Which glasses do you think look good?
The cataract surgeryis the most common human operation. In Germany alone it is carried out around 700,000 times a year. Because everyone gets it - the cataract - sooner or later in life. Strictly speaking, it is not a disease, but an aging phenomenon, similar to the graying of hair. In the course of time, our eye lens forms more and more layers starting from its capsule. However, these are not peeled off outwards, as is the case with the skin, for example, but are released into the inside of the eye lens. The lens grows inwards and is therefore packed more and more tightly. As a result, it becomes more rigid and can no longer deform. That's why you need reading glasses from around 45 years of age. Later on, the lens becomes increasingly cloudy, which is then called "cataracts". Seeing is like looking through a dirty window pane or glasses. If this condition is subjectively so disturbing that you feel impaired in your quality of life, you can operate on cataracts. The cloudy lens in the body is then replaced by a clear plastic lens - a so-called artificial lens. This is nothing more than a visual prosthesis. You can also think of it as a very strong lens that is inserted into the eye.
As with the spectacle lens, certain additives can also be grinded into the artificial lens. But what are the possibilities? What do you have to consider?
1. The power of the artificial lens
As with the spectacle lens, the first thing to do with an artificial lens is to determine the strength. The strength then decides at what distance you will be after the operation even without glasses can see sharply.
With a corresponding additional eyeglass correction, you can of course see clearly at all distances.
The "bad" news first: Unfortunately, it is not possible to adjust the eyes with the artificial lens in such a way that the youthful ability to see (sharp vision at all distances, from far to near, without Glasses) is restored. This is because the artificial lens is made of rigid plastic that cannot deform like the adolescent lens.
The quality The news is that you can at least compensate for existing visual defects to the extent that you can one Distance range, so near, medium distances or far, too without Glasses can see largely sharply.
As a patient, you have to consider before cataract surgery whether you want to see as clearly as possible in the distance, near or in a middle intermediate area without glasses. In the other areas you can of course also see, but not exactly sharply - you need additional glasses for this.
Because humans are “creatures of habit”, the ophthalmologist usually advises you to leave everything as it always was. For example, someone who has always read without glasses would be adjusted again so that close-up vision is possible without glasses and glasses are still worn in the distance. On the other hand, with someone who has always seen sharply in the distance without glasses, the artificial lens would be chosen in such a way that afterwards, as before, he only needs glasses for close range.
In the case of someone who has such a severe visual defect that previously required glasses or contact lenses at all distances, this can be weakened to such an extent that either the distance or the vicinity becomes as glasses-free as possible.
Many people find it difficult to be “spoiled for choice”. Absolute freedom from glasses is often not that terribly important to them; However, they find it very pleasant not to have to rely on glasses in all situations, even if the visual acuity is not perfect: the main thing is that you get along well for all practical matters. For those situations where optimal visual acuity is required, wearing appropriate glasses is entirely acceptable. Examples are driving a car, especially in the dark, or long, comfortable reading. We advise these patients to use a medium setting that is “good enough” for most matters of daily life and only needs additional glasses for high special requirements.
However, it must be clear: as “proud” as we are of how precisely we can usually measure and calculate today, we must also say clearly that we are not really achieving the desired result to guarantee can, because measurement techniques and computational physics, as good as they are, also have their inaccuracies in individual cases, which we cannot avoid! Unexpected results are not the result of avoidable errors, but are inherent in the inevitable nature of things.
2. Single vision lens (monofocal lens) vs. multifocal lens (bifocal / trifocal lens)
The above considerations apply to the most commonly used type of lens, the so-called single vision or monofocal lens.
In contrast to this, there are multifocal lenses which, similar to varifocal or bifocal glasses, can focus on several areas.
From the options currently available, we have decided, after weighing all the properties, advantages and disadvantages, to only use the trifocal lenses.
They each have a sharp focus in the distance, in the middle distance range and in the vicinity.
Now you will - rightly - ask: "Why don't you always use such lenses?"
Anyone who has tried varifocal or bifocal glasses knows that they also have disadvantages. It's the same with trifocal lenses: with all multifocal lenses, the incident light is distributed over several focal points (which can then be seen clearly without glasses). This means that only part of the light arrives at each point. The result is a certain loss of quality of vision. On the one hand, the division of the light into several focal points leads to a reduction in contrast. In the conditions of daytime vision in bright light, this disadvantage is not noticeable to most people.
Under poor lighting conditions, in twilight and in the dark, this becomes noticeable, depending on the demand for perfect vision.
On the other hand, the construction principle of such lenses, the fine "grooves" around the center, which one has to imagine like grooves on a gramophone record, means that bright point-shaped light sources - a classic example are the lights of an oncoming car - can appear a little splintered and with fine ring-shaped reflections .
After all, to be satisfied with such lenses, it is important that the refractive power for the distance is “hit” very precisely. Deviations from this - see the above remarks on good, but not perfectly guaranteed predictability - can be corrected well with a laser correction on the cornea - but this option - not often, but occasionally necessary - must be taken into account when choosing such an option.
