Table of Contents
What is a cataract?
Cataract is the clouding of the lens inside the eye. The effect is similar to that of looking through a ground glass. Things look fuzzy and reading is difficult. There may be glare while driving at night. Characteristically, these changes start slowly and progress over months or years.
Is there a way to prevent cataracts?
There is no way to consistently prevent cataract development. Avoiding excessive exposure to UV light by using glasses and sunglasses with UV filters may help a little.
You have cataracts - should you have surgery?
To decide whether or not to have surgery ask yourself these questions:
- Can I read, watch TV, and work on hobbies (essentially, do things I like to do)?
- Can I see stair steps, small toys on the floor, uneven ground, etc. clearly enough to avoid missteps, falls and injuries such as a hip fracture?
- Can I see well enough to avoid injuries in the kitchen, or with power tools?
- Can I drive safely, with no excessive glare from oncoming traffic at nighttime?
- Am I reasonably satisfied with my vision?
If you answered YES to every question, you have early cataracts and do not need surgery at this time. As cataracts progress, you will need new prescription glasses. If changes in prescription become too frequent, you may consider having surgery.
If you answered NO to any of the above questions you should consider surgery. Surgery is likely to:
- Significantly improve your lifestyle (you may again be able to do things you like to do)
- Increase your safety (you will lessen your chances of falls, driving accidents, work-related injury, etc.).
Note: If you are contemplating starting FLOMAX treatment for prostate problems – have your cataract surgery done before you start Flomax.
What are some of the problems with delaying surgery?
A cataract left in place for too long becomes hard and more force is needed to break it up. This, and the manipulation of the hard fragments inside the eye, may damage nearby structures. Occasionally, the lens cannot be broken and it has to be removed as a large single piece. This requires a larger cut in the cornea which has to be closed with stitches. The benefits of the modern “Small incision – No stitch” surgery are lost. The post-operative course may be stormier and the final vision may be less satisfactory than when surgery is done at the right time.
If your cataracts are already in the advanced stage we still recommend strongly that you have surgery. Your loss of vision was so gradual that you may not be aware of how much vision you have lost. You have a lot to gain by surgery since in over 95% of patients the results are excellent. You are likely to be pleasantly surprised with your new vision.
While you need not rush into surgery, you should not procrastinate because of fear. When your vision is not as good as it should be, you need surgery for your safety. Modern cataract surgery is very easy on you. It is painless, and the results are very satisfying.
Where is cataract surgery done?
Most of our cataract surgery is done in the Southgate Ambulatory Surgery Center. The Surgery Center is highly efficient because it has been set up mainly for cataract surgery. An American Board Certified anesthesiologist is on the staff. Nurses and other support personnel have extensive experience in cataract surgery, assuring a smooth and safe process. To you this means less upheaval, less anxiety and a short stay in the Surgery Center. Most patients check in, undergo surgery and are home within two hours. Patients who had one eye operation at a hospital and the other at the Surgery Center, much prefer the Surgery Center.
We also operate in the Southshore and Heritage hospitals and the Henry Ford Brownstown facility.
Cataract surgery and lens implants (IOL) - How is the surgery done?
We use the most current surgical method of cataract surgery, the “Clear cornea – Small incision – No stitch” method. There are no shots to the eye.
After mild sedation, eye anesthesia is achieved with eye drops. An ultrasound probe is introduced through a 1/8-inch, self-sealing puncture. The ultrasound breaks up the cataractous lens and the fragments are aspirated. Then, an artificial lens (intraocular lens or IOL) made of plastic or similar material is implanted into the eye through the same small incision. The lens is positioned and secured in place by the anatomical structures within the eye. No stitches are used to keep the lens in position or to close the incision through which the operation was done. Most patients do not even need an eye patch at the end of surgery. The operation is essentially painless and takes usually about 15 minutes.
What is dropless cataract surgery?
Recently, ways of placing the medication directly into the eye during surgery have been developed. It is not done on a routine basis but is available under certain circumstances
How long before I can resume normal activities?
Most patients leave the operating room without an eye patch and are able to see with the operated eye immediately. They are not allowed to drive until the next day. Most normal activities may be resumed one day after surgery. If any of your planned activities are unusual or physically intense and stressful, discuss your plans with us before engaging in such activity. We recommend that you plan to stay in the area for a couple of weeks. If this is not practical, let us know.
