Many patients are asking us: "Which lens is the best?" The answer is: "None! The reason is that everyone needs lenses matching their vision habits and eyes." This is why we are working scientifically on optics and characteristics of premium lenses or multifocal lenses and contribute to the development of lens systems in co-operation with Prof. Dr. Auffarth, Universität Heidelberg, and Prof. Dr. Schaeffel, Universität Tübingen.
We have summarized this knowledge in our MI-LENS® concept with which we select the intraocular lens tailored to your requirements by means of extensive preliminary examinations and discussions.
If you are interested in having the best vision without glasses, please feel free to make an appointment with Dr. Breyer for a non-binding individual consultation or preliminary examination. You can make an appointment by phone, e-mail, WhatsApp or our appointment app. We are also happy to call you back. We are looking forward to your message.
Predominantly, the natural lens of the eye is replaced in older patients when flexibility of the natural lens has lessened and the eye can no longer focus, or if the lens is clouded (cataract) and vision is no longer clear. In these cases, modern intraocular lenses can be implemented which can have one or several focal points, e.g. multifocal lenses with different optic principles. If, e.g., you are wearing anti-glare glasses and/or varifocal glasses and are planning to have lens surgery now, we are recommending so-called HD lenses which have less of a halo and glare effect. If required, these lenses are also available with a blue light filter or as toric lenses. This is only one example of many.
As you can see, there is not one lens that fits everyone but many different types, optical principles, refractive powers and even possible combinations. There is also the additional fact that each eye is built differently or you may even have an additional eye disease affecting the choice of lens. In the following, we are introducing a number of types of lens to you:
If you want to have a better quality of vision and gain independence from your glasses, modern multifocal lenses with multiple focal points enable you to see clearly at short, medium and long distances. In contrast to that, with standard lenses, also called monofocal lenses, you can see clearly only at a certain distance. For all other distances, you need glasses. The costs for these lenses are assumed by the German statutory health care providers. But you have always the possibility via privat pay to profit from the advantages of premium lenses.
However, depending on the manufacturer and model, the form and optical principle of multifocal lenses can vary significantly. For example, there are multifocal lenses with concentric stages or those with a sector-shaped near vision part having a HD effect. The latter are also called segmental lenses. It depends on many factors which lens would be right for you; we would be happy to discuss these factors with you in detail. Please remember that the choice of lens will determine your vision for the rest of your life.
If you also have astigmatism (curvature of the cornea) in addition to myopia and hyperopia, both can be balanced with toric lenses. Toric lenses must always be custom-made. By the way, Dr. D. Breyer was the first doctor globally to implant a toric multifocal lens with a micro-incision of only 1.6 mm. He performed this operation live at the congress of the European Society of Cataract and Refractive Surgery.
Recently, we have improved diagnostics available for implanting toric lenses by means of the Cassini LED cornea topographer. These data are transmitted wirelessly to the LENSAR laser and the surgical microscope and enable exact alignment of the lens with the "true" axis of the astigmatism. We are one of two refractive centers in Germany using this innovative technology. Read more about the Cassini cornea diagnostics here.
In contrast to a manual cataract operation, the femtosecond laser is able to make circular openings into the capsular sac in which the natural lens is located and in which the artificial lens will also be placed. FEMTIS, a special laser lens, has so-called haptics which can be attached to the anterior external capsule opening. This means that the lens stays exactly where it should be. However, this design requires some more skill and experience on the surgeon's part. In their own study, Dr. Breyer and his colleague have achieved promising results with the lens so far.
While the "macula", the point with the most visual acuity, is normally protected from damaging violet light, this protective mechanism is weakened in older persons especially. This can cause damage to the retina. Therefore, this lens offers macular protection and is our first choice if your macula already has pre-existing damage. It enables the best possible contrast vision and color vision and is also well-suited for persons with a high sensitivity to glares or diabetes mellitus.
This lens is a heavy-duty lens (HD lens) combining perfect visual acuity with the best possible contrast and realistic color perception. By correcting image errors which might be caused by artificial lenses (aberrations), it improves visual perception especially in twilight or difficult weather conditions also. According to studies, it can both shorten the braking distance while driving and increase art appreciation while looking at pictures, and it also performs excellently during sports.
In addition to the aberrations caused by the lenses, there are also aberrations which can be attributed to the eye's optics. These so-called higher-order image defects can be determined by aberrotomy. Based on these measuring results, individually custom-made lenses can be created which compensate for these smaller errors.
