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Cataract Surgery and Lens Options

Multifocal Lens vs Monofocal Lens

A cataract is a clouding of the natural lens inside your eye. This lens, located behind the iris, works just like the lens of a camera - focusing light images on the retina, which sends images to the brain. The lens can become so clouded that it keeps light and images from reaching the retina.

NORMAL vs CLOUDY
Graphical comparison of a
normal eye versus a cloudy eye.

A cataract can be the reason sharp images become blurred, bright colors become dull, or seeing at night is more difficult. It may also be the reason glasses no longer seem to help. Vision with cataracts has been described as seeing through old, cloudy film. But a cataract is not a "film" over the eyes, and neither diet nor lasers will make it go away. Eye injury, certain diseases, or even some medications can cause a cataract. A cataract is treated by removing the old clouded lens and replacing it with a new artificial lens to restore your vision. This lens is called an implant.

Once it is determined that you have cataracts and that they must be removed, there are several options for the type of lens implant that is used to restore your vision. Until recently, cataract patients received monofocal lens implants that only had a single power. With a monovision implant, you have a choice of correction for either near or far vision, but not both. The FDA has now approved multifocal lens implants for use by certified ophthalmologists. The multifocal lens can increase your chances for a life free of dependence on glasses or contacts after cataract surgery. Cataract surgery is an opportunity to minimize or eliminate the hassle of glasses and contacts from your life. The implantation process is the same for either type of lens. The main point of differentiation between the lens implants is the type of vision they provide.

Multifocal vs Monofocal

Multifocal	Monofocal
Corrects vision for far, near, and intermediate	Provides good vision at one distance (typically far vision)
Minimizes or eliminates glasses	Requires reading glasses after surgery
Partial coverage by Medicare or other insurance	Covered by Medicare or private insurance

There are two multifocal lenses available: The ReSTOR lens and the ReZoom lens. Both of these lens options require an otherwise healthy eye for optimal performance, so some patients are not good candidates for this new technology. Your eye physician can let you know if a multifocal lens is a good option for your eyes and which lens will be the best choice. Insurance generally covers the cost of cataract surgery, including the cost of a monovision implant. The cost of upgrading to a multifocal implant is not currently covered by any type of insurance. The amount that insurance pays for a monovision implant is deducted from the cost of the multifocal implant.

Astigmatism Correcting Lens

Another exciting lens implant option is the new Toric Intraocular Lens from Alcon. Eye Physicians and Surgeons was the first, and still one of the only, practices to offer this new technology. Astigmatism is a condition where the cornea has an irregular shape. Unitl recently, patients with astigmatism still required glasses after cataract surgery while patients without astigmatism enjoyed significantly less dependence on glasses. Astigmatism can be treated with glasses, contacts, and laser surgery. Since cataract surgery involves the lens inside the eye, any existing astigmatism from the cornea is still present after surgery. Fortunately, there is now a lens implant that can not only correct the cataract, but also greatly decrease astigmatism caused by an irregular conrea. Once the astigmatism is also corrected, your dependence on distance glasses will be greatly decreased or eliminated.

How is a cataract detected?

A thorough eye examination by an ophthalmologist (medical eye doctor) can detect the presence and extent of a cataract, as well as any other conditions that may be causing blurred vision or discomfort.

There may be other reasons for visual loss in addition to the cataract, such as problems involving the retina or optic nerve. If these problems are present, perfect vision may not return after cataract removal. If such conditions are severe, removal of the cataract may not result in any improvement in vision. The ophthalmologist will decide how much visual improvement is likely.

How fast does a cataract develop?

How quickly a cataract develops varies among individuals, and may vary even between the two eyes. Most cataracts associated with aging progress gradually over a period of years.

Other cataracts, especially in younger people and people with diabetes, may progress rapidly over a few months and cause vision to worsen quickly. It is not possible to predict exactly how fast cataracts will develop in any given person.

How is a cataract treated?

Surgery is the only way the ophthalmologist can remove the cataract. However, if symptoms from a cataract are mild, a change in glasses may be all that is needed for adequate vision.

There are no medications, dietary supplements, exercises or optical devices that have been proven to prevent or cure cataracts.

Protection from excessive sunlight may help prevent or slow the progression of cataracts. Sunglasses that screen out ultraviolet (UV) light rays or regular eyeglasses with a clear, anti-UV coating offer this protection.

When Should I Have Cataract Surgery?

Cataract surgery should be considered when cataracts cause enough loss of vision to interfere with daily activities.

It is not true that cataracts need to be "ripe" before they can be removed.

Cataract surgery can be performed when your visual needs require it. You must decide if you can see to do your job and drive safely, and if you can read and watch TV in comfort. Can you perform daily tasks such as cooking, shopping, yard work, and taking of medications without difficulty?

Based on your symptoms, you and your ophthalmologist should decide together when surgery is appropriate.

What Can I Expect from Cataract Surgery?

Over 1.4 million people have cataract surgery each year in the United States.

Cataract surgery is usually performed under local anesthesia as an outpatient procedure. The cloudy lens is removed from the eye, and in most cases, the focusing power lost in the removal of the natural lens is restored by replacing the natural lens with a permanent intraocular lens implant.

Your ophthalmologist performs this delicate surgery using a microscope, microsurgical instruments and other modern technology.

Although it is a common misconception, lasers are not used to remove cataracts.

In approximately one-fifth of people having cataract surgery, the natural capsule that supports the intraocular lens will eventually become cloudy. Laser surgery is used to open this cloudy capsule and restore clear vision.

After cataract surgery, you may return almost immediately to all but the most strenuous activities. You will use eye drops as your ophthalmologist directs. Several postoperative visits are needed to check on the progress of the eye as it heals.

Cataract surgery is a highly successful procedure. A majority of the cases result in greatly improved vision, unless there is a problem with the cornea, retina or optic nerve. It is important to understand that complications can occur during or after the surgery, some severe enough to limit vision. As with any surgery, a good result cannot be guaranteed.

Conclusion

Cataracts are a common cause of poor vision, particularly for the elderly, but they are treatable. Your ophthalmologist can tell you whether a cataract or some other problem is the cause for your vision loss or discomfort, and will help you decide if cataract surgery is appropriate for you.

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