Cataract Surgery

Your eye has a clear lens through which light passes, allowing you to see. When the lens loses its transparency, the cloudy tissue that develops is known as a cataract.

Cataracts cause progressive, painless loss of vision. The lens clouds naturally as we age, so people over the age of 65 usually see a gradual reduction of vision. No one is exactly sure what causes cataracts. In younger people, they can result from an injury, certain medications, or illnesses such as diabetes. Prolonged exposure to ultraviolet light may also play a role in the formation of cataracts. Studies have also shown that people who smoke cigarettes have a higher risk of developing cataracts than non-smokers.

Although cataracts usually develop without apparent pain, some indications that a cataract may be forming are:

• Blurred or hazy vision
• Double vision
• Poor vision in bright light
• Seeing halos around lights
• Yellowish tinged vision
• Night vision difficulty

If visual impairment interferes with your ability to read, work, or do the things you enjoy, then you will want to consider cataract surgery. Cataract surgery is relatively painless and is one of the most frequently performed procedures. It has a very high success rate, with more than 90 percent of cataract surgery patients able to regain useful vision.

Intraocular lenses, or IOLs, are the artificial lenses that replace the eye's natural lens when it is removed during cataract surgery. IOLs have been around since the mid-1960s, though the first FDA approval occurred in 1981. Before that, if you had cataracts removed, you had to wear very thick eyeglasses or special contact lenses to see afterward, since the natural lens that had been removed wasn't replaced with anything.

Until recently, every lens implant acted simply like a fixed-focus lens, allowing a person to see well far or near but not both.  Most of the time, people who receive these simple implants need reading glasses for near work. 

New Premium lens implants, including the Crystalens, ReZoom, ReSTOR, and Tecnis Multifocal lenses, can now provide both reading and distance vision without glasses for people undergoing cataract or refractive lens implant surgery.  Each of these implants works slightly different, and not all implants are right for all patients. Your eye surgeon will help you make an informed decision about which implant will provide a lifetime of clear vision for you. 

Traditional Lens Implants

Intraocular lenses (IOLs) are designed to primarily restore the refractive power of the eye after cataract surgery.   These lenses are made of silicone or acrylic and are usually foldable.  They can be rolled up and placed inside a tiny tube.  The tube is inserted through a very small incision – less than 2.5 mm in length.  Once inside the eye, the IOL gently unfolds.

With rapid technological breakthroughs, IOLs are now available in various new and sophisticated designs.  The newest intraocular lenses are made to correct spherical aberrations (minute imperfections in the surface of the eye) and result in clearer, “younger” vision.  Some of these lenses also filter blue light.  UV rays have long been suspected to cause cataracts and other vision problems, and many IOLs filter them out just as your natural crystalline lens did before its removal in cataract surgery. Blue light may cause retinal damage and play a role in the onset of age-related macular degeneration.

Premium Lens Implants

Crystalens® – Far, near and everything in-between

Crystalens (Bausch & Lomb) gained FDA approval in late 2003. A newer version of the IOL, known as Crystalens HD, was FDA-approved in June 2008. Crystalens was designed to restore the ability of the eye to focus, or accommodate, which is gradually reduced in patients after the age of 40.

The Crystalens implant can give reading vision (within 1-2 feet), arm’s length (2-3 feet), and distance vision without glasses, because this implant actually adjusts its position within the eye as the eye looks from far to near subjects, just like an “auto focus” mechanism on a camera.  Most people with the Crystalens have clear far (driving, television), and intermediate vision (arm’s length, computer screen) without any need for glasses.  About 90 percent of people can also read newsprint without glasses.

Click here to learn more about Crystalens®

ReSTOR® – The Space-Age Bifocal

AcrySof ReStor (Alcon) uses apodized diffractive technology — a design that responds to how wide or small the eye's pupil might be — to provide near, intermediate and distance vision. Clinical studies used to support the March 2005 FDA approval showed that 80 percent of people who received the lens didn't use glasses for any activities after their cataract surgery.

