By: Andrew J. Epstein, MD
Northern Connecticut Eye Associates
Cataracts cause slow, progressive loss of vision. As we age, the natural lens in the eye becomes cloudy and loses its ability to focus and transmit light clearly. Although cataracts are most commonly caused by the aging process, various factors including diabetes, high blood pressure, excessive UV exposure, trauma, and certain medications can also contribute to their development. Most everyone will develop cataracts at some point as they age. The main symptom patients experience is blurry vision. Additionally, headlight glare while driving at night is often a common concern. Early in the process, updating the eyeglass prescription may help, but this is only a temporary aid. Once a cataract begins to interfere with daily activities, surgery should be considered. Cataract surgery is the permanent solution, and it is the most common and most successful surgical procedure performed today.
Your ophthalmologist will explain to you in detail the procedure and lens replacement options. Cataracts are removed in an outpatient surgical center setting. In preparation for surgery, a mild relaxing agent is given through an IV in the arm, and the eye is numbed with eye drops. The ophthalmologist will remove the cloudy cataract lens by dissolving it with ultrasonics (sound waves) and then aspirating it from the eye. The cataract lens is replaced with an artificial intraocular lens (IOL). The surgery is very brief, is very safe, and afterwards patients can return to their regular activities relatively quickly with few restrictions.
IOL technology has advanced steadily in recent years, allowing patients the opportunity to “customize” their vision after surgery with respect to their need for glasses. In essence, patients can now choose how they want their eyes to focus following surgery. Modern IOL’s are technologically advanced, and they can correct near-sightedness, far- sightedness, astigmatism and presbyopia if the patient desires this correction.
There are four different categories of replacement lens options from which patients can choose:
- Standard Monofocal Lenses:
Standard monofocal lenses focus at only one distance. They do not correct astigmatism. Patients choosing this lens option should expect to need prescription glasses after cataract surgery to see in the distance in order to correct any astigmatism they may have. Some patients may also need prescription glasses to read up close, to use the computer, or to view anything else that is within a one to three foot range in front of them.
- Monofocal Lenses with Astigmatism Correction (Toric Lenses):
Astigmatism (or toric) correcting lenses are also monofocal, meaning that they focus at only one distance as well. Since they correct all of the power needed to see in the distance, glasses are typically not needed for distance vision tasks. Patients choosing this lens option should expect to need glasses after cataract surgery to read up close, to use the computer, or to view anything else that is within a one to three foot range in front of them, but those reading/intermediate glasses can be purchased over the counter (“cheater” glasses).
- Monofocal “PLUS” Lenses with Astigmatism Correction (Toric Lenses):
Astigmatism (or toric) correcting “PLUS” lenses also correct all of the power needed to see in the distance, but these lenses additionally allow intermediate vision tasks such as reading a desktop computer screen, using a tablet on a table, seeing food on a plate, and viewing a car dashboard, all without the need for glasses. Patients choosing this lens option should expect to need glasses after cataract surgery to read up close, but those reading glasses can be purchased over the counter (“cheater” glasses).
- Multifocal/Extended Depth of Focus Lenses:
Multifocal/extended depth of focus lenses offer the ability to focus across multiple distances. They also correct astigmatism if needed. Patients choosing this lens option should expect to be significantly less dependent on glasses for distance, intermediate, and near vision after cataract surgery since these lenses give them the greatest range of vision. Patients often do not need any glasses at all after cataract surgery when they choose this option.
Cataract surgery is covered by insurance after any applicable copays, deductibles, and/or co-insurance. Some of the lens choices outlined above are NOT covered by insurance so if the patient chooses one of these options, they may incur an out-of-pocket expense.
Whichever lens is selected, the patient will have better vision after surgery, since the cloudy cataract lens will be removed and replaced with the new, clear IOL. The choice among the various lens options comes down to which activities the patient wants to wear (or not wear) glasses for after surgery. Once healed, the vision will typically stay in focus for the entirety of the patient’s life, and there will not be a need to repeat the surgery in the future.
Dr. Epstein is an Ophthalmology Specialist at Northern Connecticut Eye Associates, LLC, and a Fellow of the American Academy of Ophthalmology.
