What is a Cataract?

Cataracts are an opacity or clouding of the normal crystalline lens of the eye, caused by the natural aging process, metabolic changes, injury, various forms of radiation, toxic chemicals and certain drugs. As the leading cause of vision loss among adults age 60 or older, cataracts impair vision making everyday activities increasingly difficult.

How are Cataracts treated?

During the surgery, the cloudy lens is removed from the eye. In all cases, the focusing power of the natural lens is restored by replacing it with a permanent intraocular lens implant.

What is Presbyopia and how can it be treated?

During middle age, usually beginning in the 40s, people experience blurred vision at near points such as when reading, sewing or working at the computer. There's no getting around it.  This happens to everyone at some point in life, even those who have never had a vision problem before.

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Currently an estimated 150 million people in the United States either have presbyopia or will develop it by 2025. This is generating a huge demand for eyewear, contact lenses, and surgery that can help presbyopes deal with their failing near vision. Presbyopia can be surgically treated with CK, Multifocal IOLs,  Accommodative (Crystalens) IOL, and during LASIK if one eye is set for near vision alone (this is called monovision).

If you need cataract surgery, you may have the option of paying extra for one of the new presbyopia-correcting IOLs (intraocular lenses) that potentially can restore a full range of vision without eyeglasses. Multifocal and accommodating IOLs may offer significant advantages over conventional single vision IOLs, which typically provide one of the following only: clarity at near, intermediate, or distance range - but not all three at once. For example, a single-vision or monofocal IOL might enable you to read fine newspaper print is the eye was set for near vision, but you would still need eyeglasses to drive.

Can Presbyopia be treated at the time of cataract surgery?  Yes, with either a multifocal or an accommodative IOL or by setting one eye for distance vision and the other eye for near vision (called monovision) with a single focus IOL. 

Why would I want a multifocal or accommodating IOL for cataract surgery?

The U.S. Food and Drug Administration approved certain presbyopia-correcting IOLs within the past few years. This means that, for the first time, people undergoing a cataract procedure have the chance to achieve far less dependence on eyeglasses. Remember, however, that for certain near vision activities you may still benefit from wearing eyeglasses, even if you do choose a multifocal or accommodating IOL.

But aren't presbyopia-correcting IOLs a lot more expensive? How much do I have to pay?

Presbyopia-correcting IOLs are more expensive because they cost more for companies to develop and produce, and because extra surgeon skills is required for the procedure. Also, extra care must be taken with these lenses to make sure you receive the exact right prescription for your eyes. Costs vary, depending on the lens used and if astigmatism correction is also required, but you can expect to pay between $1500 - $3400 extra per eye as an out-of pocket expense. Otherwise, basic costs of cataract surgery are covered by Medicare and most health insurance policies.

Why won't Medicare or health insurance cover the full cost of presbyopia-correcting IOLs?

A multifocal or accommodating IOL is not considered medically necessary. In other words, Medicare or your insurance will pay only the cost of a basic intraocular lens and accompanying cataract surgery. Use of a more expensive, presbyopia-correcting lens is considered an elective refractive procedure, a type of luxury, just as LASIK and PRK are refractive procedures that are not covered by health insurance.

Can my local cataract surgeon perform presbyopia-correcting surgery?

Perhaps, but you need to make sure that your eye surgeon has experience with the specific presbyopia-correcting IOL chosen for the procedure. Studies have shown that surgeon experience is a key factor in successful outcome, particularly in terms of whether you will need to wear eyeglasses following cataract surgery.

What problems are associated with presbyopia-correcting IOLs?

Reports indicate that even experienced cataract surgeons needed to perform enhancements for 10% of patients requesting presbyopia-correcting IOLs. This means you and your surgeon must be prepared to undergo a few extra steps (if needed), if you do want independence from eyeglasses. Some multifocal lenses may cause vision disturbances such as glare and halos around lights at night.

How can I improve my chance of a successful outcome if I choose to undergo cataract surgery with a presbyopia-correcting IOL?

Most cataract surgeons are highly skilled when it comes to familiar techniques associated with monofocal or single-vision IOLs. But if you want a good outcome with a multifocal or accommodating IOL, you should make sure your eye surgeon is committed to this technology and has undergone appropriate training. Also, you should thoroughly discuss any concerns with your eye surgeon. Astigmatism is a common reason for distortion of vision and can be corrected separately or at the time of cataract surgery.

What is Astigmatism?

Astigmatism is a common eye condition characterized by a non-spherical curvature of the cornea. This type of disorder is also known as a refractive error, and differs from myopia (nearsightedness), hyperopia (farsightedness), and presbyopia (the inability to focus on near objects and read up close after age forty). A person's eye is naturally spherical in shape. Under normal circumstances, when light enters the eye, it refracts evenly, creating a clear image of the object. However, the eye of a person with astigmatism is shaped more like a football or the back of a spoon. For this person, when light enters the eye it is refracted more in one direction than the other, allowing only part of the object to be in focus at one time. Objects at any distance can appear blurry and wavy. Astigmatism occurs in nearly everybody to some degree. But for significantly abnormal curvature, treatment is required.

What Are the Symptoms of Astigmatism?

People with uncorrected astigmatism often experience headaches, fatigue, eyestrain and blurred vision at all distances.

How Is Astigmatism Treated?

Almost all degrees of astigmatism can be corrected with properly prescribed eyeglasses or contact lenses. However, for patients who want independence from glasses, either at distance or for all ranges of vision - distance, intermediate and up close (near) - astigmatism can be surgically treated at the time of cataract surgery with femtosecond laser cataract surgery or separately with LASIK and other forms of laser vision correction.

How Does Astigmatism Affect My Cataract Surgery?

At the time of your cataract evaluation, the amount of astigmatism present in each of your eyes can be assessed and then determined whether astigmatism correction is recommended at the time of cataract surgery with Astigmatic Keratotomy (AK) or a Toric IOL based on the amount present and the extent of your desire to be free of glasses.

Can a cataract be removed with a laser?

Yes, at least in a partial fashion, with astigmatism correction and many of the manual components of the surgery now being performed with the Femtosecond Laser and its associated out-of-pocket expense. As best techniques continue to evolve, more components of the cataract surgery will be done in an automated fashion directed by your surgeon with laser technology. In many ways this increased sophistication of surgery requires even more training by experienced cataract surgeons using these lasers.