Cataract Surgery & Lens Implants

If you are over 40 years old it is likely that you have started to experience some of the changes in your vision that each and every one of us will encounter. Even if you have had “normal” eyesight all your life your vision begins to change in a several distinct ways. For most people who are between the ages of 40 and 60, the most obvious changes to our vision occur in the eye structure called the crystalline lens.

When we are under 40 years of age, as the name implies, the crystalline lens is typically crystal clear. It is also soft and flexible. It is this flexibility that allows the lens to change its shape and alter its curvature so that it can help focus your vision at various distances-from far, to near, to arms length, to far or near again. Thus, it is this flexibility of the lens that lets us enjoy being able to see things at all distances. As we enter our 40’s, the crystalline lens begins to lose its flexibility, making it more and more difficult for us to change focus and see arms length or close objects or reading material. This loss of flexibility is called Presbyopia.

Presbyopia, which is a term that literally means "old eyes", is a normal and expected consequence of the aging process. When the crystalline lens loses its ability to flex, it is no longer able to change its shape and effectively bend light rays as sharply. This results in a gradual and progressive loss of your ability to focus on near objects. People experiencing the start of Presbyopia often notice that their "arms are too short" to read and they have to hold close things further away to see them clearly. Presbyopia typically becomes noticeable between age forty and fifty and progressively worsens through age sixty-five. Presbyopia affects everyone including those who have cataracts. When Presbyopia begins, people who already wear glasses may need bifocals or trifocals, and those who have never worn glasses may require reading glasses. Recently, thanks to advances in lens surgery techniques and modern lens implants, lens replacement surgery has helped many patients restore their normal range of vision without dependence on bifocals and trifocals.

Cataracts & Lens Implants

Another change that occurs in the crystalline lens as we progress through our 50’s and 60’s is that the normally crystal clear lens begins to lose its transparency and gradually become yellow and cloudy. As the crystalline lens loses its transparency and its optical clarity, it may begin to disturb your ability to see well in dim illumination such as for night driving, and may create glare or just an overall dimming of your vision. Sometimes parts of the lens may actually become cloudy enough that they cause a significant decrease in your day and night vision. These symptoms are what patients who have cataracts typically experience.

If you have been told that you have a cataract, there is no need to be overly concerned as you are not alone. Each year in the United States, more than 2.5 million people have cataract surgery. Thanks to advanced surgical procedures and technology, cataract surgery is not only one of the most frequently performed surgical procedures in the United States, but it is also one of the safest and most successful surgical procedures that you can have. Cataract surgery is performed on an outpatient basis and usually only requires a few hours of your time from beginning to end.

Cataract Surgery Procedure

To begin the cataract surgery procedure, your eye will be treated with an anesthetic so that you will feel little, if any discomfort. A tiny incision will be made and a microscopic instrument will be passed through it. Using ultrasound from the tip of the microscopic instrument, we will be able to gently break the cataract into pieces small enough to be washed away, drawn through the instrument and removed from the eye.

This technique is called “phacoemulsification” and is the most advanced method of cataract surgery and crystalline lens removal available.

Once your cataract has been removed, a new permanent Intraocular Lens Implant can now replace it. The new lens is readily inserted and placed in position through the same tiny incision at the outer edge of the cornea through which the cataract was removed.

After the procedure, you will rest for a short time at the surgery center before going home. Usually we will arrange a visit to examine your eye within 24 hours after of your procedure. If necessary, we may prescribe some eye drops for you to use and ask you to wear a protective shield, mainly at night to help you remember not to rub your eye. Although each patient heals a slight bit differently, most patients see well enough to return to their routine activities within a day or so after their cataract surgery.

Presbyopia Correcting Multifocal Lens Implants

In the past, the choice of which type of lens implant to have was really made by the cataract surgeon. That's because there really weren't any options for patients. All lens implants were of a type called a monofocal lens implant. A monofocal lens implant provides excellent vision after cataract surgery-but only at one set distance-usually for seeing things at a distance and thus does not correct Presbyopia or enable you to see close object or even read without reading glasses or bifocals. This means for seeing distant signs when driving, going to a movie or going to a ballgame, a monofocal lens implant will provide the vision you need to see clearly. But with a monofocal lens implant you will most likely need to wear eyeglasses for any type of near vision activity-for example reading, knitting, sewing, playing cards or keeping your golf score will require you to wear glasses.

