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.
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.
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.
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.
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, if you are interested in decreasing your dependence on glasses, we do have an opportunity, with Multifocal intraocular lens implants, to significantly decrease your dependence on glasses after cataract surgery, permitting you to see to read, see the computer and drive without glasses.
1. Toric IOLs to correct astigmatism.
Toric IOLs correct astigmatism. Toric 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 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. Most patients do not have enough astigmatism to require a toric IOL.
2. Multifocal IOLs
If you are interested in being able to see without glasses after cataract surgery, consider multifocal intraocular lenses (IOL). Multifocal intraocular lens implants are designed to let you see simultaneously at near (reading), intermediate (computer) and far (driving, movies, TV), without glasses. Multifocal intraocular lens implants function by having multiple concentric rings that focus at variable distances. Multifocal IOL’s technology has been available for at least twenty years. The first generation multifocal IOL’s did not work particularly well. The first generation multifocal IOL’s were not capable of giving an adequate range of clear vision at distance, intermediate and near. They also had significant problems with glare from the concentric rings, especially at night while driving. However, over the last 20 years, the multifocal lens technology has slowly but significantly improved with the introduction of multiple generations of new multifocal IOL technologies from numerous lens manufacturers. Modern multifocal intraocular lens implants are much more successful now at accomplishing the goal of achieving simultaneous clear distance, intermediate and near vision. The multiple ring design of the newer multifocal IOLs causes significantly less glare at distance for night driving. I am presently implanting the Alcon PanOptix multifocal IOL and the Alcon Vivity, which have been successful in giving patients good distance, intermediate and near vision, without significant night glare or need for glasses. There is a $2195 charge per eye for the PanOptix or Vivity Multifocal IOL. Insurance does not cover this charge. I have actually been successfully monofitting patients with the PanOptix or Vivity multifocal IOL. I insert a traditional monofocal IOL for distance in the dominant eye (no additional out-of-pocket charge) and insert the PanOptix or Vivity multifocal IOL ($2195 out-of-pocket charge) in the non-dominant eye. This is usually very well-tolerated and gives the patient good distance, intermediate and near vision with minimal night glare, and without the need for glasses. Multifocal lens implants are not perfect and will not completely restore your range-of-focus to normal, like when you were 16 years old, but they are very successful at giving patients a good range of vision and permitting patients after cataract surgery to significantly decrease their dependence on glasses.
If you would like to be able to see at distance and near, but not intermediate, without needing glasses, and without the additional $2195 out-of-pocket charge for the PanOptix or Vivity multifocal IOL, I recommend monovision. With monovision, a traditional monofocal IOL is inserted at the time of cataract surgery. 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 usually adapts to monovision and transitions the vision from near and distance. The intermediate computer vision will be blurry with monovision, requiring glasses correction for computer use, or requiring the patient to sit closer to the computer than they are used to. The near vision is usually very good with monovision but distance vision is compromised in the non-dominant eye. This will affect the patient’s distance vision but the patient can always wear a mild pair of glasses to correct the distance vision, if needed, for night driving, for instance. There are no additional fees for monovision. Understandably, patients may be concerned they will not be able to tolerate monovision. In my experience, most patients adjust, with few complaints, and with a high satisfaction rate, to monovision. And if monovision is not well tolerated, you can wear a glasses correction to equalize the vision in both eyes. 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.
If you have further questions about the various lens options available in cataract surgery, we invite you make an appointment with my office to see me and my staff so we can talk you about which lens option would work best for you.
4. What to Expect from Cataract Surgery
Cataract surgery is the most commonly performed surgery in the US. Cataract surgery has an extensive safety record, and serious complications are rare and usually treatable. In my practice, 97% of cataract surgeries are without complication.
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. If you need glasses to fine tune your vision, the glasses are typically prescribed 3-4 weeks after surgery.
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.