Will I need glasses after surgery?
While the goal is to reduce dependence on glasses significantly, you must be prepared for at least some use of glasses. How much use depends on whether you had the basic, standard monofocal implant or you had one of the newer Premium IOLs implanted.
Currently, in the USA, most implants are done using the standard monofocal IOL. This lens focuses at only one particular distance (the focusing distance depends on lens power). If your lens gives you perfect distance vision, you will have to use glasses to read. If your lens gives you perfect near vision (such as for reading), you will have to use glasses to see clearly at distance. You cannot see clearly near and at distance with any monofocal lens. Many patients are happy with an in-between power that gives them adequate distance vision while allowing them to read larger print without glasses. We carefully measure the lens power and try to accommodate patient wishes. However, there are many variables in eye anatomy and surgery. Perfect results cannot be guaranteed. All medical insurances cover standard monofocal lenses.
There are newer, Premium IOLs that allow good near and far vision with the same eye. See “What is an Advanced Technology IOL?”
What is the difference between Distance vision and Near vision?
Distance vision is the vision you use while walking around, driving, reading street signs, recognizing people’s faces, watching TV, watching live sports, participating in golf and other sports, etc. It is the type of vision people use most of the time. When using monofocal lenses we recommend correction for best distance vision, rather than for near vision (used for reading, knitting, other craft activities, eating, personal care and hygiene, etc.).
If you choose correction for distance you will need glasses to read.
If you choose correction for near vision (a less common choice) you will need glasses for distance vision (for most daily activities).
What kind of Intraocular lenses (IOLs) are available?
There is the insurance covered monofocal lens (see “What is a Monofocal IOL?”) and several Premium lenses (See “What is an Advanced Technology IOL?” and “What about correcting astigmatism during cataract surgery?”).
What is a Monofocal IOL?
A monofocal lens corrects either the distance vision or, if you so choose, the near vision. It cannot correct both in the same eye. Also, it does not correct astigmatism. The usual standard lens is a monofocal lens. The cost of this lens is covered by insurance. All other lenses are Premium lenses and their cost is not covered by insurance. The normal surgery (no laser) with monofocal IOL implant is the most commonly performed surgery because it restores good vision and is the lowest cost option.
What is a Premium IOL?
They are lenses that enable the eye to focus at far and near (Advanced Technology IOL) or correct astigmatism (Toric IOL). Premium lenses are not covered by insurance. There are out-of-pocket expenses for the cost of the Premium lens, needed special tests, additional surgeon fee, and a laser fee if laser is used.
What is an Advanced Technology IOL?
Advanced Technology lenses are Premium lenses that restore distance vision and near vision in the same eye (unlike monofocal lenses which restore either distance vision or near vision). While they are truly high tech marvels, Advanced Technology lenses are still unlikely to produce absolutely crisp vision at multiple distances at all times and in all circumstances. You must be prepared for the possibility of at least some imperfections. If you are interested in a Premium lens we will go over the pros and cons with you in much greater detail.
What about correcting astigmatism during cataract surgery?
Some cataract patients have two separate problems – cataracts plus corneal astigmatism. If you are such a patient you have 3 options.
If you don’t mind using glasses all the time – We will do the usual cataract surgery with the usual monofocal IOL. No special surgery for astigmatism will be done (no additional charges). Insurance covers this lens. Astigmatism correction will be done with glasses. You will see a lot better than you do now when you get your new glasses after surgery.
If you prefer not to wear glasses all the time, but don’t mind reading glasses – We will use a Premium toric monofocal IOL. Insurance does not cover this lens. There will be an added charge to cover the cost of the toric lens, special tests and surgeon’s fees. The toric lenses are less expensive than multifocal lenses. If you have significant astigmatism I think you will find the added expense of the toric lens implant worth it.
If you want to be independent of glasses for most activities – We will use an Advanced Technology lens that also addressed astigmatism, or we can do Monovision with toric lenses (see section on Monovision below). These combined procedures should improve your far and near vision. The vision without glasses is usually good for non-critical routine daily activities. While the need for glasses is reduced in most patients you may still need glasses occasionally, depending upon the available light and the visual task being performed.
What about laser surgery?
Laser is available. The use of laser is not covered by insurance. If the laser is necessary in your case we will let you know.
What is Monovision?
