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Frequently Asked Questions about Cataracts and the new ReSTOR and ReZOOM Lenses

What is a cataract?
What causes cataracts?
How is a cataract detected?
How fast does a cataract develop?
How is a cataract treated?
When should cataract surgery be performed?
What can I expect from cataract surgery?
When is the laser used?
When a cataract is removed, will it grow back?
What complications can occur after cataract surgery?
What is the importance of pre-existing eye conditions?
What is the cause of presbyopia (loss of near vision over the age of 40)?
What is monovision?
What is the technology of the AcrySof® ReSTOR® Lens?
How is the AcrySof® ReSTOR® Lens Different From Others?
What is the technology of the ReZOOM Lens?
How is the ReZOOM Lens Different From Others?
What is meant by MIXED LENS TECHNOLOGY?
Who is a good candidate for the AcrySof® ReSTOR® Lens and the ReZOOM Lens?
When did the AcrySof® ReSTOR® Lens and the ReZOOM Lens receive FDA approval
When did Dr. Jaben receive approval to implant the AcrySof® ReSTOR® Lens and the ReZOOM Lens?
Is there a cost difference between the multifocal lenses (AcrySof® ReSTOR® Lens / ReZOOM Lens) and a monofocal lens?
Can the AcrySof® ReSTORî Lens be used for people with presbyopia (over 40 vision)?
What if my vision changes after cataract surgery?
Will the AcrySof® ReSTOR® Lens and ReZOOM Lens last for the rest of my life?
What are my options if I am still dependent on glasses after implant surgery?
What are the reasons why a patient might still need glasses after implant surgery?
Are the AcrySof® ReSTOR® Lens and ReZOOM Lens procedures reversible?
Will there be a problem with glare after AcrySof® ReSTOR® Lens and ReZOOM Lens surgery?
What type of adjustment should be expected after AcrySof® ReSTOR® Lens and ReZOOM Lens surgery?





What is a cataract?
A cataract is the clouding of the normally clear lens of the eye. It can be compared to a window that is frosted or fogged with steam. There are many misconceptions about cataract. A cataract is:
not a film over the eye
not caused by overusing the eyes
not spread from one eye to the other
not a cause of irreversible blindness

Common symptoms of cataracts include:
a painless blurring of vision
glare or light sensitivity
frequent eyeglass prescription changes
double vision in one eye
needing brighter light to read
poor night vision
fading or yellowing of colors
The amount and pattern of cloudiness within the lens can vary. If the cloudiness is not near the center of the lens, you may not be aware that a cataract is present.

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What causes cataracts?
The most common type of cataract is related to aging of the eye. Other causes of cataract include:
family history
medical problems, such as diabetes
injury to the eye
medications, such as steroids
long-term, unprotected exposure to sunlight
previous eye surgery
unknown factors

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How is a cataract detected?
A thorough eye examination by your eye doctor can detect the presence and extent of a cataract, as well as any other conditions that may be causing blurred vision or other symptoms. There may be other reasons for visual loss in addition to the cataract, particularly problems involving the retina or optic nerve. If these problems are present, removal of the cataract may improve vision, but perfect sight may not be possible.
If such conditions are severe, removal of the cataract may not result in any improvement in vision. Your ophthalmologist can tell you how much visual improvement is likely.

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How fast does a cataract develop?
How quickly the cataract develops varies among individuals and may even vary between the two eyes. Most age-related cataracts progress gradually over a period of years. Other cataracts, especially in younger people and people with diabetes, may progress rapidly over a few months. It is not possible to predict exactly how fast or how much cataracts will develop in any given person.

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How is a cataract treated?
Surgery is the only way a cataract can be removed. However, if symptoms from a cataract are mild, a change of glasses may be all that is needed for you to function more comfortably. There are no medications, dietary supplements, exercises or optical devices that have been shown to prevent or cure cataracts. Protection from excessive sunlight may help prevent or slow the progression of cataracts. Sunglasses that screen out ultraviolet (UV) light rays or regular eyeglasses with a clear, anti-UV coating offer this protection.

