From the early days of cataract surgery, ophthalmic surgeons have searched for the perfect implant. Initially, the natural lens was simply removed, and the patient was required to wear very thick eye glasses in order to see. Since this created substantial discomfort and distortion, special contact lenses were designed called Aphakic contacts to replace the eye glasses. This innovation dramatically improved patient comfort, and enhanced visual acuity.

As the surgery evolved, the development of intraocular implants vastly improved the visual situation as they eliminated the need for both the thick eye glasses, and expensive contact lenses. The first implants were placed in front of the iris, and were called anterior implants since they were located in front of the iris. Unfortunately, since they vibrated over time they caused damage to the cornea resulting in a secondary problem. In attempt to reduce this corneal insult, implants were inserted behind the iris and thus called posterior implants. This eliminated the vibration and did not adversely affect the cornea.

Further enhancements enabled the implants to be foldable, and could be inserted through a small tube which required a smaller incision, and ultimately did not even need sutures to close the surgically induced wound. Today the incision is made in the cornea and seals itself; so there are no stitches and healing occurs very quickly.

In spite of all these improvements, patients still wanted more. They wanted to completely eliminate glasses altogether following the surgery. They wanted to see clearly in the distance and at near. Thus the multifocal implants were developed. There are several types, and some are superior to others. The Restore and Resume implants are designed as alternating concentric circles of power. That is to say that the implant has actual circles on them with distance and near powers in an alternating fashion. This results in multiple images being projected on to the retina permitting the patient to see both far and near. The downside is that it also causes reflection off these borders resulting in substantial glare, especially in poor light. To date, there is little that can be done to improve this glare situation. On occasion, a pupillary constrictor, or Alphagan, a glaucoma medication, is prescribed to help reduce the glare at night. It does help, but only as long as the individual uses the drops. This glare can be visually devastating in sensitive patients. Proper patient screening is vital before implanting these lenses.

A recent innovation, the Crystalens implant does not have the concentric rings. It works on a principle similar to the natural lens of the eye, thus reducing glare. However, other issues are associated with this device. Regardless of which implant is used, a thorough understanding by both surgeon, as well as patient is vital to the success of any procedure.