Lens Surgery FAQ's
Refractive Lens Exchange (Lens Replacement Surgery)
We do not view these surgeries in terms of whether one is absolutely
better than another, but rather which procedure is most suitable for each
person’s individual circumstances. These most commonly include factors
such as amount of correction, curvature of the cornea, thickness of the cornea,
health of the eyes, age and individual motivation for/expectations of the surgery
Usually the option of Refractive Lens Exchange is reserved for people who are
already experiencing a change in
accommodation of the natural lens. Typically,
this occurs after the age of 45. Not all people over the age of 45 will desire
lens replacement surgery, however. Dr. Demong will discuss your motivation for
surgery and expectations and provide choices where possible.
Refractive Lens Exchange is an option for the correction of a wide range of
vision disturbances including
nearsightedness,
farsightedness,
astigmatism and
presbyopia. In addition:
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Distance vision and astigmatism should be stable for at least one year
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Disturbances in vision should not be related to a health disorder
more suitably treated in another manner
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Expectations should be realistic, matching what the surgery is capable
of delivering with variability in individual healing patterns
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You must be committed to optimal results by complying with
treatment and follow up examinations
Those with unstable distance vision are not candidates but there are other
factors as well. The best way to determine candidacy is to undergo a preoperative
consultation but, in general, those who have the following should not undergo lens
replacement surgery:
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Usually people under the age of 40 who still have and value accommodative strength in their own eyes
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Ranges of correction beyond the power of lens implants
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Certain forms of corneal disease
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Certain forms of dry eye syndrome
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Certain forms of glaucoma
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Chronic iritis
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Cataracts: Although cataract surgery involves the same basic steps as
Refractive Lens Exchange, the presence of a cataract changes the
classification of the procedure from elective to medically necessary and
it is important to note that in Canada, it is illegal to charge the
patient directly for a medically necessary procedure
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Retinal pathology
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Connective tissue disorders
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Immunosuppressive disorders
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Any systemic disorder or use of medication that inhibits tissue regrowth
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Mental instability or recent emotional trauma
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Pregnancy or lactation
Only you can decide if you’re ready to take the next step but if you’re
concerned about safety and reliability, the technology exists now to
provide safe, consistent and accurate results. Remember this surgery
involves the same techniques as cataract surgery and has been performed
safely in this manner for decades. The artificial lens implants do
undergo improvements over time but you need to decide whether or not
the existing lenses will meet your expectations.
Dr. Demong will make his recommendation based on the health of your eyes,
what you hope to achieve following surgery and what you do for a living.
He will describe the benefits and risks of each type of lens recommended
and allow sufficient time for your questions. Afterward, you will make
the choice you feel best matches your needs.
Although all lens implants provide protection against ultraviolet light,
the yellow tint further filters about 40% of blue light as well.
Excessive exposure to blue light is thought to have harmful effects on
the retina of the eye over time and may accelerate changes related to
macular degeneration but by adding a blue filter, your retina is well
protected and the risk of damage is minimized. The transparent yellow
tint does not affect your overall color perception.
No. The artificial lens implants are a permanent replacement for your
natural lenses and will last for the rest of your life. Vision changes
that occur as we age are attributable to changes in the natural lens of
the eye which is removed at the time of lens replacement surgery. You
will never develop a cataract as you grow older.
No. During recovery, the lens adheres to the wall of the capsular bag and
the bag itself begins to contract around the lens. Removal of the lens after
that happens places the structures of the eye at risk for complications.
You should consider Refractive Lens Exchange as a permanent, one-time procedure.
No. As with any surgery, the critical period for development of problems is
within the first week to 10 days after surgery. Once recovery is complete,
you will be at no greater risk than the general public for untoward conditions
as you age, and you may even have some advantages. For instance, you will
not develop cataracts as you age because you have no natural lenses remaining.
Yes. The options include: same day; each eye on a different day in
the same week; or each eye on a different day one week apart. Dr. Demong
will discuss your expectations and make a recommendation on the basis of
that combined with the condition of your eyes. If you undergo same day
surgery, you must be particularly diligent in following treatment instructions to the letter.
No. You will be awake for the procedure which will last about 20
minutes each eye. You may be given a mild sedative before, and
anesthetic gel during to help you relax and feel comfortable.
No. There is some minor discomfort after the anesthetic gel wears off but
there is no discomfort at the time of surgery. Freezing gel numbs the eye
during the procedure. You will notice some pressure like sensations. After the
freezing gel wears off, you will notice a gritty sensation where the incision has
been made. It feels like you have a hair or a grain of sand on the surface of
the eye and will ease as recovery progresses. If necessary, it is easily managed
with Tylenol and artificial tears. You will not likely require Tylenol more than once.
