A cataract is a clouding of the natural crystalline lens inside your eye. The native lens is located behind the iris (the colored part of the eye) and works just like the lens of a camera, focusing light images on the retina, which then sends the images to your brain. The human lens, made mostly of protein and water, can become clouded – so clouded that it keeps light and images from reaching the retina. Cataracts are an extremely common side effect of growing older. In fact, if you live long enough, chances are high you will develop the condition in one or both eyes.

The most common symptom of cataract is blurring of the vision, including difficulty reading, driving and watching television. Other important symptoms may include night vision glares, halos around bright lights, double vision, dim vision and distorted vision. Dr. Rush will examine your eyes to diagnose cataract and determine if it is the reason for your vision loss. A visually significant cataract is based on how bothersome the vision defect caused by the cataract is for your daily activities. No two patients are exactly alike. The threshold point for favoring surgery depends upon what type of activities you do and how limiting the vision is for successfully performing them.

Modern cataract surgery uses an advanced phacoemulsification medical device that integrates ultrasound power to dissolve your cataract into smaller pieces where it is subsequently extracted from the eye and replaced with an artificial intraocular lens implant or IOL.

During cataract surgery, the eye's natural lens is removed and replaced with a clear, artificial intraocular lens implant or IOL. Basic IOLs, or monofocal lenses, are covered by insurance when used to replace a lens clouded by cataracts. These lenses restore clarity and can help patients achieve clearer near vision or distance vision, but not both. Most patients will still need reading glasses after cataract surgery with standard IOLs.

The main goal of cataract surgery is to get rid of cataract, not get rid of glasses and contact lenses. But with new technology lens implants can reduce your dependency on glasses and contact lenses. This is especially advantageous to those with high prescriptions who are used to thicker glasses.

We use the Alcon AcrySof®family of lenses, and they are the most advanced and commonly used implants in the field of ophthalmology. They have been successfully implanted in tens of millions of patients. Among the Alcon lens implants, there are several options and models to consider, each with their own relative merits.

Single Vision Distance

This is the most common option with the standard wavefront lens implant. Most prefer their best distance vision with both eyes working together for optimized depth perception. But with this option, you will always need reading glasses to see up close.

Monovision

This scenario allows for your dominant eye to be set for distance and your fellow eye aimed for near. This option makes you less dependent on glasses for distance and near but has a relative disadvantage of decreasing depth perception since both eyes are not focused together as a team. Patients that have used this in the form of contact lenses for many years adapt to it and love it. Not everyone will tolerate the two eyes being slightly off balance. We would recommend experimenting with this using contact lenses to see how you are able to tolerate it before consideration.

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Toric Intraocular Lens Implant This premium technology implant is necessary for all patients with significant astigmatism that want to have the least amount of dependency on glasses post-operatively. Having either clear distance or near vision will make you less likely to need bifocals afterward.

PanOptix Multifocal Lens Implant

This premium technology implant is the absolute best option to make you completely independent from glasses for both distance and near. Multifocal technology uses a lens implant that provides the largest range of vision from distance to intermediate and near by splitting the light to focus some of it near and some of it at a distance. It is also designed in a toric style that will correct your astigmatism simultaneously.

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STRENGTHS

• Excellent improvement in all three ranges of vision

• Minimal reliance on glasses to see far away

• May only occasionally need glasses for some situations

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LIMITATIONS

• Moderate chances of halos/glare at night that may not go away

Vivity Intraocular Lens Implant

This newly-approved implant uses non-diffractive X-WAVE™ technology, which offers patients a more seamless range of vision without splitting light into different sectors of the lens. This allows the Vivity lens to deliver the same high quality of vision and contrast of a single focus lens implant, but with the added benefit of excellent intermediate at arm’s length. It has the ability to make you much less dependent upon reading glasses, especially when working on a computer.

Cataract surgery is a day surgery in our outpatient ambulatory surgery center and does not require hospitalization. It requires you remain without food or drink at midnight the night before the surgery in preparation for various types of anesthesia. The exception is that you will take all of the medicines by mouth that you would normally take with a sip of water, even on the morning of surgery, which includes any blood thinners.

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You will first meet our nurse anesthetist, who is there primarily for your safety but will also be there to ensure that you are comfortable during the procedure. They are able to give numbing eye drops, intravenous sedation and oral medications to ensure comfort and reduce anxiety. It is tailored to meet your specific needs. However, you will not be totally asleep during the surgery. We expect that you will see bright lights, feel light touch and pressure from time to time as well as cool fluid coming off and on the surface of the eye but no pain. You will also have gentle pressure on the eyelids as the speculum holds them open so that you don’t have to worry about blinking or closing your eyes during the procedure.

