Although the history of Refractive Surgery can be traced back over 100 years, the recent 20 years represents its greatest period of expansion with RK, AK, and ALK followed by PRK, LASIK, and Custom LASIK. During this modern renaissance lenses have maintained a long history of stable outcomes and have come into the mainstream.
Dr. Behler has been performing Refractive Lens Exchange for over 12 years and has been implanting refractive lenses longer than any other LASIK surgeon in Tampa Bay. He has inserted a variety of refractive implants including lenses that correct astigmatism (toric lenses) piggyback lenses for extreme amounts of hyperopia and has inserted monofocal and multifocal lenses for presbyopia.
What is Refractive Lens Exchange?
Refractive lens exchange is the same procedure as modern cataract surgery. Unlike laser procedures that alter the shape of the cornea, a refractive lens exchange alters the focusing power of the lens within the eye, leaving the cornea untouched. For this procedure, the eye’s lens is removed with a sophisticated computerized ultrasound technique called phacoemulsification, but more on that below. The lens is replaced with a lens implant that has been custom selected to provide the patient with the best vision without glasses. These lenses come in a variety of designs, materials, and powers.
Who are the best candidates for Refractive Lens Exchange? Many patients are not candidates for laser vision correction either because of their refractive error, corneal thickness, and corneal irregularity. Candidates for refractive lens exchanges are usually but not always over the age of 45. Their refractive error is usually beyond what is acceptable with corneal laser procedures. Patients who are developing early cataracts might benefit from Refractive Lens Exchange.
What are some of the advantages of Refractive Lens Exchange? Refractive Lens Exchange can correct most refractive errors including high degrees of nearsightedness, farsightedness and astigmatism. The procedure is safe with rapid visual stabilization and a long history of predictable outcomes. The procedure also eliminates the future need for cataract surgery.
Measuring your implant! The measurements used to calculate the implant power are critical. These implants have a prescription or power that must be calculated for each individual. The technologies and formulas used determine what the best implant is. At Behler Eye and Laser we use only state-of-the art technologies and formulas to derive implant power.
Dr. Behler has personally calculated the implant powers on thousands of patients over the past 17 years. He has not depended upon a technician to take measurements or calculate the powers. As a result, he understands the nuances in implant calculation. These technologies are only as good as the person operating them.
Technology:
Modern technological advances have greatly increased the accuracy of implant calculations. The IOLMaster is one such technology and is a dramatic step forward in the accuracy of implant calculation.
The IOL Master is a quick, simple means of measuring implant power. Combining performance, accuracy, and simplicity, the IOL Master sets new standards in patient care.
Zeiss IOL MASTER
Zeiss Optical Coherence Biometry
Advantages include the following:
Accuracy : Optical Coherence Biometry represents a fivefold increase in accuracy than standard ultrasound.
Speed: The IOLMaster measures very quickly. At the push of a button, all measurements can be obtained for both eyes.
No contact: Since the IOLMaster is an optical device, it can take accurate measurements without ever touching the eye.
Choice of implants:
There are many styles and materials of implants used for Refractive Lens Exchange. The choice of implant depends upon the patients’ individual exam and needs. The procedure is the same regardless of the implant style.
Examples of implant choices:
Monofocal: The most commonly used lens. These come in a variety of styles and materials including silicon, acrylic, and collamer.
Piggyback monofocal: These are 2 lenses “piggybacked” on one another. They are used primarily for patients with extremely high amounts of hyperopia.
Multifocal: These eliminate the need for monovision and can facilitate reading. There is currently one model on the market; however, there will be more options on the market in the near future.
Toric: These are monofocal lenses with astigmatism correction built into the lens. These lenses obviate the need to perform additional astigmatism correction on the cornea.
The procedure used is phacoemulsification. Dr. Charles Kelman invented the phacoemulsification procedure approximately 30 years ago. Over the past 15 years it has undergone a dramatic transformation both in technique and technology. Modern phacoemulsification is quick and painless requiring no needles, stitches, or patches. Dr. Behler has been performing phacoemulsification for 16 years and the procedure takes approximately 8 minutes.
Anesthesia: Topical anesthesia is administered and, as the name implies, eye drops only are used. No needles, patches, or stitches!
Phacoemulsification The phacoemulsifier is an ultrasonic probe that oscillates at 40,000 cycles per second. In essence, it gently turns a solid material into liquid simultaneously vacuuming it out.
The capsular bag is polished and prepared for insertion of the implant. The implant chosen is then inserted into the capsular bag. It is the power of the implant that enables one to see without glasses.
Will I experience pain during or after surgery? No. The topical anesthesia is all that is required to keep the
patient comfortable and pain free.
When can I resume normal activities? Recovery is quick
and painless. Patients can return to work the following day. Postoperatively,
topical eyedrops are used in a prescribed manner requiring minimal followup.
The procedure used is phacoemulsification. Dr. Charles Kelman invented the phacoemulsification procedure approximately 30 years ago. Over the past 15 years it has undergone a dramatic transformation both in technique and technology. Modern phacoemulsification is quick and painless requiring no needles, stitches, or patches. Dr. Behler has been performing phacoemulsification for 16 years and the procedure takes approximately 8 minutes. 
