PREMIUM IOLS

Premium Intraocular Lenses In New York City

Presbyopia is when your eyes gradually reduces its ability to read up close. It is a normal part of aging. This typically begins by mid-40s. The clear lens sits behind the iris, the colored part of the eye. When you are young, the lens is soft and flexible, easily changing shape. This lets you focus on objects both at distance and at near. After age 40, the lens becomes more rigid and cannot change shape as easily. This makes it harder to read or do any work up close. There is no way to pause or stop this naturally occurring process. Bifocals, contact lenses, LASIK, or cataract surgery are ways to correct presbyopia, thus not requiring reading glasses.
Customizable vision in cataract surgery aims to minimize the need for glasses after surgery. Dr. Rapoport spends time with each patient to develop an individualized plan to determine the best outcome for each person. 
Below are some of the tools offered.

PREMIUM IOLS NYC

MONOVISION LENSES

Monovision

With monovision, Dr. Rapoport corrects your dominant eye for seeing at distance and your nondominant eye for near vision, thereby reducing the need for reading glasses. When both eyes are functioning together, the brain naturally selects the image from the eye that has the clearer focus. Having eyes for different purposes might sound unsettling, but many patients do very well with monovision. Blended vision simply refers to monovision with a smaller discrepancy between the eyes, increasing the need for reading glasses but making it easier to adjust to the difference between the two eyes. 
Monovision and blended vision are common goals for patients over the age of 40, allowing patients to achieve good functional vision at both distance and near without the need for glasses or contact lenses.

TORIC LENSES

Toric - astigmatism correcting lens:

Advanced technology makes it possible to correct the cataracts that may be clouding your vision – and the astigmatism that may be distorting your vision – all at the same time. The Toric intraocular lens replaces your eye’s natural clouded lens during cataract surgery. It also has the ability to reduce or eliminate corneal astigmatism at the same time it corrects cataracts. Typically the result is improved distance vision and less dependence on eyeglasses. However, most patients still require corrective lenses for near and intermediate tasks. With the Toric lens, your distance vision can now be clear and vibrant following cataract surgery.
Toric intraocular lens

TRIFOCAL / EXTENDED DEPTH OF FIELD LENSES

Trifocal / Extended Depth of Field Lenses:

The Panoptix lens was FDA-approved in August 2019, having been used for many years in over 70 countries Similar to the Symfony lens below, is the first approved “Trifocal Intraocular Lens. Panoptix is clinically shown to deliver an exceptional combination of near, intermediate and distance vision, reducing the need for glasses after surgery. While the lens implant looks like a multifocal lens, the optics work differently. Instead of producing two distinct focal points, the lens uses ENLIGHTEN 9R) Optical Technology, proprietary design that optimizes intermediate vision without compromising near and distance vision. It can correct both spherical and astigmatic corrections, and builds on Alcon’s proven AcrySof IQ IOL platform. With this lens, patients, can achieve excellent clarity at distance and a range of clear vision at near for patients receiving the lens. The unique technology allows for reading vision that is at a level in between the Symfony and the traditional multifocal lenses. Dr. Rapoport was one of the first group of surgeons in NYC to implement this lens with success in her practice.

ALCON VIVITY LENS

Alcon Vivity Lens:

This lens provides some minimal depth of field, while not compromising any contrast sensitivity, distance vision, or causing any higher order aberrations. While the other multifocal and extended depth of field lenses are not safe to implant in patients with significant glaucoma, macular degeneration, or other retinal pathology, the Vivity is safe to implant in this group of patients  and provides a larger range of in focus vision than a monofocal lens. This is the perfect choice for patients who have conditions such as advanced glaucoma or macular degeneration but who still want more range of in focus visions than a standard monofocal lens.  

ALCON PANOPTIX IOL

Alcon Panoptix:

The Panoptix lens was FDA-approved in August 2019, having been used for many years in over 70 countries. It is the first and only “Trifocal Intraocular Lens” and the most advanced IOL that is now available. Panoptix is clinically shown to deliver an exceptional combination of near, intermediate and distance vision, reducing the need for glasses after surgery. While the lens implant looks like a multifocal lens, the optics work differently. Instead of producing two distinct focal points, the lens uses ENLIGHTEN 9R) Optical Technology, proprietary design that optimizes intermediate vision without compromising near and distance vision. The lens can achieve excellent clarity at distance and a range of clear vision at near for patients receiving the lens. Before, the light would be split in two ways – for distance and for near, resulting in a potential gap in vision. With the Panoptix trifocal lens, there is no gap.
The Panoptix can correct both spherical and astigmatic corrections, and builds on Alcon’s proven AcrySof IQ IOL platform. With this lens, patients, can achieve excellent clarity at distance and a range of clear vision at near for patients receiving the lens. The unique technology allows for reading vision that is at a level in between the Symfony and the traditional multifocal lenses. Dr. Rapoport is one of the first group of surgeons in NYC to implement this lens with success in her practice.