A sterile drape covers you so as to keep the surgical field sterile, but you will have cool air blowing underneath to give you plenty of breathing space where your oxygen levels and other vital signs are closely monitored. You should understand that there is no special action required on your part except to listen to our instructions, where we coach you through the entire procedure in a stepwise fashion.

The surgery itself lasts approximately 15 minutes start-to-finish but you will spend up to two hours at the surgery center, most of the time spent preparing for surgery and being discharged with post-operative instructions. You must have a driver to take you to and from the surgery as it is not safe to travel alone with effects of IV sedatives in your bloodstream.

The first post-operative visit will occur within 24 hours of the surgery, many of them on the same day of surgery so as to eliminate your travel time, especially for those traveling from out of town. You will be given post-operative instructions at this first visit, including any activity restrictions and on the use of the eye drops. The eye medication is used in the operative eye with one drop being used three times daily for a total of 3 weeks from the time of the surgery.

Your next visit will occur either one more time immediately prior to the surgery of the second eye to ensure good healing progress or three weeks from the time the surgery on the second eye is completed.

Usually, your vision will start to recover dramatically over the course of the first few days, but as with surgery anywhere else on your body, your eye requires a healing process in order to achieve your best vision. On average, this healing occurs over a time period of 3 weeks in order to achieve your maximum visual outcome; some people quicker, some people a little bit longer. No two individuals will be exactly alike, and each individual eye will have a slightly different experience both during and after the surgery. All detailed instructions will be reviewed and given to you in written form after your surgery.

In the interim period between surgery of the two eyes, it is typical for the eyes to be imbalanced. Many patients discover that the old glasses don’t work well during this time. This is why we try to schedule the surgery on both eyes back-to-back within a week of each other if possible. In the meantime, you may use over-the-counter readers alone or some patients even remove the lens from the old glasses. You will have to decide what will work best for you.

At the three-week post-surgery follow-up visit from the time of the second eye surgery, you will be sent back to your regular eye care provider to receive prescription strength glasses if necessary. It requires this healing time for our most accurate prescription measurements, otherwise, we would have to change or update them immediately if it shifts due to incomplete healing time. It is important to allow this time for it to settle.

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Most patients are able to return to their normal activities including work within the first few days after surgery. We ask that you don’t do anything overly strenuous that would be outside your normal activity routine. We don’t ever tell people to drive or not to drive. We don’t work for the Department of Transportation and don’t make these determinations for you. All we can tell you is what your vision is, but you have to make this determination if you are safe to drive based on your confidence level and the applicable government regulations from the DOT.

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As with any surgical procedure there are inherent risks, and your results cannot be guaranteed. Your doctor will provide you with more detailed information about the potential risks and benefits to help decide whether or not you are an appropriate candidate for cataract surgery. Written informed consent document will be reviewed at the time of your evaluation.

Yes, medical insurance including Medicare, Medicare supplements, and private commercial carriers, covers treatment for visually significant cataracts. They do not, however, cover the additional expense for upgraded intraocular lens implants. This expense must be paid out of pocket, something for which there are financing options available.

No, with successful removal of the cataract, it is gone for good. Over time you may develop a cloudy film behind the lens implant that can blur the vision, like looking through a cloudy windshield. This is not a regrowth of the cataract but rather a posterior capsular opacity. During the original cataract procedure, a thin portion of the cataract is intentionally left behind to allow for a support system to position the intraocular lens implant. The capsule usually starts off crystal clear but may tend to cloud over with time. A specialized laser treatment performed in the office that takes 60 seconds or less is able to polish off this cloudy film and restore vision. Patients who develop blurry vision later should be evaluated for this condition.

When your eyes were young, your natural lens was both transparent and flexible. Because of this, your vision was most likely stabilized until you reached your forties. Around that time, you may have noticed that you had to hold a menu or a book farther and farther away to read it, even with your best distance glasses prescription. Many people end up wearing a pair of reading glasses or bifocals to compensate for this aging process of the eye. This condition of not being able to focus up-close with one’s distance prescription is called “presbyopia”, and eventually affects everyone, including those who are nearsighted, farsighted, have cataracts, or had perfect vision most of their life. There are lens implant options during cataract surgery that will mitigate the effects of presbyopia after your surgery.