Cataract & IOL Treatment
What Are Cataracts?
Inside our eyes, we have a natural lens. The lens bends (refracts) light rays that come into the eye to help us see. The lens should be clear, like the top lens in the illustration.
Vision Problems with Cataracts
If you have a cataract, your lens has become cloudy, like the bottom lens in the illustration. It is like looking through a foggy or dusty car windshield. Things look blurry, hazy, or less colorful with a cataract.
What Are the Symptoms of Cataracts?
Here are some vision changes you may notice if you have a cataract:
What Causes Cataracts?
Aging is the most common cause. This is due to normal eye changes that happen to start around age 40. That is when normal proteins in the lens start to break down. This is what causes the lens to get cloudy. People over age 60 usually start to have some clouding of their lenses. However, vision problems may not happen until years later.
Other reasons you may get cataracts include:
Most age-related cataracts develop gradually. Other cataracts can develop more quickly, such as those in younger people or those in people with diabetes. Doctors cannot predict how quickly a person’s cataract will develop.
You may be able to slow down your development of cataracts. Protecting your eyes from sunlight is the best way to do this. Wear sunglasses that screen out the sun’s ultraviolet (UV) light rays. You may also wear regular eyeglasses that have a clear, anti-UV coating. Talk with your eye doctor to learn more.
Cataract Diagnosis and Treatment
Your ophthalmologist will examine and test your eyes to make a cataract diagnosis. This comprehensive eye exam will include dilation. This means eye drops will widen your pupils.
Slit-lamp exam: Your ophthalmologist will examine your cornea, iris, lens, and the other areas at the front of the eye. The special slit-lamp microscope makes it easier to spot abnormalities.
Retinal exam: When your eye is dilated, the pupils are wide open so the doctor can more clearly see the back of the eye. Using the slit lamp, an ophthalmoscope, or both, the doctor looks for signs of cataracts. Your ophthalmologist will also look for glaucoma and examine the retina and optic nerve.
Refraction and visual acuity test: This test assesses the sharpness and clarity of your vision. Each eye is tested individually for the ability to see letters of varying sizes.
Once I have a cataract diagnosis, what should I do?
Cataracts can be removed only with surgery. If your cataract symptoms are not bothering you very much, you don’t have to remove a cataract. You might just need a new eyeglass prescription to help you see better. You should consider surgery when cataracts keep you from doing things you want or need to do.
How does cataract surgery work?
Cataract surgery is an operation to remove your eye’s lens when it is cloudy.
The purpose of your lens is to bend (refract) light rays that come into the eye to help you see. Your own lens should be clear, but with a cataract, it is cloudy. Having a cataract can be like looking through a foggy or dusty car windshield. Things may look blurry, hazy, or less colorful.
The only way to remove a cataract is with surgery. Your ophthalmologist will recommend removing a cataract when it keeps you from doing things you want or needs to do.
During cataract surgery, your cloudy natural lens is removed and replaced with a clear artificial lens. That lens is called an intraocular lens (IOL). Your ophthalmologist will talk with you about IOLs and how they work.
What to Expect with Cataract Surgery
Before surgery: Your surgeon will measure your eye to determine the proper focusing power for your IOL. Also, you will be asked about any medicines you take. You might be asked not to take some of these medicines before surgery. You may be prescribed eye-drop medicines to start before surgery. These medicines help prevent infection and reduce swelling during and after surgery.
The day of surgery: Your ophthalmologist may ask you not to eat any solid food at least 6 hours before your surgery.
Cataract removal surgery may be done in an outpatient surgery center or in a hospital. Here is what will happen:
Cataract Surgery Recovery
Days or weeks after surgery:
What Are the Risks of Cataract Surgery?
Like any surgery, cataract surgery carries risks of problems or complications. Here are some of those risks:
Cataract surgery will not restore vision lost from other eye conditions, such as macular degeneration, glaucoma, or diabetic retinopathy. Your ophthalmologist will talk with you about the risks and benefits of cataract surgery.
Posterior Capsular Opacification
Your vision could become cloudy or blurry weeks, months, or years after cataract surgery. This is not unusual. Your doctor might call this a “posterior capsular opacification (or PCO).” It's also called "secondary cataract" or "scar tissue." It's not like a scar you get on your skin. But because it happens after the eye has healed from cataract surgery, some people think of it as a scar. It happens when a membrane called the posterior capsule becomes cloudy. It might help to think of the posterior capsule as a transparent pocket. It holds your IOL in place. It also once held your eye’s natural lens (what became the cataract) in place. If you notice cloudy vision again, you might need to have a laser procedure. The laser creates an opening in the cloudy capsule and is called a posterior capsulotomy (or a YAG laser capsulotomy). This procedure helps restore clear vision.
Cataract Surgery Costs
Cataract surgery costs are generally covered by Medicare if you are Medicare-eligible. Private insurance usually covers cataract surgery as well. Medicare will cover your costs if your vision tests at a certain level of acuity or clarity. Private insurance plans may have similar vision requirements. If your surgery is covered, you may still have some costs. Special types of IOLs will cost more. Choosing to have cataract surgery before your vision has deteriorated enough will cost more.
In certain cases, it might be possible to get coverage before you meet the age or vision requirements. Talk with your ophthalmologist if you are considering having early cataract surgery.