Today, we are able to offer you the choice of a presbyopia correcting multifocal lens implant. A presbyopia correcting multifocal lens implant provides excellent vision after cataract surgery at a variety of distances. Depending on your specific vision requirement, there are several types of presbyopia correcting multifocal lens implants your cataract surgeon might suggest including the ReSTOR® Lens Implant, the ReZoom™ Lens Implant and the Crystalens™ Lens Implant. Each of these lens implants or intraocular lenses (IOL) works in a different way to help you achieve your vision correction goals of being able to see at a variety of distances after cataract surgery. Multifocal lens implants correct both your distance vision and your presbyopia after cataract surgery. For the vast majority of patients, having a multifocal lens implant means that you will be able to see at distance and up close without being dependent on eyeglasses. So, patients choosing to have a presbyopia correcting multifocal lens implant will likely find that they can drive, watch television, read or do crafts-without the need for glasses.

In general, patients who choose to have monofocal lens implants will be dependent on glasses either some or most of the time in about 70% of cases. Patients who choose to have multifocal lens implants will only be dependent on glasses either some or most of the time in about 15% of cases. So, patients choosing multifocal lens implants typically experience a greater overall freedom from glasses allowing them to participate in most everyday activities without dependence on, or the hassle of glasses.

As with any surgical procedure, there are risks as well as benefits. During your consultation at Connecticut Eye Center with Drs. Albergo and Austin, we will perform a cataract examination and then arrange your cataract surgery scheduling. In addition, we will the spend the time necessary to review what typical daily routine activities are most important to you-and whether being independent of glasses for those activities is something that you would like to achieve. As you prepare for your visit to our their office, you may want to begin thinking about what those activities are so that you can discuss them with the staff.

If you decide to have a presbyopia correcting multifocal lens implant, the experienced and friendly staff at Connecticut Eye Center will take the time necessary to fully explain any additional fees related to the multifocal lens implant that you might be responsible for. Medicare and most insurances cover the cost of the cataract surgery, the surgical facility fee for cataract surgery, the cataract surgeon's fee for cataract surgery-but not the cost of the multifocal lens and its implantation. In most cases, the additional cost of the multifocal lens is the responsibility of the patient. Our staff will be able to review the cost as well as the payment options, should you decide that the multifocal lens is the best choice.

Common Questions About Cataracts & Cataract Surgery

• How Do I Know If I Have A Cataract?
  
  If you think you have a cataract you may experience one or more of the following common symptoms:
  • Cloudy or Blurry Vision
  • Lights may seem to bright with uncomfortable glare being troubling. Headlights may seem too bright at night and you may actually see haloes around lights.
  • Colors may seem faded or yellowed.
  • Night vision will be disturbed and may be difficult.
  • You may experience shadowy images, double images or even multiple images.
  • You may seem to require frequent changes in your eyeglasses or contact lenses.
  • If the cataract is small you may not notice any changes in your vision. Cataracts grow slowly and thus you may only notice gradual changes in your vision.
  • Some people with a cataract find that their near vision seems to temporarily improve.

• How Are Cataracts Treated?

For those patients with early cataracts, it may seem that your vision is sometimes improved by using different eyeglasses, magnifying lenses, or stronger lighting. These types of remedies do not really treat the problem, as cataracts tend to change over time.  Cataract Surgery is the only effective treatment. The surgical treatment of cataract is involves removing the cloudy lens and replacing it with a substitute implantable lens, called an Intraocular Lens (IOL) or Lens Implant. A cataract needs to be removed when it interferes with your everyday activities, such as driving, reading, or watching TV. It is important that you and your eye surgeon make that decision together. In most cases, waiting until you are ready to have cataract surgery will not harm your eye. If you have cataracts in both eyes, the cataract surgeons at Connecticut Eye Center will remove them one at a time in order to achieve the best possible results. Sometimes, it is necessary to remove a cataract even if it doesn’t seem to cause problems with your vision. This is the case if it prevents a thorough examination of the retina or optic nerve, or treatment of another eye problem, such as age-related macular degeneration or diabetic retinopathy.