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.
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:
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.
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. Typically, the central rings focus for reading and the outer rings focus for intermediate and distance. Multifocal intraocular lens implants are only moderately successful at accomplishing the goal of achieving simultaneous clear distance, intermediate and near vision. When used to attempt to simultaneously correct for near, intermediate and distance, multifocal IOLs are problematic. The multiple ring design of the multifocal IOLs often cause glare at distance, especially for night driving. This night glare is not correctable with glasses. Most people eventually adapt to this multifocal-inducd night glare, but a small percentage of patients are so bothered by this night glare that the multifocal lens implant has to be explanted (removed) from the eye and replaced with a monofocal IOL. The second problem with the multifocal lens implant is that vision with the multifocal lens implant is dependent on pupil size. As mentioned above, the central rings of the multifocal lens implant focus for near and the outer rings focus for intermediate and distance. If the pupil is very large (as in the dark for driving at night), or very small, (as in bright sunlight), the multifocal lens may not function well, causing difficulty with reading or glare for night driving, especially if the multifocal lens is not well centered. When used to simultaneously correct for near, intermediate and distance, multifocal lens implants are potentially problematic with a moderately high dissatisfaction, or at least, frustration rate. If your goal is simultaneous sharp vision without glasses at near, intermediate and distance, multifocal lens implants may be a disappointment for you.
However, in my experience, the Symfony multifocal IOL does work well in one specific situation: monovision (see below).
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.
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.