Hello, Can someone explain the difference between refractive cataract surgery vs traditional cataract surgery? Many thanks.
Can you explain a bit more. Not sure what you are asking.
I have 2 reasons for this question. (1) One cataract surgeon I visited charges extra for refraction and I didn't have a chance to follow up on what that means. (2) Another surgeon's website seems to infer that you could get one or the other. I was wondering if traditional refers to basic lenses and refractive refers to premium; or if traditional does not improve vision but refractive does. On a related note, I have seen diagrams of all Clareon lenses online. I was surprised to see that the toric is very similar to the Vivity. Both show one tiny circle surrounded by a slightly larger circle in the center of the lens. I know that means the Vivity offers EDOF, but what does that mean for the toric? Thanks!
Sounds like marketing. So you'd have to ask the clinic what the difference is. We can only guess. It could be the "refractive" is doing the procedure on people that do not have a cataract (often called refractive lens exchange) or it could mean that they take extra care in the diagnostics and maybe during the procedure itself (with ORA for instance) to make sure you get the best possible visual outcome (public health will determine a target with an IOL Master of course but they don't really care if they miss the target… as long as the visual axis has been cleared they have done their job and you can just get glasses). But again these terms you are asking about are not in common use / commonly understood so you'd have to ask the clinic.
Toric is an astigmatism correcting version of the same lens. So there is a Vivity and a Vivity Toric for example but you can't tell by looking at them. They look identical. Most lenses come in both a regular and toric version.
In general "refraction" is a term used to describe the power of the lens in the eye. Your eyeglass prescription is a record of your refractive error. I have not seen it used to describe an IOL or as a type of cataract surgery. . What is essential for doing cataract surgery is a measurement of the eye dimensions with the most critical being the length of the eye. Older technology which may still be in use is to use an ultrasonic method which touches the front of the eye. The newer and better method is to do it optically. Some clinics may offer the optical as an extra cost option over the ultrasonic method. The two common optical instruments used are the Lenstar and IOLMaster. . It is also common to use a Pentacam instrument which maps the profile of the eye. It also can give a measure of the astigmatism. Some clinics may charge extra for that too. If you are looking for an eyeglass free solution it is best to be measured for astigmatism to find out if you need a toric lens. . As David explained Clareon is a new material. By now both the monofocal and the Vivity are likely available in the Clareon material. . All current lenses are going to correct and improve your vision. The difference between them are the degree to which them improve a range of distances. The basic types are monofocal, EDOF, and multifocal (MF). There is a premium for the EDOF and MF types.
Standard cataract surgery replaces the natural lens that has become cloudy (the cataract) with a monofocal lens. Refractive cataract surgery also seeks to correct some or all of the patient's refractive error. See "What is Refractive Cataract Surgery?" at allaboutvision. See also "What You Need to Know About Refractive Cataract Surgery" at ucfhealth ("The goal of a refractive cataract procedure is to successfully eliminate the need for prescription eyeglasses with full vision correction after cataract removal.").
Interesting. I have never heard that term used. Seems more like a market description to push patients into more expensive optional procedures and lenses. All IOLs provide refraction to correct vision. They seem to be almost suggesting a standard monofocal does not provide refraction correction, but of course it does. Or, the other thought is that unless you pay extra for the "refractive surgery" they will not take as much care in the measurements and IOL power calculation. We will just get things close and then you can fix the residual with glasses... Seems to me that even with a standard monofocal you want to get the best possible measurement and most accurate calculation of the IOL power to get the outcome you expect.
Is there a name for the common ultrasonic measuring instrument? Alternatively, is there a way I can determine whether my eye is being measured optically? Do patients ask this during their exam? Many thanks.
I'm not familiar with the term ORA. Could you please explain? Thanks again!
