To see or not to see: the pros and cons of lens replacement surgery

Not being able to see the world properly can feel like missing out on a lot – and there’s only so much one can tolerate about scratched-up spectacles, painful contacts, and constantly blurry vision. Many vision impairments can be attributed to issues with the lens of the eye, a small transparent oblong-shaped ball of proteins. Whilst these issues are not dangerous to health, they can impact how people go about their daily lives. Activities that were once simple and ubiquitous like reading, writing, watching movies, going on walks in the evening, and driving become difficult and even hazardous. Vision can be completely restored with lens replacement surgery, but there are caveats to consider. Mr Mfazo Hove, an accomplished ophthalmologic surgeon in London, goes through how the lenses can have problems, and the pros and cons of lens replacement surgery.

Which visual impairments can be attributed to issues with the lens?

The lens, located behind the iris, refracts light that enters the eyes and focuses it on the retina, converting it into electrical signals with which the brain makes images and thus we have sight. Over time it can deteriorate, get cloudy, and change structure or position, leading to vision problems such as:

• Cataracts, when the lens gets cloudy and causes blurred, indistinct vision.
• Presbyopia, when the lens becomes stiff and diminishes the ability to focus on close objects.
• Astigmatism, when the lens is positioned at the wrong angle and causes the vision to be blurry and lights to be fuzzy or streaky.

This is why lens replacement surgery, also known as refractive lens exchange and intraocular lens (IOL) surgery may be an enticing opportunity for those with any of these addressable vision issues. The short procedure consists of destroying the natural lens and replacing it with one that is synthetic.

There are a few kinds of IOLs, each with a different effect. The most common are monofocal lenses, which are only able to focus at a specific depth, either far-, mid-, or short-range. Multifocal lenses are also available, which enable the patient to see at all sorts of distances.

There are possibilities of drawbacks, which are important to consider before undergoing this procedure. Below we lay out the benefits and the disadvantages of IOL surgery so you may consider the best option for you.

What are the benefits of IOL surgery?

IOL surgery can restore vision from a variety of sight impairments and is effective for comorbid issues, for example, someone struggling with both myopia and cataracts can have them both eliminated in one procedure. Patients can enjoy clear, bright vision and will be able to focus on things at different distances without strain.

It is a short procedure and short recovery time, with vision improvement being reported within days after the procedure. It’s a safe surgery with a success rate of 95 per cent. Ophthalmologic surgeons have to be thoroughly trained to execute this procedure, and the tools are extremely precise, minimising the trauma inflicted on the eye and promoting rapid healing.

It is designed to be a permanent solution so that patients need not rely on glasses or contact lenses thereafter. As the IOL is synthetic, it cannot form cataracts and it should not be susceptible to change.

What are the disadvantages of IOL surgery?

It can take a patient some time to adjust to their IOLs, so there may be a period of discomfort, headaches, and perceiving halos and glares around lights (most common in multifocal lens impants), but this should cease after a few weeks.
 

There are risks of complications post-surgery, as with any procedure, such as infection, swelling and rejection of the IOL. It is not uncommon for a thin membrane to grow behind the IOL in a process called posterior capsular opacification, but this can easily be treated by a quick laser surgery. The most serious risk is retinal detachment, which if not seen with immediacy will result in permanent blindness.

This is a procedure that ultimately not be suitable for everyone. If there are further degenerative issues with your eye, or if the issue stems not from the lens but from other parts of the eye, then the IOL surgery will not be sufficient to address the sight problem. The procedure may not be economically accessible for everyone too. If it is not greatly impacting the patient’s quality of life, it may be preferable to live with the sight issue.

It is important to consider the impact of this procedure in comparison to the cost and risks. Your doctor or ophthalmologist should discuss this with you so that you may make an informed choice about your vision and eye health.

If you are considering lens replacement surgery or are struggling with other visual impairments, Mr Mfazo Hove is available for consultation via his Top Doctors profile.