Lens Options in Cataract Surgery
One of the first questions many people ask about cataract surgery is "Will I need to wear glasses after surgery?" Today, you may choose advanced technology lens implants to help decrease your dependence on glasses or contact lenses. To understand if this is the right choice for you, it helps to give you some background information. With cataract surgery, Dr. Dale can address two concerns: cloudy vision due to the cataract, and focus problems due to the shape and power of your eye. Medicare and private insurance plans cover the cost of manual cataract surgery with a basic, single-focus intraocular lens implant. Essentially, your cloudy lens is replaced with a clear lens. However, at the same time as your cataract surgery, if you want to decrease your need for glasses or contacts, you can also elect an additional procedure or an advanced-technology lens implant to help with focus issues. It can be confusing to keep the different options straight, so let's look at a couple of example patients and how the choices they make affect their vision.
Diane loves hiking outside and gardening. She has cataracts in both eyes. She wears glasses all of the time because she has a moderate amount of astigmatism in both eyes. Her glasses help her to have clearer focus both for far away from activities and for reading. She would love to be able to hike and work outside without prescription glasses on but doesn't mind glasses for reading.
A great choice for Diane would be an astigmatism-correcting intra-ocular lens. The astigmatism-correcting, or "toric" lens, can bring the distance into focus and significantly decrease Diane's dependence on glasses when she is outside. She will still need glasses for reading, computer work, and playing cards, but enjoys the freedom of being able to hike without glasses. For patients with moderate amounts of astigmatism, a toric lens can improve your focus, but still doesn't allow you to have both distance and near focus.
Paul works as a computer programmer and enjoys reading. He has cataracts in both eyes. He would prefer to decrease his need for glasses as much as possible. His eyes are healthy, and he does not have a significant amount of astigmatism. Paul knows he will still need to wear glasses sometimes, but he would be happy if he did not have to rely on glasses to focus 100% of the time. A great choice for Paul would be a multifocal lens. For the right patients — those with lower amounts of astigmatism and healthy eyes — a multifocal lens can allow you to focus for both near and distance activities without the help of glasses.
Jill has worn contact lenses for the last fifteen years, with one eye corrected for far away vision, and one eye corrected for near vision. This contact lens strategy is called “monovision”. With her monovision contact lenses, she has enjoyed being able to do much of her reading and computer work without glasses, and still being able to see clearly in the distance. Now that she has cataracts, she would like to know if she can still use her monovision contact lenses after surgery. Jill has a couple of options. She could consider having multifocal lenses implanted in each eye, to give her both distance and near focus in each eye. She could have basic, single focus lens implants in each eye, but have Dr. Dale select the lens implant powers so that just as before one eye is focused for distance, and one eye is focused for close-up. She’d then have the monovision effect, but without her contact lenses.
Monovision — one eye for distance and one eye for near — is a compromise that some patients love, and some patients dislike and have difficulty adapting to. The best candidates for monovision are patients who have already experienced monovision in contact lenses.
Larry is a commercial truck driver and often drives at night. It is very important for him to have the clearest, sharpest vision he is able to. He has a mild amount of astigmatism in both eyes, so he has his clearest vision when he wears his glasses. He’d like to see more clearly without his glasses on. Larry is a good candidate for a procedure called a “corneal relaxing incision” (aka limbal relaxing incision or corneal arcuate incision). This involves making an additional incision in the cornea at the time of the cataract surgery in order to re-shape the cornea.
June enjoys a wide variety of activities. She’s worn glasses for much of her life and has fun with picking frames that fit her personal style. She doesn’t mind continuing to wear glasses for all of her activities after cataract surgery, and so for June, a great choice is the basic single focus lens implants.
Her uncorrected (without glasses) vision may be improved with surgery, but she’ll continue to have her sharpest focus with glasses for both distance and near activities.
Whatever your choice, our team will do our best for you. Our first goal is for every patient to have a safe, comfortable and positive experience.