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 see clearly in the distance for driving or TV.

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

If you would like to be able to see at distance and near without needing glasses, I highly recommend monovision. With monovision, a traditional monofocal IOL, or if needed, a toric IOL, is inserted at the time of cataract surgery in your dominant eye and either a monovision lens or multifocal IOL is inserted in your non-dominant eye . The dominant eye is set to focus at distance and the non-dominant eye is set to focus at near. With monovision, patients can usually see to drive and to read without glasses.  After an initial adjustment period, the visual system adapts to monvision and transitions the vision from near and distance automatically. The intermediate computer vision may be blurry with monovision, requiring mild glasses correction for computer use, or requiring the patient to sit a little closer to the computer than they are used to. The near vision is usually very good with monovision but distance vision is slightly compromised in the non-dominant eye. This usually does not affect the patient’s vision but the patient can always wear a mild pair of glasses to correct the distance vision, if needed, for night driving, for instance. And if we use the Symfony multifocal IOL in the non-dominant eye for monovision, the patient can see intermediate and near, making for a smoother transition between distance, computer and near vision.  Neither option is perfect but if your goal is to function without glasses, I strongly recommend monvision.  There are no additional fees for traditional monvision. There is a $2100 fee, not covered by health insurance, for blended monovision with the Symfony IOL.  Understandably, patients may be concerned they will not be able to tolerate monovision. In my experience, most patients adjust  easily,  with few complaints, and with a high satisfaction rate, to monovision.  Monovision will not give you perfect vision in every situation but it will significantly decrease your dependence on glasses and allow you to perform most daily activities without glasses.