Around the age of 45, a slow process, which is not immediately noticed, sets in: the endogenous lenses lose flexibility and thus we lose the capacity to see close objects sharply. Smallprint becomes harder to read and eventually our arms are not “sufficiently long”. Astigmatism knocks at our door.
An alternative to reading glasses or varifocals which often provoke vertigo or headache is the exchange of the proper stiffened lens with “intelligent artificial lenses” that refract the light in several focuses thus enabling a vision in to different distances. Therefore they are called multifocal lenses. The patient benefits from the fact that he does not need any glasses in everyday life.
Refractive lens exchange with multifocal lenses means that the endogenous often aged and stiffened lens is replaced by a new intelligent artificial lens (multifocal lens). This is based on the surgical technique that is used with cataract surgery which is a routine surgery applied in Germany alone approximately 700.000 times a year.
A small incision at the edge of the cornea allows the access to the lens. The core of the natural lens is shredded by ultrasonic waves and suctioned. This process is called Phakoemulsification. After that an artificial lens which previously has been calculated according to the grade of defective vision is introduced. The artificial lens is folded so that the incision needed for the introduction can be microscopic. The lens unfolds itself in the capsular sack and positions itself accordingly. Multi-/ trifocal lenses correct defective vision for near and far distances.
Essentially, the refractive lens exchange is based on the surgery technique that is used with cataract. It is a gentle routine surgery with a low complication rate which normally is executed on out-patients and under local anaesthesia.
During refractive lens exchange the endogenous stiffened eye lens is removed and replaced by a new artificial lens. Surgery is done only one eye at a time. Once the eye has recovered from the surgery, the second eye undergoes surgery.
Prior to surgery, several specialised examinations are required, for one to find out the right gradation for your new artificial lens and secondly to check your health and that of your eyes.
During lens surgery an anaesthetist is at your side who if you wish, can administer sedation. You experience the surgery in a drowsy sleep-like form. For this purpose you should be sober. Do not eat 6 hours and drink 2 hours before surgery. You need an accompanying person.
The eye is anaesthetized with special eye drops which makes the eye completely insensitive to pain. During the entire surgery patients are awake and responsive.
During surgery the upper and lower lid are kept open with a small spring (surgical lid- barrier). You do not have to keep your eye open by yourself. To prevent the eye from drying, a wetting agent is applied in regular basis on to the eye surface. Surgery is executed with a specific surgical microscope.
After local anaesthesia the physician makes a small incision, shorter than 2mm. This incision opens a small aperture that allows access to the inside of the eye.
Through this aperture the natural lens is liquefied by ultrasound and suctioned. The lens capsule remains intact. It surrounds and protects the eye lens and, at the next step, serves as “carrier” ror the new artificial lens.
Prior to implantation, the new artificial lens is folded by the surgeon. Due to this the aperture through which the lens is inserted into the eye, can be microscopic.
The artificial lens unfolds itself in the lens capsule and slides into its final position. Flexible bars keep it in the capsule sack. The new lens is in the same place where the old one used to be.
The procedure is so gentle that the microscopic incision does not have to be sutured. It closes by itself - similar to a valve – without scars. Normally the surgery is over in less than 10 minutes. Generally speaking, the whole stay in the Smile Eyes Clinic is less than 2 hours.
The eye which has undergone surgery is covered with an ointment bandage which is removed the next day and the eye examined. After a certain monitoring phase we let you go home. You are not allowed to drive a vehicle so please bring an accompanying person.
On the day of surgery take it easy. Best is to lie down at home. The first day after surgery the ointment bandage is removed and the eye examined. Your doctor gives you medication which you are supposed to take according to his instructions.
On the whole, during the first days after surgery you will notice a considerable improvement of your visual faculty. But initially for a short time the vision is compromised by the irritation of the eye. You have to show a little patience until reaching your final good visual acuity.
Please take the prescribed medication regularly and punctually and respect the appointments for examination.
Do not squeeze or rub your eye in any event. Even with a small self-closing incision, your eye has not yet regained its normal robustness.
In the first days after surgery your face should not be sprinkled with water. If you wash your hair, be careful to incline your head backwards. During the first days you should avoid getting your eye in contact with soap.
After three days you can undergo physical effort and play sports. Sports such as swimming or diving, or sauna should be avoided until your surgeon gives his permission, normally at the latest after two weeks.
Generally you can go back to work after 2 to 4 days.
Guiding a vehicle needs the permission of your surgeon.
Multifocal lenses are highly developed intelligent artificial lenses. They divide the light into several focuses – that´s why they are called multifocal – thus enabling to see clearly in to different distances without reading glasses or varifocals.
Apart from astigmatism, artificial lenses can be used to correct short-sightedness, far-sightedness and corneal curvature.
The trifocal lens is a development of the multifocal lens with an additional focus. Besides distance and proximity also the intermediate distance can be focused. Computer work is not a problem any longer.
After the implantation of the artificial lens the refraction power of the eye does not change anymore the patient does not need glasses for lifetime. The big advantage of never having to wear glasses is “purchased” with a slightly diminished visual quality in single sectors. The reason for this lies in the physical principle of the multi-/ trifocal lenses which constantly divides the light between near, intermediate and far distance.
Undesired scattered light or light effects because of the high translucency of the trifocal lenses are rare. Even with bad light conditions very good refractive results can be obtained.
Approximately one third of the patient s need an additional minor laser correction of the cornea.
The refractive lens exchange surgery with multifocal lenses is based on the surgical technique that is applied at routine surgery of cataract.
Nevertheless even with this surgery– as with all other surgical interventions – there is a remaining risk of complications. As with any surgery there is the possibility of an infection which can be reduced to a minimum by the application of the relevant antibiotic eye drops. Rarely after surgery clouding of the lens capsule can manifest itself (the so-called opacification) but with a simple laser treatment can mostly be eliminated.
To exclude all possible risks, extensive pre- and after examinations as well as extensive patient attendance are implicit in the Smile Eyes Clinics.