Cataract Surgery Information
A cataract is a clouding of the human eye's natural lens. Affecting more than 22 million Americans, it is the most common cause of vision loss in people over age 40.
A cataract starts out small at first and has little effect on your vision. Symptoms usually progress very gradually. You may notice that your vision is slightly blurred or “cloudy.” A cataract may make light from the sun or a lamp seem too bright or glaring. Or you may notice glare from oncoming headlights when you drive at night. Colors may not appear as vivid as they once did. Eventually you may find it more difficult to see things at far distances or read in dim lighting. Your glasses may not work as well as they used to.
What Causes Cataracts?
The human lens works much like a camera lens, focusing light onto the retina for clear vision. The lens is mostly made of water and protein. But as we age, some of the protein may clump together and start to cloud. This is a cataract, and over time, it may grow larger and cloud more of the lens, making it harder to see.
Researchers worldwide have identified factors that cause cataract development. Advancing age is by far the most common cause. Other less common risk factors include: UV radiation, diabetes, hypertension, obesity, smoking, prolonged use of corticosteroid medications, statin medicines used to reduce cholesterol, previous eye injury or inflammation, previous eye surgery, hormone replacement therapy, significant alcohol consumption, high myopia, and family history.
When symptoms begin to appear, you may be able to improve your vision temporarily by using stronger glasses, magnification, appropriate lighting or other visual aids. Cataract surgery is your only treatment option when your cataracts have progressed enough to impair your vision and affect your activities of daily living. Many people consider poor vision an inevitable part of aging, but cataract surgery is a simple, relatively painless procedure to regain your vision at any age.
Modern day cataract surgery is highly successful in restoring vision. In fact, it is the most frequently performed surgery in the United States, with more than 3 million Americans undergoing cataract surgery each year. Nine out of 10 people who have cataract surgery regain very good vision, somewhere between 20/20 and 20/40.
The surgery is performed as a same-day outpatient procedure. A family member or friend will need to drive you home afterwards. You will be given some sedation to relax you and topical anesthesia to numb the eye. Your surgeon will remove your clouded lens and replace it with a clear, intraocular lens (IOL) implant. There are typically no needles or stitches used. The surgery usually takes 7 to 15 minutes. During surgery you will see bright lights and colors with minimal to no discomfort. Afterwards, a patch is placed on the eye. Complications from surgery are very rare. Most patients recover very quickly and can drive and do normal activity the next day after surgery. You will be on eye drops for about a month and will require 2 to 3 follow-up office visits per eye. Vision will be restored as soon as the next day, but may take up to a week for improvement.
CATARACT SURGERY – KNOW YOUR OPTIONS
Cataract surgery is the most common type of surgery performed in the United States. It is also one of the most successful and safest. The goal of cataract surgery has been the same for decades. It involves removing the “cloudy” human lens and replacing it with an artificial intraocular lens implant or IOL. Recent advances in cataract surgery include improvements in surgical techniques and micro-surgical instrumentation. One of them is the use of a laser to perform Laser Cataract Surgery. Another major development is the introduction of advanced technologies used in the intraocular lens implant (IOL). These are commonly referred to as Premium IOLs or Advanced Technology IOLs. These lenses along with laser have added to the success of cataract surgery by allowing patients to become much less dependent on glasses (or contact lenses). Not everyone is a good candidate for Laser Cataract Surgery or Advanced Technology IOLs. Dr. Chiang will determine this during your pre-operative visit.
What are Advanced Technology IOL implants?
Many patients have myopia(near-sightedness), hyperopia(far-sightedness), or astigmatism all their life. Also, most patients develop presbyopia(the need for reading glasses or bifocals) in their 40’s. All of these can finally be corrected using Advanced Technology IOL implants.
Of course, myopia, hyperopia, astigmatism, and presbyopia can be corrected with glasses, bifocals, progressive lenses, or contact lenses. Some patients actually prefer to wear glasses full-time. However, patients who want to rid themselves of the burden of glasses can opt for an Advanced Technology IOL implant when having cataract surgery. The IOL is permanent so this is a once in a lifetime decision.
