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Refractive Lens Exchange FAQ

What is Refractive Lens Exchange (RLE) surgery?
What are the Advantages of RLE surgery?
Who is a Good Candidate for RLE Surgery?
What can I expect on the day of surgery?
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® ReSTOR® 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 complications can occur after RLE surgery?



What is Refractive Lens Exchange (RLE) surgery?
Refractive Lens Exchange surgery (RLE) is a non-laser, internal eye procedure that is performed the same way as cataract surgery, only patients do not have cataracts yet. During this procedure, the eye's clear, natural lens is removed and is replaced with a monofocal or multifocal artificial lens. The two multifocal lenses used by Dr. Jaben are the AcrySof® ReSTOR® and ReZOOM lenses.

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What are the Advantages of RLE surgery?
There are several advantages to RLE surgery. The most obvious is that this surgery has years of successful history and the cornea <http://www.usaeyes.org/glossary/bc.htm#Cornea> remains intact. If you have a thin cornea, dry eyes, or other minor cornea problems, RLE may be a better alternative than corneal-based excimer laser surgery such as LASIK or PRK. And, because RLE removes the natural lens, there is no possibility of developing cataracts in the future. If you already have cataracts forming, RLE may make a lot of sense. If you are presbyopic (the need for reading glasses), RLE may be a better alternative. There is little need to have any surgery affecting the cornea if within a short period of time you will be having cataract surgery anyway or you already cannot change focus from distance to near (this happens to most people in their mid-to-late forties).



Who is a Good Candidate for RLE Surgery?
If you would like to have improved vision, are in good general health, and are willing to accept the slight risk that comes with all surgeries, you could be a good candidate. If you:
- Are over 40
- Want to depend less on glasses or contact lenses
- Have severe myopia <http://www.the-lasik-directory.com/myopia.html>  or hyperopia
- Have severe myopia or hyperopia as well as early cataracts
- Would like to treat presbyopia <http://www.the-lasik-directory.com/presbyopia.html> with an intraocular lens implant (IOL)
- Are looking for an alternative to LASIK

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What can I expect on the day of surgery?
Before surgery -
Once you and your ophthalmologist have decided that you will have RLE surgery, your eye will be measured to determine the proper power of the intraocular lens that will be placed in your eye during surgery. Ask your ophthalmologist if you should continue to take your usual medications. Finally, make arrangements to have someone drive you to and from the surgery.

The day of surgery - Surgery is usually done on an outpatient basis. You may be asked to skip breakfast, depending on the time of your surgery. When you arrive for surgery, you will be given eyedrops and perhaps a sedative to help you relax. A local anesthetic will numb the eye area. Your eye will be kept open by a special instrument. You may see light and movement, but you will not be able to see the surgery while it is happening. The skin around your eye will be thoroughly cleansed and sterile coverings will be placed around your head. Under an operating microscope, a small incision is made in your eye. Microsurgical instruments are used to break apart and suction the natural lens from your eye. The back membrane of the lens (called the posterior capsule) is left in place.

An intraocular lens implant will be placed inside your eye to replace the natural lens that was removed. When the surgery is complete, the doctor will often place a shield over your eye. After a short stay in the outpatient recovery area, you will be ready to go home.

Following surgery…this is very important
You will need to: use the eyedrops as prescribed, be careful not to rub or press on your eye, use over-the-counter-pain medicine if necessary, avoid very strenuous activities until the eye has healed, continue normal daily activities and moderate exercise, ask your doctor when you can begin driving, and wear eyeglasses or eye shield as advised by your doctor.


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.



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 zones 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.



What is meant by MIXED LENS TECHNOLOGY?
When did Dr. Jaben receive approval to implant 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.



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.



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.



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.



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



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 havesystem has 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 manysome 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.



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 dosystem does 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 six (6) months 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.



What complications can occur after RLE 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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