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When should cataract surgery be performed?
Cataract surgery should be considered when cataracts cause enough loss of vision to interfere with daily activities. It is not true that cataracts need to be ripe before they can be removed. Cataract surgery can be performed when your visual needs require it. You must decide if you can see to do your job and drive safely, or if you can read and watch TV in comfort. Can you see well enough to perform daily tasks, such as cooking, shopping, yard work or taking medications without difficulty? Based on your symptoms, you and your eye doctor should decide together when surgery is appropriate.

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What can I expect from cataract surgery?
Over 1.4 million people have cataract surgery each year in the United States, and 98% of those surgeries are performed with no complications. During cataract surgery, which is usually performed under local or topical anesthesia as an outpatient procedure, the cloudy lens is removed from the eye. In most cases, the focusing power of the natural lens is restored by replacing it with a permanent intraocular lens implant. Your eye doctor performs this delicate surgery using a microscope, miniature instruments and other modern technology.

In some people who have cataract surgery, the natural capsule that supports the intraocular lens will become cloudy. Laser surgery is used to open this cloudy capsule, restoring the clear vision.

You will have to use eye drops as your eye doctor directs. Your eye doctor will check your eye several times to make sure it is healing properly.

Cataract surgery is a highly successful procedure. Improved vision is the result in over 98% of cases, unless there is a problem with the cornea, retina, optic nerve or other structures. It is important to understand that complications can occur during or after the surgery, some severe enough to limit vision. If you experience even the slightest problem after cataract surgery, your eye doctor will want to hear from you.

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When is the laser used?
The posterior capsule sometimes turns cloudy several months or years after the original cataract operation. If this cloudiness blurs your vision, the subsequent procedure using a laser can be performed by your surgeon.

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When a cataract is removed, will it grow back?
Once the natural lens of the eye is removed, it will not grow back. If you develop an opacity in the capsular bag (the structure in the eye that holds the implant), this opacity which is often called a secondary cataract can be removed with a laser procedure in the office.

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What complications can occur after cataract surgery?
Some of the more serious complications that may affect your vision in 2% of cases are:
infection
bleeding
swelling of the cornea or retina
detachment of the retina.
loss or decrease in vision
Call your ophthalmologist immediately if you have any of the following symptoms after surgery:
pain not relieved by non-prescription pain medication
loss or decrease in vision
redness in or around the eye
nausea, vomiting or excessive coughing
injury to the eye
Fortunately, with modern technology and excellent surgeon skills, 98% of cataract surgery cases are uncomplicated and result in improved vision.

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What is the importance of pre-existing eye conditions?
Even if the surgery is successful, you still may not see as well as you would like to. Other problems with your eyes, such as macular degeneration (aging of the retina), glaucoma or diabetic retinopathy, may limit your vision after surgery. Even with such problems, cataract surgery may still be worthwhile.

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What is the cause of presbyopia (loss of near vision over the age of 40)?
The exact cause of presbyopia continues to be debated. Some think it has to do with an increasing rigidity of the proteins and fibers in the natural lens of the eye that gradually increases with age naturally. Some feel it has something to do with changes in the internal eye muscles and spatial changes of the internal eye structures. Regardless, it is an inevitable vision change that all humans will experience. While there is not an ideal form of treatment, much interest and research continues.

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What is monovision?
This technique has long been an option for contact lens wearers who have developed presbyopia. One eye, usually the dominant eye, is fitted for distance and the other eye, usually the non-dominant eye, is fitted for near. Some brains readily adapt and are not bothered by the disparity between the two eyes while other brains do not adjust at all and never are able to overcome the imbalance created by this technique. It seems to be either an all or nothing phenomenon for most. This same approach can also be applied to patients undergoing cataract surgery and attempting to deal with presbyopia. Monofocal implants are used for distance in the dominant eye and for near in the non-dominant eye. Generally it is useful to try this with a contact lens before surgery to determine if the patient will be able to accept this system. Reversal of monovision implants is possible with additional surgery, but it is best to try contact lenses preoperatively to see if the patient is a good candidate.

