. When you arise after surgery, you will notice an immediate improvement compared to when you entered the surgical room, but your best vision will not be enjoyed until much later in the evening or early the next morning when dilating drops have worn off.

You'll remain at our Centre for a brief period during which our nurses will review instructions to follow the first evening. They will also provide a brochure outlining those details. Our registered nurse on call will contact you after you've returned home to check on your condition, review instructions and answer any questions you may have.

Now, let's examine the procedure in more detail:

Lens Replacement

2. Phakic Lens Insertion (Anterior Implantable Contact Lenses)

Your Phakic Lens Surgery will be performed at Dr. Demong's private surgical suite located adjacent to our office. A mild sedative and series of eye drops will be administered in preparation for treatment. At the same time, our nurses will describe the anticipated process and answer your questions.

Anesthetic gel will be used to numb your eyes. Your eyelids will be gently parted with a spring-like device to prevent blinking. You will not feel this, nor will you experience any discomfort throughout your treatment.

Then, Dr. Demong will cover you with surgical drapes, ensuring you can breathe comfortably under them. He'll ask you to look at a bright light in the microscope above you and you'll need to remain very still. He makes a small opening on the surface of your eye then uses a special insertion device to guide the foldable Phakic lens implant into the correct position in front of your iris. The lens then unfolds like a blossom and supplements the strength of your natural lens. Upon completion, the incision will seal without a stitch and the eye will require no patch.

Most of the time, Dr. Demong will recommend that both eyes undergo the procedure the same day to hasten recovery and facilitate stereo vision. Dr. Demong will rescrub, change gloves, instruments and drapes and add more anesthetic gel to the second eye between the two procedures. Then the entire process will be repeated again on the fellow eye. When you arise after surgery, you will notice a profound improvement compared to when you entered the surgical room, and your vision will undergo its most dramatic transformation within the first few hours after surgery.

You'll remain at our Centre for 2 hours during which time our nurses will review instructions to follow the first evening. They will also provide a brochure outlining those details. Before leaving our Centre, Dr. Demong will examine your eyes and check your eye pressure. Our registered nurse on call will contact you after you've returned home to check on your condition, review instructions and answer any questions you may have.

Now, let's examine the procedure in more detail:

Phakic Lens Insertion