IDr. Demong will stop working and ask you to look straight into the microscope
again. Your eyelids will be parted with a surgical clamp so you cannot blink.
If you need to cough or move, the nurses will have asked you to move your hand
in warning so they can caution Dr. Demong prior to it happening.
Your procedure will last about 20 minutes each eye. You will be at the Surgery
Centre for about 2 ½ hours, however, to allow sufficient time for preparation
and recovery before you return to the comfort of your own home.
No. Eye drops and the freezing gel used at the time of surgery create
a mild haziness that seems like looking through a veil for a few hours
after surgery. However, most people remark how they can focus on their
surroundings immediately upon sitting up from the surgery bed.
Improvement is rapid and most are able to function before bed time.
Vision may take up to 1 week to become clear enough to drive after surgery.
Fine improvements continue over a 6 week period. We remind those who are
considering lens replacement surgery that the perception of “perfect”
vision varies between individuals, just as healing patterns vary.
Individual results vary but most people see well enough to drive and return to
work within 1 week of surgery. By far the majority of our patients see well
without glasses or contacts once recovery is complete. Note that unless a
multifocal lens has been selected, 95% of people require reading lenses for close
work. We also stress that the goal of lens replacement surgery, like laser surgery,
is to reduce or eliminate dependency upon corrective eyewear for clear vision,
not perfection of vision which may or may not be experienced.
Eye drops are required to reduce surgical risks and moisten the eyes.
Antibiotic drops are used for one week to control the risk of infection.
As well, a combination of anti-inflammatory drops are used to control swelling
and irritation inside your eyes and encourage regulated healing. These drops
are used for 4 weeks, but artificial tears are used for several months to
supplement natural tear production in your eyes. Tear production is disturbed
for a few months after surgery while sensory nerves regrow. During this
period, artificial tears will support good hydration, promoting comfort and clear vision.
The goal of lens replacement surgery is to decrease or eliminate
your dependency upon corrective eye wear but there are no absolute
guarantees. The vast majority of people see well without correction
after surgery but you will likely require reading glasses if you
have not selected a
multifocal lens implant.
Most people return to work or school within 1 week of surgery.
Goggles will be required if you work in a dusty or hazardous environment
and you will need to delay your return if your work requires lifting.
Everyone will notice their eyes tire easily for the first week after returning
to work. Use artificial tears liberally and take frequent breaks until you become
accustomed to your new vision.
Most people resume driving within 1 week of surgery. We check your visual acuity
the first day after surgery and can tell you if you are seeing well enough to
drive at that time. Most people need a few extra days and up to a week before driving at night.
Careful selection of your
surgeon continues to be the single greatest factor in
optimal surgical outcome. It is important to feel comfortable with your surgeon
in addition to evaluating his expertise. Reputation is a good start but we also
suggest asking your optometrist for a recommendation. Use a
checklist of questions
to interview your surgeon at the time of the consultation and note how questions
are answered in addition to the information provided.
Yes. We offer a link to third party financing for those interested:
www.medicard.com.
Payment is forwarded to our Surgery Centre directly and we need not have any knowledge of your personal
financial arrangements.
Most appointments can be arranged within a few weeks of contact.
You can contact us by email or by phone at 403-254-6007 or 1-800-976-3937.
When our administrative assistant contacts you to schedule the appointment,
she will describe any required physical preparations. In addition, we suggest that you carefully
review all parts of the website to better increase your understanding of lens replacement surgery.
As well, we suggest you contact your current eye care specialist to inform him/her of your plans and
request a copy of your most recent examination findings to be forwarded to us by fax at 403-254-5887.
Finally, we invite you to print out and complete refractive registration
forms and questionnaires
to be brought with you at the time of your appointment
ReSTOR specific questions:
No. The ReSTOR lens differs in the way the varying distance prescriptions
within the lens transition from one strength to the next. It features 12
separate strengths, or zones, covering the same amount of prescription strength
that most natural eyes can adjust for between near and distance vision. As a result,
this lens most closely imitates the natural ability of the eye to focus at all
distances, although no artificial substitute is as effective as the natural youthful eye.
This lens has been specifically designed to reduce haloes and glare.
Still, you may notice a faint series of rings around points of light.
These are mild and do not prevent driving or other night activities.
These mild distortions tend to diminish with time over a 6 month period
and are most notable during the period of time between surgery of the
first eye and the second eye, if both are not done the same day.
The lens has been designed to provide a full range of vision.
Near vision and distance vision will appear slightly crisper
than intermediate vision because of the design of the lens but
you will quickly adjust once both eyes have undergone surgery.
Full stability is appreciated about 6 months after surgery.