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What is the technology of the AcrySof® ReSTOR Lens?
Intraocular lens implants (IOL) were introduced in England in 1949. They have been used routinely in cataract surgery since the mid 1970s to correct vision. The AcrySof® ReSTOR® Lens uses the same AcroSof® hydrophobic acrylic lens material as the original AcrySof® monofocal lens, which was developed and introduced by Alcon Laboratories, Inc. and has been implanted in over 21 million eyes worldwide since 1991. Studies on the original AcrySof® lenses have demonstrated a high level of material biocompatibility within the eye. The shape, configuration and dimensions of the AcrySof® ReSTOR® Lens are exactly the same as the previous monofocal versions so there are no significant changes to surgical technique from standard cataract surgery. The new technology that allows the near to distance range of vision involves a series of elevated ridges on the surface of the optic portion of the lens which vary in height and separation. These ridges cause the implant to focus a portion of the light rays from distance objects and a portion from near objects simultaneously depending on pupil size in different lighting conditions. This is the apodized diffractive optical technology.

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How is the AcrySof® ReSTOR® Lens Different From Others?
The AcrySof® ReSTOR® optical system uses apodized diffractive technology to provide a range of vision from near to mid-range to distance activities. It is intended for patients who are interested in decreasing or even eliminating their dependency on glasses and contact lenses. It is specially designed to distribute light in response to the size of your pupil at any given moment, distributing the appropriate amount of light to near and distant focal points. It is convex on both sides and is made of a soft acrylic plastic. It is folded and inserted into the eye through a small incision about 1/8 of an inch. Once inside the eye, it gently unfolds into position. 90% of patients implanted with this lens system are completely independent of spectacles after surgery.

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What is the technology of the ReZOOM Lens?
Intraocular lens implants (IOL) were introduced in England in 1949. They have been used routinely in cataract surgery since the mid 1970s to correct vision. The ReZOOM Lens uses the same acrylic lens material as other monofocal lenses, which was developed and introduced by Advanced Medical Optics, Inc. and has been implanted in millions of eyes worldwide. Studies on the original acrylic lenses have demonstrated a high level of material biocompatibility within the eye. The shape, configuration and dimensions of the ReZOOM Lens are exactly the same as the other AMO monofocal versions so there are no significant changes to surgical technique from standard cataract surgery. The new technology that allows the near to distance range of vision involves a series of rings on the surface of the optic portion of the lens which vary in size and separation. These ridges cause the implant to focus a portion of the light rays from distance objects and a portion from near objects simultaneously. This is called zonal refractive optical technology.

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How is the ReZOOM Lens Different From Others?
The ReZOOM optical system uses zonal refractive technology to provide a range of vision from near to mid-range to distance activities. It is intended for patients who are interested in decreasing or even eliminating their dependency on glasses and contact lenses. The ReZOOM Lens has uniquely proportioned visual zones that provide major advantages. Each ReZOOM Lens is divided into five different zones with each zone designed for different light and focal distances. Unlike other earlier multifocal lens designs, the ReZOOM Lens has proportioned the size of its zones to provide for good vision in a range of light conditions. For instance, some zones have been designed to offer greater low light/ distance vision support during night driving. It is convex on both sides and is made of a soft acrylic plastic. It is folded and inserted into the eye through a small incision about 1/8 of an inch. Once inside the eye, it gently unfolds into position. 92% of patients implanted with this lens system reported wearing glasses either "never" or "occasionally after cataract surgery.

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What is meant by MIXED LENS TECHNOLOGY?
When the same multifocal lens is placed in both eyes of the same patient, this is referred to as MATCHED TECHNOLOGY. Sometimes a patient is better served by having an AcrySof® ReSTOR® Lens in one eye and a ReZOOM Lens in the second eye; this is often referred to as MIXED TECHNOLOGY. This may result in a better overall range of vision for near, intermediate and distance vision. This choice should be chosen in conjunction with Dr. Jaben and is based on numerous factors evaluated during the preoperative assessment. Although this arrangement may lead to some differences in individual eye performance when comparing one eye separately to the other, the brain seems to easily balance MIXED TERCHNOLOGY for binocular vision. This combination when appropriately used may allow for the best advantages of both types of implants.