ReSTOR lens is a non-moving lens implant.  This high-tech manufacturing process gives the lens a gradual blending of focusing power thought the entire lens surface.  With the ReSTOR lens, over 90 percent of people can see both distance objects (road signs) and near objects (reading material within 1-2 feet) without difficulty, especially in good light.  Also, as with all multifocal lenses, a period of adjusting to the lens, or your brain getting used to the lens, is required.  The length of the period depends on multiple factors, including age and vision requirements of the person.

Click here to learn more about ReSTOR®

ReZoom® – Progressive Lens inside the Eye

ReZoom (Advanced Medical Optics) is a multifocal refractive IOL that distributes light over five optical zones to provide near, intermediate and distance vision. ReZoom was FDA-approved in March 2005.  In a European study of 215 patients, 93 percent of ReZoom recipients reported never or only occasionally needing glasses.

The ReZoom lens, like the ReSTOR lens, is a non-moving lens implant. It gives near (1-2 feet), arm’s length (2-3 feet), and distance vision simultaneously because it has three focusing zones. Light entering the eye passes through all three of these zones simultaneously.  This means there is no “learning curve” for reading with this lens.  Distance and reading vision are available almost immediately.  However, some patients may have difficulty with driving at night because of glare from oncoming lights.  This can occur with any lens implant, but is more likely with implants that focus light in two or more places at once. 

TECNIS® Multifocal IOL – Youthful Vision after Cataracts

The Tecnis Multifocal IOL (Abbott Medical Optics or AMO) is a diffractive artificial lens with specific zones that provide near, intermediate and distance vision. Company officials say the lens has a proprietary design to enhance vision at all distances without depending on the size of the pupil as it expands in low light or constricts in bright light. The Tecnis is also shaped to correct for certain higher-order aberrations, which helps improve the ability to see contrasting objects, particularly at night. AMO reported a 95 percent patient satisfaction rate in clinical trials leading to FDA approval in early 2009.

Monovision

If your cataract surgery involves both eyes, you might consider monovision. This involves implanting an IOL in one eye that provides near vision and an IOL in the other eye that provides distance vision. Usually people can adjust to this, but if you can't, your vision may be blurred at both near and far. Another problem is that depth perception may decrease because there is less binocular vision — your eyes aren't working together as they once did.

The people who do best with this method are those who are already used to monovision with contact lenses, which is a common way of correcting presbyopia. If you can't adjust to monovision after your cataract surgery, you may wish you had tried a multifocal or accommodating IOL instead. Some surgeons will trial-fit a cataract patient in monovision contact lenses prior to inserting monovision IOLs.

Toric IOLs for Astigmatism

Toric IOLs are designed to correct astigmatism. Most surgeons who treat astigmatism in their cataract patients tend to use astigmatic keratotomy (AK) or limbal relaxing incisions, which involve making incisions in the cornea. But in addition to or even instead of corneal astigmatism, some people may have astigmatism, caused by irregularity in the shape of the natural lens capsule. This can be corrected with a toric IOL.

IOL Cost and Availability

Statistically, cataract removal/IOL implantation has one of the highest success rates among all surgeries, but it's important to know the risks beforehand. Ask your surgeon to explain any potential problems that your new IOLs could cause.

You'll also need to think about cost. Cataract surgery is covered by Medicaid, Medicare and virtually all health insurance plans. The traditional IOL implants are fully covered as well, since insurers view these implants as medically necessary. But the newer implants — such as ReStor, ReZoom and Crystalens, as well as toric lenses— are not currently covered (even if the procedure itself is), because they cost more and because their special features tend to be viewed by insurers as "nice to have" but not absolutely necessary. Medicare will reimburse the surgical facility for the cost of a traditional IOL, and the patient will be responsible for the difference.

Our practice also offers financing plans for patients who do not have insurance, or whose insurance does not cover the procedure they wish to undergo.  Our staff will work with you to devise a payment plan that lets you work within your budget while still receiving the treatment you desire.  Please feel free to call us today to discuss your financing options.

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