The bad news about dysfunctional lens syndrome (DLS) is that you already have it. Everyone suffers the progressive effects of DLS. It starts almost the moment you are born and progresses relentlessly everyday you live until you have your lens dysfunction repaired.
What is Dysfunctional Lens Syndrome?
DLS is the progressive loss of function of the natural lenses inside your eye. The lens is clear and flexible when you are born. The clarity of this vital part of your eye allows light to pass cleanly through without light scatter, glare, or blurry vision. It’s flexibility allows it to change shape and focus so you can see both far and near objects. From the day you were born, your lens started to lose both its clarity and its flexibility. The early losses go largely unnoticed.
Dysfunctional Lens Syndrome Stage 1
In stage one of DLS the loss of flexibility causes you to loose your ability to focus on close objects. The ability to focus on close objects is called accommodation. A one year old can literally focus clearly on an object immediately in front of his/her eye. By two years of age, an infant can no longer focus that close and would you would have to move an object a bit further out before it would be in focus again.
This deterioration continues at a steady pace, but most don’t notice it at all until around age 40 when they start having trouble focusing at 14-16 inches from their eye, which is where we hold a book. At first you can move the book further away and still read, but in the end, you have to add magnification to make the letters large enough to read.
Why do we Lose Accommodation?
To explain lens dysfunction it is helpful to first describe a fully functioning lens. Healthy lenses are rounded. This makes it magnify objects so they look larger. It works like the magnifying glass you may have played with as a youngster or a strong pair of reading glasses.
Lenses are held in place by a series of small fibers called zonules. These zonules are connected to a small muscle called the ciliary body. When the muscle is relaxed, the zonules are under tension. This stretches the lens making it flat instead of round. The flatter shape makes objects in the distance in focus.
When the ciliary body muscle flexes, it relieves the tension on the zonules. This allows it to spring back to its natural rounded shape, making it like a magnifying glass so you can see objects up close.
As you age, lenses lose their elasticity so that they don’t spring back to as round a shape as they did when you were younger. They no longer can magnify enough to see up close. Reading glasses are needed to make up for the loss of accommodation.
Dysfunctional Lens Syndrome Stage 2
In Stage 2 of DLS you have the loss of focusing ability from stage 1 plus the proteins that make up the lens become discolored enough to cause mild glare and visual blur.
These proteins start out completely clear. They allow light to pass through without being scattered. As we age, the proteins denature, turning from clear to a yellow color.
To understand the process of denaturing proteins, consider egg whites. They made up of clear proteins. As the egg whites are heated up, the proteins denature and turn white.
In a similar fashion, as the proteins slowly denature throughout life, they change from clear to a yellow color causing blurry vision and glare with night driving.
The HD analyzer is a test we use to determine how much light scatter you are experiencing. It projects a beam of light to the back of your eye. The beam reflects off the back of your eye back into the HD analyzer where it measures how much the beam has been scattered by your eye.
Dysfunctional Lens Syndrome Stage 3
In stage three of DLS, you lose the rest of your ability to focus and the yellowing of the lenses becomes dark enough that we call it a cataract. If left untreated, the cataract will turn dark brown. It would be like trying to look through a dark brown bottle. Glare would be horrible, it would be difficult to recognize signs until you were right next to them, and reading would become challenging. Ultimately, this turns completely white and you would be blind, only able to see light.
Dysfunctional Lens Replacement
The good news about DLS is that there is a cure: dysfunctional lens replacement. This involves removing the dysfunctioning lens and replacing it with a plastic intraocular lens implant. The new intraocular lens is clear, restoring clarity of light transmission. Advanced technology intraocular lens implants can be toric (astigmatism correcting) or they can be a multifocal or accommodating implants to restore some focusing ability. Many patients with mulifocus or accommodating implants do not need glasses for near or far vision after the surgery. While these implants are not perfect, they are spectacular. The ability to correct many of the ravages of DLS dysfunctional lens replacement is one of the marvels of modern medicine.
Dysfunctional Lens Replacement Costs
Dysfunctional lens replacement costs depend on which stage you choose to have the surgery and the level of advanced technology you choose to employ.
Once the faulty lens is removed, it never grows back. You only have to have it removed once. Those that choose to have it replaced in stage 1 or early stage 2 to improve focusing ability and visual quality never have to go through the progressive glare and blurry vision of late stage 2 or stage 3 DLS. The procedure goes by various names such as clear lens extraction, or refractive lens exchange (RLE). At this stage the repair procedure would be considered elective so insurance would not help pay for the replacement.
If you wait until late stage 2 or certainly by stage three, the lens would officially be labeled a cataract and the replacement would be called cataract surgery. At this level, the standard replacement costs would be considered medically necessary and insurance would cover the basic parts of the cataract surgery costs.
The procedure to remove a lens in stage 1 is pretty much identical to removal in stage 2 or 3 except that the stage 1 lenses are soft like jello and the stage 3 are hard and brittle like toffee.
If you elect to have image guided, laser cataract surgery with an advanced technology intraocular lens implant to help correct astigmatism or restore some focusing ability then insurance would cover the medically necessary parts of the surgery depending on deductables and you would pay some amount for the additional elective services.
Everyone blessed with long life should eventually have their DLS repaired. Cataract Surgery is the most common surgery performed in the world because everyone has it done twice, once for each eye. The question is, “At which stage of of lens dysfunction do you choose to have it repaired?”
If you have additional questions about DLS, please schedule a time to meet with me or post a comment.