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Who is a good candidate for the AcrySof® ReSTOR® Lens and the ReZOOM Lens?
If you have a cataract and are in good eye and general health, you may be a candidate for this surgery. This implant is especially designed for patients who are motivated to reduce or even eliminate their dependency on glasses. Unfortunately, if you have already had cataract surgery, have significant other eye disease such as macular degeneration or corneal disease, have large amounts of astigmatism or have had Radial Keratotomy (RK) refractive surgery, you are likely no longer a candidate for this lens. Alcon Laboratories Inc., the manufacturer of the implant, has indicated that the following patients should not consider the Acrysof® ReSTOR® Lens for implant surgery; essentially the same recommendations hold true for the ReZOOM Lens:
Patients that are hypercritical with unrealistic expectations
Patients with excessive complaints about their prescription glasses or contact lenses
Patients who are intolerant of monovision
Patients who drive at night for a living or whose occupation or hobbies depend on good night vision
Patients who are happy wearing glasses
Patients who want guarantees on surgical outcomes
Patients who have pre-existing complaints about nighttime glare
In addition, if there is a problem encountered with the eye during surgery that will not allow perfect implantation and centering of the lens, then Dr. Jaben may need to make an intraoperative decision to abort the lens and choose an implant better suited for the situation.

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When did the AcrySof® ReSTOR® Lens and the ReZOOM Lens receive FDA approval?
The US FDA approval was granted to Alcon Laboratories, Inc, on March 23, 2005, for use of the new ReSTOR® Lens in the United States; FDA approval was granted to Advanced Medical Optics (AMO) for the new ReZOOM Lens later the same year. However, significant experience with and information about the implants in Europe and South America were already available where over 12,000 multifocal lenses have been implanted since April 4, 2003, and with similar results as achieved in the US FDA studies.

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When did Dr. Jaben receive approval to implant the AcrySof® ReSTOR® Lens and the ReZOOM Lens?
In June 2005, Dr. Jaben received training and approval by Alcon to implant the new Acrysof® ReSTOR® lens. Alcon contracted an independent research company to monitor all cataract surgeons interested in implanting the new lens. Dr. Jaben's implant outcomes were rated as excellent. He implanted his first AcrySof® ReSTOR® Lens in a patient at the SouthPark Ambulatory Surgery Center in August 2005. Dr. Jaben began implanting the ReZOOM lenses in 2006 after similar training and evaluation.

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Is there a cost difference between the multifocal lenses (AcrySof® ReSTOR® Lens / ReZOOM Lens) and a monofocal lens?
Most insurance health plans including Medicare and supplemental policies will allow their beneficiaries to choose this new technology. However, the beneficiary is responsible for paying the additional charges for the new technology and added services (please see the ReSTOR® / ReZOOM Fee Schedule section on this website). If the patient satisfies their health plans criteria for cataract surgery, then the health plan will typically cover the surgical and facility event as usual, but will not cover the added costs of the new technology. If the patient does not satisfy their health plans criteria for cataract surgery, then the patient must be responsible for all surgical, facility and implant costs. All noncovered expenses are expected to be paid by the patient before surgery can be scheduled and the implant can be ordered. Dr. Jaben's surgical counselor, Cathy Echerd, is available to research insurance health plan issues and discuss payment since health plan criteria for surgery, copays, deductibles and coverages differ for individual patients.

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Can this lens be used for people with presbyopia (over 40 vision)?
In many cases, people over age 40 may begin wearing glasses for the first time in their lives. The Acrysof® ReSTOR® Lens and ReZOOM Lens can benefit those wearing only reading glasses. However, patients need to make a well-informed decision about this choice since a clear, healthy lens is usually being removed in this scenario and replaced with the artificial multifocal lens. This technique can restore patient's ability to deal with near vision tasks which has been lost due to presbyopia. The AcrySof® ReSTOR® Lens and ReZOOM Lens procedure in this situation will likely not be covered by most insurance health plans since it is unlikely that the criteria for having a cataract will be met.

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What if my vision changes after cataract surgery?
Due to the small incision (approximately 1/8 inch) and sutureless surgical techniques used by most cataract surgeons for intraocular lens implant surgery in today's world, vision usually does not change or only changes very slightly during the remainder of one's life. These techniques cause only minimal changes in the structure and shape of the eyeball and result in less scarring. Other than the incision and the natural lens of the eye, the remaining structures change very little with age. Since the incision that removes the lens is small and sutureless, there is very little that will change over time.

