Cataract Surgery Options
Perhaps no other single surgery is more successful in America today than cataract surgery. In large part, this is due to the great strides made in the technology behind the cataract removal and lens implantation.
Safety
It is among the safest surgeries performed worldwide. In recent years more than three million procedures are performed annually in the U.S. with over a 98% success rate. In our hands we have been able to keep the complication rate to less than one half of one percent. Typically, the surgery is done in two separate procedures (one eye at time) on an outpatient basis under local anesthesia. The patient's normal activity is usually resumed in about 24 hours.
Conventional Cataract Surgery and the need for glasses
Vision Correction with Intraocular Lenses (IOLs)
Monovision IOLs
Accommodative or Multifocal IOLs
Recovery
Potential for follow-up treatment
Vision Correction Options
There are some decisions that Dr. Winthrop can help you make regarding the type of lens (IOL) we will use in place of your own clouded lens.
Conventional Cataract Surgery and the need for glasses
The IOL used is a monofocal lens; it will have only one focal point. The focal point that is most often chosen by patients is distance/infinity vision. Thus, the majority of patients will need glasses to assist with near tasks.
Occasionally, patients who have been nearsighted their entire life will be given a monofocal IOL to retain nearsightedness (where they see fine up close with the naked eye). In this case, they will wear glasses that assist them with distance/infinity vision.
There are some patients, regardless of whether they are nearsighted or farsighted, who will wear bifocals simply for convenience.
Finally, patients who have moderate or excessive astigmatism may be required to wear glasses for all fields of vision (near, intermediate, and far) although many can be helped to great near or far (but not both) vision through the use of what is called a Toric IOL (a Premium lens for which there is an upcharge beyond the normal insurance coverage). I use the Acrysof Toric Intraocular lens from Alcon Laboratories, the world’s leader in ophthalmic surgical products. Many professions as well as leisure activities such as golf, biking, bird watching, and flying require or are at least improved by excellent uncorrected distance vision such as the Toric IOL offers. back to top
Vision Correction with Intraocular Lenses (IOLs)
Several proven technologies, some newer and some longer term, can allow today's cataract patients to decrease their dependence on glasses and in some cases even eliminate them all together. These include Monovision with Intraocular lenses (IOLs), Multifocals such as ReStor and Technis, as well as the Crystalens accommodating IOL. These options are discussed for your consideration below. back to top
Vision Correction with Monovision
Monovision occurs when a monofocal (single focus) IOL corrects one eye to achieve good vision at near and the other eye for far vision. This is done to decrease the need for glasses. This condition, induced with IOL surgery, is really only recommended for those patients who have had monovision via contact lenses in the years prior to cataract surgery. For those with much astigmatism, a Toric lens can be used (see above) to provide monovision. back to top
Vision Correction with Accommodative or Multifocal IOL
Accommodative and Multifocal IOLs can be a great way to minimize or, in some cases, eliminate dependence on glasses.
An Accommodative IOL – such as the Crystalens from Bausch & Lomb – will perform in such a way as to provide far, near, and intermediate focus. This is accomplished by a lens that accommodates or flexes to provide a "zoom" function. The IOL rests in the natural lens capsule, which is connected by marionette-like strings called zonules to the same muscles that provided our natural lens with the ability to accommodate or zoom itself before we experienced presbyopia. By exercising these muscles, we can cause a bowing of the Crystalens and induce accommodation to provide varying degrees of near vision. Relaxing these same muscles allows the lens to focus at distance. back to top
Multifocal lenses – like the ReStor from Alcon Laboratories, the ReZoom from American Medical Optics, or the Technis multifocal – provide two focal points, far and near, with what is called "simultaneous vision." That is, portions of the IOL focus at distance, while other portions or zones of the same lens focus at near. The brain naturally takes the portion that is required for the given task and dismisses the other portion or zone. These lenses may also be referred to as "zonal" lenses.
There are several factors involved when considering whether someone is a good candidate for these lenses, including the presence and degree of astigmatism, diseases of the retina (diabetic maculopathy and macular degeneration among them), diseases of the optic nerve (including severe glaucoma), and other ocular diseases.
Accommodative and Multifocal lenses, just like Toric lenses, are considered Premium IOLs and, as such, they are usually not reimbursed by insurance carriers; thus the patient must incur some additional expenses in the process. back to top
Recovery
Over 95% of patients can expect to return to normal activities within 24 hours of surgery. I will counsel you on this subject at your first post-operative appointment on the day following your surgery. While you will be asked to use eye drops after surgery, they need no refrigeration so they travel well. back to top
Potential for follow-up treatment
In the majority of cases, at some point a small membrane will need to be removed in the office using a simple 20-second laser procedure known as a YAG capsulotomy. This small membrane will form in the eye months or even years later as cells deposit themselves between the IOL and the back wall of the lens capsule, a condition known as posterior capsular opacity (PCO). back to top