I'm not sure what you mean by saying "All IOLs provide a refraction to correct vision." As the University of Central Florida posting, to which I cited, says: "Following standard cataract surgery, patients often require corrective eyeglasses to fix refractive errors, such as astigmatism, nearsightedness, farsightedness, and presbyopia (farsightedness caused by loss of elasticity of the eye’s lens)." Further: "The goal of a refractive cataract procedure is to successfully eliminate the need for prescription eyeglasses with full vision correction after cataract removal." (Original emphasis). . To me, the difference seems straightforward. The UCF posting contains further discussion of refractive errors.
The ultrasonic method is usually called an A-Scan. I would pay the extra cost for an optical method. I believe the IOLMaster 700 is best, and the Lenstar 900 a close second. The big advantage of the IOLMaster over the Lenstar is that it takes much less time when you can't blink or move your eye to complete the test.
You would normally ask for this method during your initial consult with the surgeon.
ORA is an Alcon method of measuring the optics of your eye during the cataract surgery after the natural lens has been removed. It is a second and final check on what power of lens is needed. It may be justified if you have very high myopic or hyperopic eyes, or have had previous Lasik surgery. For standard eyes it probably does not add much, if a good method such as the IOLMaster 700 is used for the pre surgery measurement.
All IOLs provide refraction correction. That is the purpose of measuring the eyes with instruments such as the IOLMaster 700 and using IOL Power calculation formulas such as the Hill-RBF. . If you want to be eyeglasses free, then it makes sense to correct astigmatism if it is over 0.75 D. And of course if you want an extended depth of focus then you need to use mini-monovision with standard monofocal lenses or pay extra for an EDOF or MF lens. There is no extra cost to mini-monovision with standard monofocal lenses.
Bilateral implantation of monofocal IOLs with the same target is refractive surgery in the sense that, of necessity, the IOL must have a power and that power, all going well, will achieve the intended refractive result. But it's not mysterious or marketing hype for (at least some) ophthalmological surgeons to use the term "refractive cataract surgery" to refer to the use of (premium) IOLs intended, all going well, to correct all (or enough) refractive errors so that the patient ends up with full vision without eyeglasses. . Why is this such a big deal?
These paragraphs from the ucf article make it sound to me as if they're talking about multi-focal toric lenses: . "This is why refractive cataract surgery is such a groundbreaking advancement. This procedure utilizes complex, multifocal IOLs to replace the natural lens and restore the eye’s ability to perceive nearby and far-away objects—without the need for glasses or toric contact lenses. . . . *** to be an eligible candidate, the patient has to have an eyeglass or toric contact lens prescription that falls within a certain range to mitigate potential risks and reduce the chances of poor refractive outcomes."
There is nothing new or groundbreaking about multifocal IOLs. Yes they continue to evolve and improve but they have been around for a long time. What the website doesn't seem to mention is that there are pros and cons to ALL IOLs, including multifocal IOLs. You trade off image quality for focus range. Yes, Mutifocal IOLs will give you a wide range of functional vision without glasses but vision quality is not as good as with a monofocal. And they have side effects at night like halos around lights. And they have contrast loss. And you may still need readers in low light. Monofocal IOLs on the other hand have great image quality and contrast but it's only optimized for one distance so you will need glasses a lot more. Unfortunately there is no free lunch.
I think, because of the way that article is written, you may be confusing refractive error with focus range. Refractive error is when the intended target is missed, regardless of what kind of IOL is implanted. With a multifocal they still choose a target (distance) and that target can be still be missed. Refractive error doesn't mean not being able to read without glasses. If I get a monofocal targeted for distance and the surgeon nails it… perfect plano, 0 sphere, 20/20… there was no refractive error… even though you need glasses to read up close.
It is not a big deal if one understands that premium lenses are not required to achieve a full range of refractive correction. Monofocal lenses with the appropriate powers will deliver those results at no extra cost. . Seems inappropriate for surgeons to imply that premium lenses are the only way to achieve the results. It strikes me that the term may be used to dupe patients into spending the extra money ($4-6 K) for premium lenses.
" Monofocal IOLs on the other hand have great image quality and contrast but it's only optimized for one distance so you will need glasses a lot more." . That is why mini-monovision is used. You get the advantages of monofocal lenses and the depth of focus if each eye is optimized differently.