The History of The Intraocular Lens Implant

Intraocular Lens Implants have become a routine part of cataract surgery.
Remember using your grandmother’s magnifying glass to burn a hole in a leaf? The lens focused the sun’s rays to a point. This concentrated light-point was hot enough to start a fire.

The natural lens of the eye focuses in-coming light. Without the lens, the eye cannot focus properly. A lens might be removed if it gets cloudy enough to blur vision. (This clouding usually occurs with age and is called a cataract.) Or, some type of trauma or disease might dislocate the lens. Whether the lens is removed or displaced, vision is too blurred to be very useful without it.

Cataracts have been surgically removed for centuries. In more recent history, the focusing power lost by removing the lens was replaced by wearing cataract glasses. You have probably seen these thick lenses...they look like the bottom of a soda bottle. Cataract lenses filled a great need by restoring vision to patients after surgery. But because of the lens’ thickness, there are problems with depth perception and peripheral vision.

Then came contact lenses. Using a contact on an eye with no natural lens (a condition termed aphakia regardless of the cause) restores vision effectively. The problems of the thick glasses are gone. However, contact lenses have problems of their own. They must be removed, cleaned, and reinserted. (Even if they are continuous wear, some handling is required.) Patients whose fine motor skills are compromised have difficulty with these tasks. Furthermore, contacts are a foreign body introduced into the eye, and carry an increased risk of infection. And some eyes simply cannot tolerate a contact lens.

Believe it or not, a breakthrough occurred during World War II. Fighter pilots of that era were sometimes involved in accidents where the plastic windshield of their aircraft was shattered. Doctors found, to their amazement, that shards windshield that entered the eye were tolerated by the eye’s tissues. The fragments might remain inside the eye for years, and the eye would not react.

If the eye would tolerate accidental implantation of plastic particles, why not a plastic implant ground with a lens prescription? Eventually FDA approved, intraocular lens implants (IOLs) are now a routine part of cataract surgery. Their use is so common that these days there must be an overwhelming reason NOT to implant a lens at the time of surgery. In addition, patients who had cataract surgery in pre-IOL days can often have an implant put in now, relieving them of the need for thick glasses or contacts.

The story of the IOL is not finished. Work is now being done on using IOLs in refractive surgery. In this case, an IOL is implanted in an eye while the natural lens is still retained. The need for glasses and contacts is eliminated (or very nearly so) without cornea-altering procedures.