Richard A. Levinson, M.D. > Cataract Surgery

Cataract Surgery

Cataract surgery is the most common surgery performed in the U.S. today. It is performed on an out-patient basis and can offer significant improvements to vision. In cataract surgery, the clouded lens of your eye is replaced with a plastic lens, an intraocular lens (IOL). Cataract FAQ’s.

What are cataracts?

Cataracts are a slowly-progressing discoloration of the lens of the eye that probably actually starts the day we are born. The lens is crystal clear at birth but slowly turns brown with age, mostly due to UV-induced changes in the proteins of the lens. Everybody’s lens discolors with age but not everybody needs cataract surgery. Eventually, the brown discoloration of the lens may interfere with vision and that’s when you need cataract surgery.

When do you need cataract surgery?

Cataract surgery is elective. You have cataract surgery when your lens has discolored to the point that you are having difficulty seeing to perform your daily activities. Typical cataract-induced vision complaints are glare in bright light or at night from headlights, blurred, dim or distorted vision. The cataract does not physically damage the eye but it sure can blur the vision. When you are having difficulty seeing to do your daily activities, like driving, especially at night, reading, seeing to walk safely, etc., then you need to consider cataract surgery.

Obviously, if you are having difficulty seeing to perform your daily activities, you need to have your eyes examined. Cataracts aren’t the only cause of blurred vision. You may just need your glasses prescription updated, or you may have other problems with your eyes, like glaucoma, macular degeneration, dry eye, etc.

Cataract surgery.

During cataract surgery, a small, self-sealing 1/8 inch incision is made in your eye’s cornea – the clear, outer layer of your eye. The wound is so small it does not even usually require a suture to close. The lens of your eye is removed and an intraocular lens (IOL) is inserted in its place. The IOL is not susceptible to discoloring like your original lens. You may feel pressure during your cataract surgery, but the majority of patients do not describe the procedure as painful. Anesthetic eye drops are administered to numb your eye.

IOL (Intra-Ocular Lens) options.

There are many different IOL options available. Traditionally, monofocal IOLs have been used in cataract surgery. Monofocal IOLs focus the eye at one distance only and do not correct astigmatism. These lenses are usually covered by insurance and, depending on the lens selected, will allow you, without glasses, to see distance and/or near objects. With monofocal IOLs, you may have to use eyeglasses to read, see the computer and/or for distance vision.

We have an opportunity, by selecting an appropriate IOL lens style, to significantly decrease your dependence on glasses after cataract surgery, permitting you to see to read and drive without glasses. To do this, we have three options:

Toric IOLs correct astigmatism. These IOLs are not covered by insurance and cost the patient out-of-pocket about $1000 per eye. The standard monofocal IOL does not correct astigmatism, thus requiring the patient with astigmatism to wear glasses to see clearly. However, with the toric IOL correcting the patient’s astigmatism, patients can expect to permanently significantly decrease their astigmatism. Toric IOLs are not perfect; they typically correct 60-90% of the astigmatism, which is usually adequate for permitting patients with astigmatism to function without the need for glasses to correct their astigmatism.

Multifocal IOLs are designed to let you see at near, far and intermediate distances without glasses. They are moderately successful at accomplishing this goal. These advanced IOLs are not usually covered by insurance. Multifocal IOLs function by having multiple concentric rings that focus at variable distances. Multifocal IOLs have 3 significant drawbacks. First, multifocal IOLs are sensitive to pupil size and to how well the lens is centered. There are different multifocal lens styles available to try and address these inherent problems of multifocal IOLs, but, in general, reading vision may be compromised in dim or bright light, and at night or in the dark when the pupil is large, there will be glare from the concentric rings. This can make night driving difficult. And if the multifocal IOL is not perfectly well centered, near vision may be compromised and nighttime glare can be accentuated. No matter how precise the cataract surgeon is in attempting to position the the IOL, the IOL can slightly shift during the invevitable subsequent healing and not not remain centered ideally. It is not easy to try and recenter a minimally decentered IOL. Second, multifocal IOLs focus simultaneously at near, intermediate and far but the quality of vision is compromised. Images are not crisp at any distance. This can especially be a problem in eyes that have early or advanced macular degeneration, either now or in the future. Third, multifocal IOLs are expensive and are not covered by insurance. They typically cost $2000 per eye. Multifocal IOLs may require 6-12 months of adjustment before patients are comfortable with their vision. 1-2% of patients may never be able to adjust to the multifocal IOL and may require a second procedure to remove the multifocal IOL and replace it with a standard monofocal IOL. Based on these drawbacks with multifocal IOLs, I do not recommend multifocal IOLs. In fairness, many patients are satisfied with multifocal IOLs and are able to see to drive and read without glasses correction. However, in my experience, they could have obtained better distance and near vision, without the nighttime glare, and without spending $2000 per eye, with monovision.

If your goal is to be able to see at distance and near without needing glasses, I highly recommend monovision instead of multifocal IOLs. With monovision, a traditional monofocal IOL, or if needed, a toric IOL, is inserted in each eye. The dominant eye is set to focus at distance and the nondominant eye is set for near. Patients can see to drive and to read without glasses. There is less night glare and the quality of vision is sharper with monvision than with multifocal IOLs. The near vision is usually very good with monovision but distance vision is slightly compromised. The patient can always wear a mild pair of glasses to correct the distance vision, if needed. Neither option is perfect but if your goal is to function without glasses, I strongly recommend monvision instead of multifocal IOLs. I, Dr. Levinson, personally have monovision and I am extremely satisfied with the quality of my vision; I do not need glasses. There are no additional fees for monvision. Understandably, patients may be concerned they will not be able to tolerate monovision. In my experience, patients adjust much more easily, and with less complaints, and with a higher satisfaction rate, to monovision than they do to multifocal IOLs.

What to Expect from Cataract Surgery

This type of eye surgery is one of the most commonly performed surgeries in the US. Cataract surgery has an extensive safety record, and serious complications are rare and usually treatable.
After your surgery, you may experience:

  • Itchy eyes
  • Dry eyes
  • Blurry vision
  • Mild discomfort
  • Discharge from your eyes

Most patients can return to normal daily activities within 24 hours after cataract surgery with only minimal restrictions. Your vision may continue to adjust to the IOL for a month or so, and you may want to use reading glasses during this time. After about a month, your eyes and vision should adapt to the IOLs.

The blurriness and poor vision caused by a cataract can be devastating and can interfere with your day-to-day activities. If a cataract is affecting your ability to drive, read and enjoy life, cataract surgery may be right for you.
To learn more about Denver eye care services for cataracts, please contact Richard A. Levinson, M.D., to schedule an appointment.