What is a Cataract?

Do I need cataract surgery?

Cataracts do not improve and can not be treated. The only known remedy is cataract surgery. Cataract surgery should be performed whenever you feel that your vision is impairing your daily activities of living. If you are not having any difficulties with your vision, you probably do not need cataract surgery unless the cataract is threatening the health of the eye (rare).

How is cataract surgery done?

Cataract surgery is usually an easy experience. You will need to arrive about an hour before the surgery time to have dilating drops instilled into the eye. The surgery, usually 25 minutes in length, is performed while you are awake and does not require any shots. You should not experience any pain and an anesthesiologist is always present to help you relax or calm your nerves.
A tiny incision is made in the clear cornea and the cataract is quickly sucked out using a small probe. A lens implant is then folded and inserted into the eye through the tiny incision without the need for sutures. The day after, most people do not feel any discomfort at all and usually full restoration of vision occurs within the first week. Most people find that there is a huge improvement by the very next day. Most can work and drive within a few days of the surgery.

Are you going to use a laser? 

No. The jury is still out as to whether or not this is a superior method to the time-tested phacoemulsification method. In this procedure a small probe is placed through the tiny incision in the eye and the cataract is gently “emulsified” ie: broken up into tiny pieces which are then sucked out of the eye by the probe. This usually takes only a few minutes and is not visible by the patient. This is performed through the tiny, self-sealing incision which does not need to be sutured

 Will I get a lens implant?

All patients undergoing cataract surgery will receive a lens implant in their eye to replace the cataract that was removed. This is necessary because, like a camera, the eye would be unable to focus light effectively without a lens. There are many different types of lens implant and they are generally made out of plastic or acrylic. The lens implant that we choose is custom tailored for your eye preoperatively during the measurements that we take prior to the surgery.

Vision after cataract surgery

More than 97% of people who receive a standard IOL during their surgery will have their vision restored to how it was before they developed their cataract. The role of cataract surgery is to remove the cataract and to improve vision, but it does not avoid the need for glasses. Medicare and most other insurance will cover cataract surgery because it is MEDICALLY NECESSARY but they will not cover any costs related to avoiding glasses. Patients who want to enjoy their excellent vision without the need to wear glasses may want to consider all the options (see below):

Options in Cataract surgery

Option 1– Basic Option– This is what most insurances will pay for in full. There are no extra charges for this surgery other than your deductible, copay or co-insurance. It provides a regular lens implant and does not correct astigmatism. This type of surgery is not designed towards independence from glasses.

Option 2- Astigmatism correction– Fixing astigmatism during cataract surgery nearly always improves clarity of vision without glasses.  There are two ways of doing this depending on the amount of astigmatism present.  Low astigmatism can be corrected with tiny corneal incisions ($750 /eye) and high astigmatism is corrected with a Premium Toric Lens Implant ($1250/eye). Both of these options provide good vision without glasses for either distance or near.   In many cases we can customize this type of surgery to provide good uncorrected distance for both distance and near.

Click here for more details on Astigmatism Correction

Option 3- Multifocal Implants– This surgery uses Premium multifocal IOL’s which correct astigmatism as well as distance, intermediate and near vision.  This surgery costs $2250 per eye over the rate for basic cataract surgery.

 

Are there other ways to reduce my dependence on glasses”?

Yes.  We have already discussed the role that multifocal IOL’s play in reducing dependence on glasses.  But there are also other ways of achieving this.  For example, monovision is a technique in which this can be accomplished without the use of multifocal IOL’s.  Monovision involves one eye, usually the dominant one, being corrected for distance vision, and the other eye being corrected for near.  With monovision both eyes work together, allowing you to see clearly at any distance.  It may sound complicated and “unbalanced” but most people adapt so successfully to monovision that they may not be able to tell which eye is set for distance and which is set for near.  Monovision can be achieved with regular and toric IOL’s, as well as with surgical astigmatism correction.  It is often a very good substitute for the more expensive and often more finicky multifocal IOL’s.

Are there any disadvantages to multifocal IOL’s or monovision”?

Nothing in life is 100% and even with our premium options some people still require occasional glasses for night driving or for reading and computer work.  Some people experience glare, starbursts or haloes when driving at night (especially with the multifocal IOL’s) but this fades over time in 95% of cases.

Are the results of cataract surgery “guaranteed”?

There is no such thing as “guaranteeing” the results of any surgery. Fortunately, the complication rate of cataract surgery is very low. According to the American Society of Cataract and Refractive Surgery, the overall success rate is 98% or higher. It is rare but not impossible for vision to be worsened or lost. A Medicare study of 200,000 patients showed that 99.5% of patients had no severe postoperative complications. It should also be noted that the final outcome of cataract surgery depends on the overall health of your eye in general.

Can cataracts come back after surgery?

No. However, it is possible to get a cloudy membrane (posterior capsule opacification) behind the artificial lens implant. This is sometimes erroneously called a “second cataract” and it can cause blurry vision. The good news is that this problem can be rapidly, safely and painlessly treated in the office within a few minutes with a Yag Laser Capsulotomy. Complications occur under 1% of the time and should be discussed with the surgeon prior to the procedure.