Medical News Today: Pseudophakia (IOL): Signs you need them and complications

Pseudophakia translates from the Latin to mean false lens. The term refers to the implanting of an intraocular lens to replace a natural lens, the lens being the clear part of the eye that focuses light and images, enabling a person to see.

Pseudophakia often occurs during cataract surgery. A cataract causes clouding or blurring of the lens in a person’s eye and is a common condition often related to aging.

According to the National Eye Institute (NEI), more than half of Americans will either have a cataract or have had cataract surgery by the age of 80 years old.

What are the signs that you need IOLs?

Mature male patient having eye exam at optometrist.
IOLs may be recommended if a person requires cataract surgery, or has symptoms similar to that of cataracts. An optometrist can assess whether IOLs are needed.

The signs are similar to those of cataracts.

Cataracts, which occurs when proteins in the lens clump together, can blur vision and make it difficult to focus.

Common symptoms and signs of cataracts include:

  • cloudy or blurry vision

  • difficulty seeing in poor or dim lighting and at night

  • images seem as if a brownish to yellowish filter has been added

  • double vision in the affected eye

  • difficulty seeing or focusing on things at a distance and up close

  • seeing faded, less vibrant colors, especially hues of purple and blue

  • needing extra lighting to see close-up, especially when reading

  • extra sensitivity to harsh light, such as sunlight or glare from car headlights

  • light sources may appear to have a ring or halo around them

  • having to change eyeglass or contact lens prescriptions more often than normal

Usually, the larger the cataract, the more severe or serious symptoms are although cataracts are painless. 

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What to expect with IOL implantation?

Once implanted, the IOL becomes a permanent, functioning part of the eye.

For the first few days after surgery and IOL implantation, a few mild side effects can be expected.

Common symptoms associated with cataract surgery include:

  • mild irritation, usually itchiness, redness, and swelling

  • droopy eyelid

  • mild sensitivity to light

  • blurry vision

In rare cases, some people develop serious complications, most commonly, an infection.

Symptoms that require immediate medical attention include:

  • pain continuing after taking over-the-counter pain medications

  • intense or increasing eye redness

  • vision loss

  • fever

  • eye discharge

  • bleeding in the eye

  • skin rash

  • facial swelling

  • difficulty breathing

  • feeling the IOL, seeing the lens edge, or another discomfort

  • double vision

  • increased eye pressure

What are the types of IOL?

Most IOLs are made out of plastic, acrylic, or silicone.

Currently, there are different types of IOLs available including:

Standard monofocal IOLs

IOLs or intraocular lenses.
There are various types of IOLs or intraocular lenses. Some will be covered by health insurance, and some will not.

This single focus lens is usually used to correct or restore vision in the distance. Many people will not need to wear glasses for this after surgery, but most people still require eyeglasses to read or to focus on objects close-up. Until recently these were the only type of IOLs commonly used.

As a result, monofocal IOLs are considered the standard for cataract surgery and covered by most insurance companies or Medicare.

Multifocal IOLs

Similar to progressive or bifocal eyeglasses, multifocal IOLs have several differently powered rings that allow clear sight at near, intermediate, and far distances.

Usually, the brain quickly learns what ring corresponds to what distance and seamlessly transitions between them. This reduces the need for reading glasses after surgery.

In many cases, this type of IOL is considered an elective upgrade and not covered by insurance entirely.

Toric IOLs

People with cataracts and astigmatism require a specialized IOL.

Astigmatism occurs when the lens or the cornea on the front surface of the eye, is oval or cylindrically-shaped instead of being round.

In nearly all cases toric IOLs are considered an elective upgrade and, again, are not fully covered by insurance.

Accommodative IOLs

In many ways, accommodative IOLs are the closest to a natural lens.

Although they contain only a single focus, they can respond to eye muscle cues, moving forward to focus on nearby objects and backward to focus on objects further away. This allows someone to see both distance and close-up and may reduce the need for glasses after cataract surgery.

In nearly all cases, accommodative IOLs are also considered an elective upgrade and are not fully covered by insurance companies or Medicare.

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How are IOLs implanted?

Consultant Ophthalmologist performing cataract eye surgery in an operating room.
IOLs are implanted during cataract surgery. The success rate of cataract surgery is very high.

When vision worsens, and cataracts begin to interfere with everyday activities, surgery is usually the only option. 

According to the NEI, cataract surgery is one of the most common, effective, and safest types of surgery used in the United States. About 90 percent of people who undergo cataract surgery see an improvement in vision.

Before surgery, an eye specialist will determine the type of IOL needed by measuring the size and shape of the eye.

Medicated eye drops are commonly prescribed before and after surgery to prevent infection and reduce inflammation, or swelling.

Precisely what happens on the day of surgery depends on the type of procedure chosen by the doctor and surgeon.

How is the procedure done?

While anti-anxiety medications may be given, a person will typically be awake during the operation. Although light and movement will be noticeable during surgery, what is being done will not be seen by the recipient.

Most surgeries that are uncomplicated will only take 10 to 20 minutes in total.

Steps involved include:

  • The surgeon cutting a small hole in the front of the eye at the edge of the cornea or clear covering of the eye, using a blade or laser.

  • A probe being inserted through the cut that transmits ultrasound waves, aiming at the lens and protein clumps, or cataracts.

  • The surgeon using a suction device to remove the lens once it and the cataracts have been broken into smaller pieces.

  • A new artificial or IOL being inserted behind the iris where the old lens was.

  • A patch put over the affected eye to shield it from light while it recovers.

  • If no side effects are noted within 15 to 30 minutes after the surgery is over, most individuals are free to leave.

The surgeon will explain at-home care tips, such as to avoid pushing on or touching the affected eye. They will also explain what activities should be avoided during recovery and for how long.

Eye drops will usually be prescribed to prevent infection and help with inflammation. Multiple postoperative visits are usually scheduled with a doctor after surgery, to assess an individual’s progress, and to look for complications. 

Usually, a complete recovery from IOL surgery will take about 8 weeks after which, a person can resume their normal activities.

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