Monofocal IOL have a uniform focus and provide excellent image quality but have a limited range of focus. It is very useful to be able to see clearly at a range of distances after surgery, and surgeons using conventional lenses commonly aim for to minimally spread the focus between the two eyes to achieve a greater depth of focus. This strategy is called blended monovision. Typically, for patients with good vision in both eyes, the aim is to achieve a clear focus for one eye in the distance and the other at arm’s length. This helps to minimise spectacle dependence for most activities. However, reading glasses are normally needed for  reading , and a distance prescription may be preferred for some activities – especially in low lighting conditions (e.g. theatre, cinema, night driving).

These lens implants are well tolerated and provide enhanced spectacle independence, allowing good unaided vision for both distance, computer and reading. However, whilst premium IOLs produce a greater depth of focus than conventional lenses, there can be a compromise on image quality. Some patients can be troubled by dysphotopsia – light scatter symptoms  (e.g. starburst, glare and haloes) and therefore premium IOLs may not be the right choice if you do a lot of night driving. At your consultation, Mr Maurino, who has published extensively in the fields of premium lenses,  will be in  able to advice you on  IOLs choice. 

Toric IOLs (for the correction of astigmatism) are used to correct astigmatism on the cornea. Toric IOLs are inserted at a specific position within the eye and are very effective at correcting up to 8 dioptres of astigmatism. Mr Maurino uses Toric IOL routinely and has published extensively on the subject. Best results are achieved in patients with at least 1.5 D of corneal astigmatism.

n special situation Vincenzo Maurino will advice also the IC-8 IOL that uses a pinhole technology to minimise need for spectacles for any distance and help correcting astigmatisms and presbyopia. This technology is best for patients with abnormal corneal shape (after corneal transplants, eye traumas, keratoconus, radial keratotomy and high prescription laser vision correction) to achieve better spectacles independence and minimise the risk of dysphotopsia.   

RLE, like cataract surgery a commonly performed surgical procedure. Like any type of surgery, complications can occur but are very rare. The rate of complications is the least with a very experienced and specialist cataract surgeon like Mr Maurino.

• In the absence of other eye problems that may limit vision, most of patients having RLE-cataract surgery will be able to achieve driving standard of vision or better without glasses after treatment. These results are greatly improved by combining state of the art surgical and lens implant technology with great experience and expertise thus significantly increasing the safety and the outcomes of surgery.
• Reading glasses are normally required after surgery, but dependence on spectacles for near vision can be reduced by using premium lenses (trifocals, EDoF or toric).
• Implants should not deteriorate after surgery , in the absence of any new problems in the eye, clear vision should be permanent once recovery from the cataract surgery is complete provided no other pathology appear later in life. However, some implants may become opaque in time and need changing. This is rare and can be dealt with in the unlikely event it does happen.
• The most common reason for visual deterioration after RLE-cataract surgery is a frosting-over of the tissue surrounding the IOL, known as posterior capsular opacification (PCO or Secondary Cataract). This is treated by a quick and effective YAG laser capsulotomy procedure in the office. Whilst PCO is  not uncommon , it  can be sorted by a quick in office laser procedure lasting 2 minutes.
• Although very rare, RLE-cataract surgery can result in visual loss. Complications that can cause serious visual loss after RLE-cataract surgery include infection, spontaneous rupture of sub-retinal blood vessels during surgery (choroidal haemorrhage), or untreatable retinal detachment. Such complications are extremely rare;  it is important to be aware that you should immediately attend our Casualty Department at Moorfields (open 24/7) for an emergency eye examination if you experience either a progressive increase in pain or sudden loss of sight after RLE-cataract surgery. 
• Sight-threatening complications such as retinal detachment or infection can often be treated successfully if they are caught at an early stage. Any patients experiencing sudden onset or worsening of flatters, flashing lights and shadow in the vision must be seen by an eye surgeon immediately.
• Approximately 1 in 100 patients will require a second operation to correct problems resulting from RLE-cataract surgery. In the vast majority of these patients, the final visual outcome is good, but visual recovery may be delayed.
• Approximately 1 in 100 patients will require a laser procedure to further reduce spectacle dependence (such as for instance Femto LASIK or No Touch LASEK) if desirable.
• Approximately 1 in 50 patients can experience sudden onset of floaters after RLE-cataract surgery. This can happen naturally with age and more commonly in patients with short sight. Floaters are usually well tolerated, and the brain is able to ignore them, but you must be aware of this possibility. Also, if you experience a sudden onset of flashing lights, floaters or any similar symptoms, you should be examined immediately to exclude a retinal involvement, which could cause a detached retina.
• Dysphotopsia:  It is common after cataract and RLE surgery to become aware of some unawanted visual side effect. Dysphotopsia is awareness of glare, halos and starburst especially at night when driving and in artificial light.  Can happen with any type of implants and usually is temporary and improves with time. It is more common with premium presbyopia correcting implants (multifocal/trifocals/EDoF and similar) due to the more sophisticated optical design needed to achieve less spectacles dependence. Mr Maurino will explain in details the risks and management of dysphotopsia  at the time of consultation. Having performed premium lens implants surgery in hundreds of cases and published studies on premium IOL technology,  he is in a unique position to advise you and help to choose the best implant for you.