What do you do if you don't have Medicare or private insurance coverage? You may still be able to reduce and manage the cost of cataract surgery. Ask about payment plans through your doctor's office. See if your employer offers flexible spending accounts that can help. Your ophthalmologist can help you learn more about the costs of cataract surgery. Discuss your options for affording the procedure.
IOL Implants: Lens Replacement After Cataracts
An intraocular lens (or IOL) is a tiny, artificial lens for the eye. It replaces the eye's natural lens that is removed during cataract surgery.
The lens bends (refracts) light rays that enter the eye, helping you to see. Your lens should be clear. But if you have a cataract, your lens has become cloudy. Things look blurry, hazy, or less colorful with a cataract. Cataract surgery removes this cloudy lens and replaces it with a clear IOL to improve your vision.
IOLs come in different focusing powers, just like prescription eyeglasses or contact lenses. Your ophthalmologist will measure the length of your eye and the curve of your cornea. These measurements are used to set your IOL's focusing power.
What are IOLs made of?
Most IOLs are made of silicone, acrylic, or other plastic compositions. They are also coated with a special material to help protect your eyes from the sun's harmful ultraviolet (UV) rays.
The most common type of lens used with cataract surgery is called a monofocal IOL. It has one focusing distance. It is set to focus on up close, medium range, or distance vision. Most people have them set for clear-distance vision. Then they wear eyeglasses for reading or close work. Some IOLs have different focusing powers within the same lens. These are called multifocal and accommodative lenses. These IOLs reduce your dependence on glasses by giving you clear vision for more than one set distance.
These IOLs provide both distance and near focus at the same time. The lens has different zones set at different powers.
This lens move or change shape inside your eye, allowing focusing at different distances.
For people with astigmatism, there is an IOL called a toric lens. Astigmatism is a refractive error caused by an uneven curve in your cornea or lens. The toric lens is designed to correct that refractive error. As you plan for your cataract surgery, talk to your ophthalmologist about your vision needs and expectations. He or she will explain IOL options to you in more detail.
Traditional Cataract Surgery vs. Laser-Assisted Cataract Surgery
Which one is right for you?
Are you planning to have a cataract surgery? If so, you may have two surgical options:
Traditional cataract surgery is one of the most common surgeries in the world. It is recognized as being safe and effective. Laser cataract surgery is not covered by most insurance plans. It costs more than traditional cataract surgery as well. In specific situations, it may provide some advantages. So how do you decide which type of cataract surgery to have?
Here are some things you should understand about both kinds of cataract surgery. Talk with your ophthalmologist about which is best for you. Feel free to get another eye surgeon’s opinion as well.
How is traditional cataract surgery done? Phacoemulsification is the name for traditional cataract surgery. Your surgeon creates a small incision in your cornea by hand with a scalpel. They insert a small instrument through this opening. It goes behind your pupil, where the eye’s lens sits in a capsule. Your surgeon creates a round opening in the capsule. Then your surgeon inserts a pen-shaped probe through that opening. The probe applies sound waves (ultrasound) to break up the cloudy lens. Then the surgeon suctions out the broken-up pieces. They replace your lens with an artificial intraocular lens (IOL). The surgeon closes the incision with a special liquid and self-seal. Stitches are commonly not needed.
How is laser-assisted cataract surgery done? A camera/ultrasound device is placed over your eye to map its surface. It also gathers information about your lens. The device sends the results to a computer that programs the laser. This tells the laser the exact location, size, and depth of incisions. The surgeon uses the laser to make the corneal incision and the opening in the capsule. They may also use energy from the laser to soften the cataract. An ultrasound probe breaks the lens into pieces and suctions them out. The surgeon then puts the IOL in the eye. Again, the incision usually does not need stitches.
To whom can ophthalmologists offer laser-assisted cataract surgery?
Medicare guidelines determine who can get this laser surgery. Only certain patients qualify for it.
Your surgeon can offer laser-assisted cataract surgery if:
In this situation, the laser creates specific incisions in the cornea to reshape it. This corrects your astigmatism.
Your surgeon can also offer laser surgery if you choose a premium lens. For example, this may be a toric or multifocal IOL that corrects astigmatism. Laser cataract removal allows surgeons to see and map the lens capsule better. It also helps them to place the opening in the capsule more precisely. This allows for better centering of the IOL.
Can you have laser cataract surgery if you don't meet the conditions? If you don’t meet at least one condition, a surgeon cannot offer or charge for the laser surgery.
Which type of cataract surgery has a shorter recovery time? The recovery time for both types of surgery is the same. Some people can see clearly almost immediately. Others may find their vision clears within a week or two. It takes about 3 months to fully recover from cataract surgery.
What benefits does laser cataract surgery offer? Using a laser allows the surgeon to make precise incisions in less time. It can improve accuracy and consistency. In some cases, the laser can provide more correction than traditional surgery.
However, studies do not show that laser surgery results in fewer complications. Also, studies haven't found that laser surgery provides better outcomes. Your outcome depends in large part on the skill and experience of your surgeon.
What do you want from cataract surgery?
Replacing a cloudy lens and wearing glasses for some things is perfect for many people. For others, getting the best possible vision without glasses is the goal. You and your surgeon can decide the best option for you based on your needs.
How do cataracts affect your vision?
Inside our eyes, we have a natural lens. The lens should be clear. With cataracts, your lens becomes cloudy. Things look blurry, hazy, or less colorful with a cataract. Most age-related cataracts develop gradually. Doctors cannot predict how quickly a person's cataract will develop.