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Will the AcrySof® ReSTOR® Lens and ReZOOM Lens last for the rest of my life?
Any intraocular lens implant whether it is monofocal or multifocal is very likely to remain intact for the duration of one's lifetime regardless of age. Replacement may be needed only very rarely in the case of damage or dislocation due to trauma. It is very rare to experience spontaneous dislocation, implant clouding, implant deterioration or large changes in vision all of which could result in the need for exchange or replacement. All implant materials used today are very reliable and durable.

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What are my options if I am still dependent on glasses after implant surgery?
There are options: (1) you may use corrective lenses such as contact lenses or glasses; (2) an implant exchange can be performed to change the initial implant with a second same or similar implant to obtain a better focusing power; and (3) refractive surgery such as laser vision correction may be performed on the cornea to achieve better focus.

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What are the reasons why a patient might still need glasses after implant surgery?
If the eye is healthy and there are no pre-existing eye health problems, then requiring glasses after surgery in addition to the implant means that the eye is out of focus for one of the following reasons:
the lens implant does not settle where expected due to unpredictable healing changes
there are unexpected healing changes in the incision or on the eye's surface
the measurements and calculations for the implant power prior to surgery were not accurate
if the implant calculations were accurate, it is possible for human and individual patient variability
an incorrect implant was used
a complication developed either during or after surgery

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Are the AcrySof® ReSTOR® Lens and ReZOOM Lens procedures reversible?
It is possible to remove and exchange an AcrySof® ReSTOR® Lens, the ReZOOM Lens, or any other implant although the surgery to do so may be technically more difficult than the initial surgery. There may be a 30 to 90 day period of neural adaptation in the brain's vision center for any AcrySof® ReSTOR® Lens or ReZOOM Lens patient to adjust to their new optical system. Due to this adjustment period, it is required that every AcrySof® ReSTOR® Lens and ReZOOM Lens patient plan for, at minimum, a 90 day period of adjustment after implantation of the second eye before other options are considered. Patients are urged to critically evaluate their expectations and options and carefully consider the decision for this new technology BEFORE the initial surgery to avoid any second surgery with its additional risks.

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Will there be a problem with glare after AcrySof® ReSTOR® Lens and ReZOOM Lens surgery?
All implants have increased Nighttime Visual Disturbances (NVDs) such as glare and halos around lights. The apodized diffractive technology in the AcrySof® ReSTOR® Lens (which is not found in other implants) decreases these NVDs when compared to other multifocal IOLs, but does not eliminate them completely. The zonal refractive technology in the ReZOOM Lens may have slightly more NVDs as compared to the ReSTOR® Lens, but there is not too much difference. Monofocal IOLs have a 6-9% chance of moderate to severe NVDs while the AcrySof® ReSTOR® and ReZOOM systems have a 25% chance of moderate to severe NVDs. These typically improve during the first 90 days following surgery. All patients should expect to deal with these NVDs in the early period after surgery and many patients may notice them long-term. However, most patients report that these NVDs are not a problem, do not interfere with driving, and are not as bad as the glare related to cataracts that many patients experience before surgery.

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What type of adjustment should be expected after AcrySof® ReSTOR® Lens and ReZOOM Lens surgery?
Two concepts are important here. The first is BINOCULAR SUMMATION. This means that the AcrySof® ReSTOR® and the ReZOOM optical systems do not work unless both eyes are implanted with the lens. After the first eye, the desired results will not be noticed. After the second eye is implanted, the results will begin to become apparent. Therefore, we suggest that the second eye be implanted soon after the first eye's surgery is completed, usually within 2 to 6 weeks. The second concept is NEURAL ADAPTATION. This means that the vision center in the brain will need time to adapt to the new optical system. This time varies for each patient. Most patients will notice the benefits of the multifocal IOL very quickly, but it may take up to 90 days for the finer aspects of the system to be accepted such as a decrease in Nighttime Visual Disturbances (NVDs), intermediate or mid-range vision, binocular summation, and depth perception.

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copyright Scott L. Jaben, M.D.