We have drawn up a “checklist” with which you can “check” with good reliability whether you are a “good candidate” for such a lens:
Is the freedom from additional visual aids (glasses) a high priority / importance for my quality of life?
a) Yes. Of course I want to see well, but if the ultimate perfection is not
is given, I don't think that's bad - the main thing is no glasses!
b) For me, perfect eyesight is paramount. Preferably, of course
without glasses, but if you can only achieve perfection with glasses, then that's better.
Is seeing at dusk and at night, especially when driving, of considerable importance to you?
a) As long as I can do that, the ultimate perfection is not here for me either
required if I don't need glasses for it.
b) I do not find any restrictions in this regard, even of a minor kind
acceptable just so as not to need glasses.
It may be necessary to correct the refractive power with the laser on the cornea in order to achieve the best possible result.
a) I have no problem with that, if it serves my goal of freedom from glasses.
b) It would not be worth another operation to me just to avoid glasses
For everyone who sees “a” as applicable for themselves, for whom “the main thing is that no glasses in everyday life” are so important that they are willing to accept the above-mentioned compromises - which should not be dramatized, but also not trivialized - in These lenses are a very good option to buy.
By the way: Multifocal lenses are not covered by statutory health insurance.
The Monovision or the so-called "Goethe view" (the famous privy councilor had this situation by nature). Here the eyes are adjusted differently - one for the distance, the other for the near. The advantage over trifocal lenses is that no problems such as stray lights are to be expected, since "normal" monofocal lenses are used. The disadvantage is naturally that you have "two different eyes". This can partially impair spatial vision, and this difference can also be annoying when driving at night. However, both can be temporarily compensated with glasses at any time in situations in which it should interfere.
Whether you are eligible for this procedure depends largely on whether you can subjectively tolerate the difference between the two eyes. You can try this out with contact lenses before an operation.
3. Toric artificial lens
A toric artificial lens compensates for a curvature of the cornea. It is nothing other than that which can also be ground into a spectacle lens. So if you have an astigmatism and want to rely on glasses as little as possible after an operation, you can have this correction built into the artificial lens.
This correction can of course be combined with the options mentioned above and is also essential for its optimal effectiveness.
By the way: The toric lens is not covered by statutory health insurance.
4. Aspherical lens
At a spherical, i.e. spherical lens, the incident light is refracted more strongly in the outer areas of the lens than in the center of the lens. A blurred image is created. Our body's lens is spherical. That is why we see better in good lighting, because then our pupil is narrow and light only falls through the center of the lens.
Aspherical on the other hand means "not spherical". An aspherical lens has the advantage that the light rays are refracted to the same extent over the entire surface of the lens, even if the pupil becomes wide in the dark. This improves the quality of vision, especially in poor lighting.
By the way: For those insured by the statutory health insurance companies, there are no additional costs for aspherical lenses.
5. Blue filter lens
Since our retina and especially the point of sharpest vision (macula) is exposed to a lot of light in the course of life, it - like the skin - is not spared light-dependent aging. It is particularly caused by the "short-wave" part of the light, i.e. the more blue, violet and ultraviolet parts of the light. These are therefore also a risk factor for the development of age-related macular degeneration, which in advanced stages can mean a loss of reading ability.
Our natural eye lens and all available artificial lenses therefore have a filter for UV light. A Blue filter lens In addition, due to its yellowish color, it has a protective property in the area of visible blue light. By the way, with increasing age, our natural lens itself develops more and more blue light filtering properties!
Even if this sounds very logical in theory, an advantage of blue filter lenses has not yet been proven in practice. On the other hand, no significant disadvantage (disturbance of the sense of color or the day-night rhythm, for which blue light is also important) could be detected.
By the way: There are no additional costs for blue filter lenses for those insured by statutory health insurances. We use them in patients at risk for age-related macular degeneration - otherwise on special request.
Which lens is right for me?
We normally recommend a monofocal lens, in which the glasses-free area is set as the patient was used to before the operation or would like to deviate from it.
If there is also a certain curvature of the cornea, this can be caused by a toric lens be balanced. This enlarges the area that you can see clearly without glasses. We always recommend one because of the better image quality aspherical lenswhich does not have to be paid additionally in Bavaria.
We recommend a blue filter lens if there is already damage to the macula or if there is an increased risk of it.
We recommend "Monovision" to patients for whom the greatest possible freedom from glasses has a high priority, who perceive the difference between the two eyes in a contact simulation as tolerable and who want to be able to compensate for the compromise with glasses in special situations, if necessary.
We recommend multifocal lenses for those patients for whom "the main thing is that no glasses in everyday life" are so important that the compromises described in terms of visual quality take a back seat and who do not shy away from post-correction if necessary.
As you can see, there are a number of points of view and considerations that you as the person affected have to take into account and that you can only decide yourself.
Like any choice, this is not without torment; but since you only have to meet them once in a lifetime, you can take all the time you need.
And finally: We as your ophthalmologists are happy to assist you with our experience and advice. We cannot make the decision for you - but we can provide explanations, answer questions and give examples.
Our advice is always and absolutely based exclusively on your best interests - nothing else.
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