Laser Lens Replacement (LLR) also called Clarivu™* or NuVu by some providers is a procedure where the natural lens of the eye is replaced with a high performance mulifocal lens.
At Centre for Sight, we use the highly sophisticated trifocal lens which reliably eliminates the need for glasses altogether. The erroneously labelled “Multifocal Lenses” are actually Bifocal lenses providing distance and near but no intermediate vision. Trifocal lenses have exactly what the word means – 3 points of focus including intermediate vision – vital for using computers, seeing the dashboard on the car and using a mobile phone or iPad at a comfortable distance. Please be aware not all providers use the same lenses.
TWO trifocal lenses are available on the market:
Both lenses work on similar principles and are available at Centre for Sight and implanted as a focusing lens in both Laser Lens Replacement or Laser Cataract Surgery. Laser lens replacement or LLR involves removal of the natural crystalline lens within the eye and replacement with a high performance intraocular lens implant. The procedure has a number of names including LLR, PRELEX, Clarivu™** and others. This is often confusing for the consumer and at Centre for Sight, we believe in being very transparent and thus label procedures in generic terms.
For those who have high levels of astigmatism (1.75D and above) implants with built in correction of astigmatism may be required. Fortunately both Physiol and Zeiss manufacture these Toric Trifocal lenses, however they need to be specially ordered. The lens calculation is quite sophisticated and when implanting the lens at the time of surgery, accurate placement of the lens in the correct angle is vital for a good outcome.
Centre for Sight is UK’s longest and most experienced provider of the FINEvision trifocal lenses. This lens unlike other bifocal multifocal (Restor, Tecnis, MPlus,) provides 3 distinct points of focus – Far Intermediate and NEar hence the name FINEvision. The lens really does provide patients with complete freedom from glasses and contact lenses.
Moderated by Sheraz Daya, Medical Director of Centre for Sight, this roundtable discussion between European Key Opinion Leaders reviews the lens’s unique characteristics and unveils clinical practice pearls. The lens in use at Centre for Sight since January 2011 has been a major leap forward with all patients so far eliminating the need for glasses altogether. Click on the link below to read…
The following graphs illustrate outcomes of the earliest FINEvision lens implanted at Centre for Sight. The graphs show visual outcomes of patients at distance, intermediate (60 and 80cm) and near (40cm). All patients in this group reported independence from spectacles.
The lens is a diffractive lens with a series of rings. The main portion of the lens works to correct distance. A series of diffractive rings correct for near and a smaller ring added on to the diffractive rings corrects for intermediate. The lens takes information and splits this into 3 points of focus.
The brain receives information at 3 focal points and learns to eliminate the “noise” from the blurry points of focus. This process is called adaptation and the time it takes for each individual to adapt varies. This is a new optical system that the brain needs to understand and not unlike getting a new pair of glasses or going to the dentist where teeth may be rearranged and it takes time to get used to the change. Adaptation takes place much faster once both eyes are treated. Often on the first or second day patients see well at distance and near and in time are able to read at intermediate. Vision continues to get better with time as illustrated in our results.
Whilst the vast majority of patients are suitable, not all are. For instance if the cornea has abnormal optics, then the lens will not work well. Age Related Macular Degeneration (ARMD), advanced glaucoma and Diabetes are some conditions where the use of trifocal lenses are contraindicated.
Authored by Sheraz Daya MD FACP FACS FRCS(Ed) FRCOphth
Mr Daya is the Medical Director of Centre for Sight and listed amongst the 100 most influential ophthalmologists in the world (https://theophthalmologist.com/power-list/2018/sheraz-daya/).
Next review due January 2025.