JOHNSON & JOHNSON SYMFONY IOL

Johnson & Johnson Symfony Lenses:

The Symfony lens was the first lens to be approved by the FDA with the designation “extended range of focus” intraocular lens. Similarly to the Panoptix, while the lens implant looks like a multifocal lens, the optics work differently. Instead of producing two distinct focal points, the lens can achieve excellent clarity at distance and a range of clear vision at near for patients receiving the lens. The arrival of the Symfony lens is welcomed news because many patients who were not good candidates for a multifocal lens may, in fact, be very good Symfony candidates. One specific group of patients consists of cataract patients with significant astigmatism.
Our expectations for extended depth of field patients are that they should be able to pass a driver’s test, navigate their cell phone, perform most computer tasks, and read their Ipad without the need for glasses. A multifocal lens (see below) can be considered a bit stronger than the Panoptix or Symfony with regards to its ability to provide newspaper or paperback book reading vision to implanted patients. While complete spectacle independence is often our goal with our refractive cataract surgery patients, we are, of course, unable to guarantee any specific outcome. The risk of glare/ halos at night is significantly lower with the Panoptix and Symfony lens than it is with traditional multifocal lenses, however there is still a very minor risk of night vision disturbances.
tecnis symfony lens

MULTIFOCAL LENSES

Multifocal Lenses:

The more traditional multifocal lenses provide better near vision but have a higher risk of glare and halos. The only time Dr. Rapoport implants a true multifocal lens is in conjunction with the Symfony lens for an outcome called “personalized vision.” The Symfony lens is placed in the patient’s dominant eye, the eye usually used for distance activities, and the multifocal lens is placed in the patient’s nondominant eye.

TECNIS MULTIFOCAL IOL

Tecnis Multifocal Lens:

The Tecnis Multifocal IOL, manufactured by Johnson and Johnson (J&J)), has been approved for use in the U.S. since 2009. The advanced TECNIS Multifocal Lens is an excellent option for cataract and presbyopic patients and can provide excellent vision at near, intermediate and far distances under all lighting conditions … day and night. The TECNIS Lens allows people to read a menu in a dimly lit restaurant, take a walk at dusk and even drive at night. Most importantly, the TECNIS Multifocal Lens has allowed thousands of people to achieve independence from glasses. The fully diffractive surface of the Tecnis Multifocal IOL provides advanced image quality at all distances under any lighting conditions and regardless of pupil size, according to J&J. Nearly 9 out of 10 people who have had Tecnis Multifocal IOLs implanted in their eyes enjoy freedom from eyeglasses after cataract surgery, the company says.

Are You a Good candidate for Multifocal IOLs?

If you have a pre-existing visual condition other than cataracts that affects your vision in one or both eyes (macular degeneration, an epiretinal membrane, or Fuchs dystrophy, for example), you typically will be happier with standard monofocal IOLs rather than multifocal IOLs, which require good visual capability in both eyes for best results.
With Panoptix – you should expect to have great distance and intermediate, and relatively good near vision. You may (or may not) need to have an over-the-counter pair of reading glasses. Risk of glare/ halos is minimal.
With personalized vision (Symfony + Tecnis Multifocal) – you should expect to have great distance, intermediate and near vision, but with the chance that you will have some glare and halos. You may need to determine what your willingness to accept some compromise in the clarity of your distance vision (with glare and halos) for the convenience of being less dependent on computer glasses and/or reading glasses after cataract surgery in deciding which of these two options you may want.

Laser-assisted Cataract Surgery:

Laser-assisted cataract surgery is sometimes called “femtosecond cataract surgery” or “femtosecond- assisted cataract surgery.” Using laser- assistance during cataract surgery allows for a more gentle and precise approach in which the laser performs many of the steps that otherwise must be done manually. Specifically, the laser can be used to create the opening in the capsular bag which contains the lens and can be sued to soften the lens, thus requiring less ultrasound energy to break up the lens in the eye, resulting in less potential damage to the cornea. The laser-assisted technique may be particularly beneficial in patients with Fuchs’ Dystrophy or cataracts which have become very advanced or white (mature).
In patients with corneal astigmatism, the laser can be used to make incisions in the cornea which may reduce or eliminate this astigmatism, thus decreasing the reliance on glasses or contacts. In patients who do not have enough astigmatism to require a toric intraocular lens, but enough that they will still require glasses, contacts, the femtosecond lens is a great option to eliminate this astigmatism.
Furthermore, for the best visual outcomes with toric and multifocal IOLs, the exact placement of the lens inside the eye is critical — more critical than when a monofocal IOL is used. Use of a femtosecond laser during certain steps in cataract surgery can help us better position the toric or multifocal IOL to take full advantage of the design of the lens for optimal vision.
We feel it is important to stress that everyone’s eyes and visual needs are different. After thoroughly evaluating your ocular situation and discussing your visual goals, we will explain the benefits and limitations of the available lens implants for your specific case and help you select the best option.