The standard IOL and toric IOLs are monofocal lenses that cannot give you clear distance vision and clear near vision in the same eye. If you chose monovision we will adjust the power of the right and left eye differently in order to give you good distance vision in one eye and some near vision in the other eye. Most people tolerate this convenient combination of acceptable distance vision and some near vision.
What kind of surgery (IOL) should I get?
Today, there are many options and patients may find it difficult to make a choice with confidence. Once you decide to have surgery we will provide you with far more detailed information than is possible here and we will help you navigate through it. Here are some general concepts and a summary about what is available.
Before you decide what type of surgery to have, you need to carefully evaluate how you spend most of your time and what kind of vision you use for those activities; distance or near vision (see “What is the difference between Distance vision and Near vision?”). Also think about how you feel about wearing glasses. These are very important issues. You have a one-in-the-lifetime opportunity to obtain the vision you want. Think carefully about them. Try to answer to yourself:
Do you mind wearing glasses after your surgery?
How important is to you to be less dependent on glasses?
Try to decide what type of vision is most important to you:
- clear distance vision, or
- a good combination of distance plus near vision, or
- clear near vision
Then we will suggest the type of surgery that is most likely to provide you with the vision you want.
To summarize:
If you want good vision at least cost you need the monofocal IOL. Because distance correction (not near correction) is recommended, you will need glasses for reading. If you also have significant astigmatism you will need glasses at all times. If you choose near vision correction you will need glasses for distance.
If you want to see both near and far without glasses, you need either an Advanced Technology IOL or Monovision.
If you want to reduce your astigmatism and do not mind reading glasses, you need a Premium toric IOL.
If you have significant astigmatism and wish to see both near and far, you will need either a Toric (astigmatism-correcting) Advanced Technology lens or Monovision done with toric lenses.
Is the Premium IOL a wise investment?
This discussion applies to Advanced Technology lenses and to toric lenses (astigmatism-correcting lenses).
Developing cataracts is a nuisance but, unlike in the past, it also gives you a once-in-the-lifetime opportunity to significantly improve your vision, and reduce your dependence on glasses, possibly for the first time in your life. If you were born nearsighted, farsighted or with astigmatism these problems can often be corrected during cataract surgery.
The Premium lens is expensive but the cost needs to be put into perspective by comparing the benefits of Premium IOLs against benefits afforded by other purchases you may make with the same amount of money.
When buying a car, some people choose to buy basic transportation. There is nothing wrong with that. For basic transportation all you really need is the basic stuff – provided by any small inexpensive car. Similarly, the reason to have standard IOL surgery is to satisfy your basic vision needs.
Other people buy a large car to make the ride safer, a car with A/C to make the ride more comfortable, a GPS to make travel more convenient, a stereo system to make the ride more fun, etc. The cost of these options is far more than the cost of Premium lens surgery. Still, they are willing to pay for these extras knowing full well that they will enjoy them for only the few years while they own that particular car.
Compare the costs and benefits of buying the car options with the cost and benefits of Premium lenses. You will usually use the car for only a couple of hours per day. You will experience the benefits from the Premium lenses every day, all day long, from the time you wake up and look at your bedside clock till you fall asleep.
Every time you get a new car you will have to pay for the same options all over again; the Premium IOLs are a one-time investment for a lifetime of benefits.
So the answer to the question “Is the Premium lens a wise investment?” depends mostly on your financial situation. The benefit of improved vision throughout the day, day in and day out, is large. Over a lifetime, the cost per day is minimal. It seems that if you can afford the initial expense, the answer should be “Yes, it’s well worth it!”
What are the complications of surgery?
The most serious complications are severe bleeding inside the eye and infection inside the eye. With the improvements in techniques and instrumentation, severe bleeding has become extremely rare. Serious infection is said to occur once for each 1,000 operations. In our own experience it is closer to once in 2,500 operations. Less dramatic complications, with no major vision loss, occur in about 2% of operations.
How will I see after surgery?
The vast majority of patients notice great improvement in vision sharpness and in color perception. Years ago we did a study of 200 consecutive patients undergoing cataract surgery. All patients whose only eye problem was cataracts regained sufficient vision to allow them to resume driving. Patients who, in addition to cataracts, had diabetic eye problems or macular degeneration showed less complete vision recovery. The extent of vision improvement in these patients was limited by the vision loss caused by diabetes or macular degeneration.