What types of Advanced Technology IOL implants are available?
A toric IOL implant is designed to correct astigmatism. This IOL gives patients with astigmatism the best possible distance vision without the need for glasses. Over-the-counter glasses can be used for reading. This lens can give patients fairly good near vision if done with monovision. An LRI (limbal relaxing incision) may be performed to enhance the results. More information about monovision and LRIs are on the next page. The AcrySof® IQ and TECNIS® Toric IOL are currently the most advanced toric implants available.
A multifocal IOL implant is designed to correct presbyopia. This IOL can give patients excellent distance and near (reading) vision without the need for glasses. An LRI is sometimes used to correct any astigmatism. The AcrySof® IQ ReSTOR IOL and TECNIS® Multifocal IOL are currently the most advanced multifocal implants available.
The Crystalens® is another type of IOL that is designed to give patients excellent distance and, usually, acceptable near vision. The near vision results are similar to monovision and are not as good as with the AcrySof® IQ ReSTOR IOL or TECNIS® Multifocal IOL. The results are also not as predictable.
Dr. Chiang is experienced in all types of Advanced Technology IOL implants. If you are a candidate, he can discuss all the options with you.
What is Laser Cataract Surgery?
This can also be called Laser Refractive Cataract Surgery or Femto-Laser Assisted Cataract Surgery where a femtosecond laser is used for the critical steps of the surgery, including the corneal incisions, astigmatic keratotomy, capsulotomy, lens fragmentation, and imaging/alignment of the IOL. Many patients opt to have laser cataract surgery to increase safety, treat minor astigmatism, and enhance the precision of the IOL. It also makes the procedure bladeless and has been proven to speed recovery time.
What are the costs?
Manual cataract surgery without using laser along with the basic monofocal IOL implant is covered under your medical insurance. Other costs may include insurance deductibles and prescription medications. Surgery with an Advanced Technology IOL is considered a refractive procedure with the goal of eliminating the need for glasses. This is not considered a medical problem; therefore, these IOLs are not covered by your medical insurance. Costs include the implant along with the additional testing, calculations, and equipment needed to implant the lens. Laser Cataract Surgery with astigmatic keratotomy and/or imaging/alignment of the IOL is also considered a refractive procedure and is not covered by your medical insurance. Payment for the use of the laser for this purpose and payment for Advanced Technology IOLs is due prior to surgery. Some patients require a separate enhancement procedure after surgery. This is included at no additional cost.
For most patients, these extra costs can be partially recouped by not having to buy prescription glasses or contacts after surgery. Patients who often spend over $400 every 2 years on prescription glasses will save some money in the long run.
What is monovision?
Monovision is a common and often effective technique used to reduce or eliminate the need for reading glasses. It can be achieved using contact lenses, laser refractive surgery, or using a standard monofocal or toric IOL implant with cataract surgery. The goal of monovision is to correct one eye for distance vision and the other eye for near vision. Not everyone is a good candidate for monovision and the results can vary. There is no additional fee for monovision.
What is an LRI(Limbal Relaxing Incision)?
Before toric IOLs were available, astigmatism was most commonly treated using LRIs. An LRI involves making one or two incisions on the cornea using a diamond blade. As these incisions heal, the cornea reshapes and becomes more spherical, thus correcting the astigmatism. LRIs work well for mild amounts of astigmatism. The surgical fee for an LRI is $500 per eye. There is no extra fee if an LRI is performed along with a multifocal IOL or when used to enhance the results of a toric IOL. An LRI is also not needed when performing Laser Cataract Surgery.
There are numerous websites and advertisements for Premium or Advanced Technology IOLs and Laser Cataract Surgery. Many are written by the IOL or laser manufacturers. Most of the information on them is actually quite accurate and valuable. There is no doubt that the creation of Advanced Technology IOLs and Laser Cataract Surgery are great breakthroughs in ophthalmology. The results are nothing short of amazing. However, every individual patient is different and not all patients are good candidates. After your cataract evaluation, please ask questions and Dr. Chiang will give you an honest opinion as to what is best for you.