After replacing the natural lens with an intraocular lens (IOL) in a cataract operation or for correction of very severe myopia or hyperopia and astigmatism (curvature of the cornea), there may be some remaining refractive errors making it necessary to continue to wear glasses at certain distances. One reason for this is the distance of the artificial lens from the cornea which cannot be predicted exactly - despite extensive pre-surgical diagnostics, improved surgical methods and high precision in producing the artificial lenses. The add-on lens is placed in the eye in addition to the intraocular lens to compensate for existing refractive errors, for example if the implanted IOL corrects long-distance vision but glasses are still needed at short and medium distances. In this case, the add-on lens is placed in front of the IOL four to six weeks after the first operation to establish clear vision without glasses at short and medium distances also; glasses may only be required to be worn for specific tasks like working on the computer under certain circumstances.
Placing an add-on lens can be performed even years after placement of the IOL if it is no longer sufficient due to natural progression of the ametropia. A later exchange of the add-on lens is also possible in a gentle manner without any problems. There are more advantages for placing an add-on lens as an alternative to exchanging the IOL:
In addition to fine adjustments, the add-on lens may also be used to strengthen the effect of the intraocular lens in correcting severe ametropia. This makes sense if the main lens on its own would be too weak to compensate for e.g. severe hyperopia (farsightedness). In these cases, the add-on lens is also implanted four to six weeks after the main lens. The combination of an IOL with an add-on lens may also be a suitable solution in other cases since two lenses with less power are less thick than a singular lens with a higher power.
Using an add-on lens is also recommended in pediatric cataract surgery since refraction changes in children due to their growth. The add-on lens can be updated without having to replace the intraocular lens in the capsular sac.
Rodov L, Reitblat O, Levy A, Assia EI, Kleinmann G. J Refract Surg. 2019 Jul 1;35(7):434-440. doi:
10.3928/1081597X-20190618-01. PMID: 31298723.
Schallhorn SC, Teenan D, Venter JA, Hannan SJ, Schallhorn JM. J Refract Surg. 2019 Jul 1;35(7):426-433. DOI: 10.3928/1081597X-20190530-01, PMID: 31298722.
Tarib I, Kasier I, Herbers C, Hagen P, Breyer D, Kaymak H, Klabe K, Lucchesi, R, Teisch S, Diakonis VF, Hahn U, Fabian H, Kretz FTA. J Refract Surg. 2019 Jul 1;35(7):408-416. doi: 10.3928/1081597X-20190417-02. PMID: 31298720.
Breyer DRH, Kaymak H, Ax T, Kretz FTA, Auffarth GU, Hagen PR. Asia Pac J Ophthalmol (Phila). 2017 Jul-Aug;6(4):339-349. doi: 10.22608/APO.2017186. PMID 28780781.
Kaymak H, Höhn F, Breyer DRH, Hagen P, Klabe K, Gerl RH, Mueller M, Auffarth GU, Gerl M, Kretz FTA; Klin Monatsbl Augenheilkd 2016; 233(08): 923-927; DOI: 10.1055/s-0042-104064; PMID: 27385257
Kretz FT, Breyer D, Klabe K, Hagen P, Kaymak H, Koss MJ, Gerl M, Mueller M, Gerl RH, Auffarth GU.
J Refract Surg. 2015 Aug;31(8):504-10. doi: 10.3928/1081597X-20150622-01; PMID: 26274516
Höhn F, Tandogan T, Breyer DR, Kaymak H, Hagen P, Klabe K, Koss MJ, Gerl M, Auffarth GU, Kretz FT; Functional Results One Year after Implantation of a Bitoric, Trifocal Intraocular Lens, Klin Monbl Augenheilkd. 2015 Aug;232(8):957-61. doi: 10.1055/s-0041-103335. Epub 2015 Aug 19. PMID: 26287540
Kretz F.T., Breyer D, Klabe K, Auffarth GU, Kaymak H, J Refract Surg. 2015 Jul;31(7):431-6. doi: 10.3928/1081597X-20150518-11. PMID: 26186561
Breyer D, in: Ophthalmologische Nachrichten 05.2015
Rita Menucci, MD, Eleonora Favuzza, MD, Francesca Guerra, MD, Giovanni Giacomelli, MD, Ugo Meschini, J Cataract Refract Surg 2014; 40:1479-1487 2014 ASCRS and ESCRS
Steven Dewey, MD, George Beiko, BMBCh, FRCSC, Rosa Braga-Mele, MD, MEd, FRCSC, Donald R. Nixon, MD, FRCSC, DABO, Tal Raviv, MD, FACS, Kenneth Rosenthal, MD, for the ASCRS Cataract Clinical Committee, Instrumentation and IOLs Subcommittee, J Cataract Refract Surg 2014; 40.1549-1557 2014 ASCRS and ESCRS
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