Cataract Surgery & Multifocal Lens Implants
Reviewed by Marc Michelson, M.D.
If you have been told that you have a cataract, there is no need to be overly concerned as you are not alone. Each year in the United States, more than 2.5 million people have cataract surgery. Thanks to advanced surgical procedures and technology, cataract surgery is not only one of the most frequently performed surgical procedures in the United States, but it is also one of the safest and most successful surgical procedures that you can have. Cataract surgery is performed on an outpatient basis and usually only requires a few hours of your time from beginning to end.
To begin the procedure, your eye will be treated with an anesthetic so that you will feel little, if any discomfort. A tiny incision will be made and a microscopic instrument will be passed through it. Using ultrasound from the tip of the microscopic instrument, we will be able to gently break the cataract into pieces small enough to be washed away, drawn through the instrument and removed from the eye.
Once your cataract has been removed, it can now be replaced by a new permanent Intraocular Lens Implant. The new lens is readily inserted and placed in position through the same tiny incision at the outer edge of the cornea through which the cataract was removed.
After the procedure, you will rest for a short time at the surgery center before going home. Usually we will arrange a visit to examine your eye within 24 hours after of your procedure. If necessary, your cataract surgeon may prescribe some eye drops for you to use and ask you to wear a protective shield, mainly at night to help you remember not to rub your eye. Although each patient heals a slight bit differently, most patients see well enough to return to their routine activities within a day or so after surgery.
Presbyopia, which literally means "old eyes", is a normal and expected consequence of the aging process. The crystalline lens within your eyes is soft and flexible when you are younger. As you approach your 40's presbyopia occurs as the composition of the crystalline lens changes, making it harder and less flexible. When the crystalline lens loses its ability to flex, it is no longer able to change its shape and effectively bend light rays as sharply, and the ability to focus on near objects is diminished. People experiencing the start of presbyopia often notice that their "arms are too short" to read and they have to hold close things further away to see them clearly. Presbyopia typically becomes noticeable between age forty and fifty and progressively worsen through age sixty-five. Presbyopia effects everyone including those who have cataracts. When presbyopia begins, people who already wear glasses may need bifocals or trifocals, and those who have never worn glasses may require reading glasses.
Helping You Choose the Best Lens Implant
In the past, the choice of which type of lens implant to have was really made by the cataract surgeon. That's because there really weren't any options for patients. All lens implants were of a type called a monofocal lens implant. A monofocal lens implant provides excellent vision after cataract surgery-but only at one set distance-usually for seeing things at a distance. This means for seeing distant signs when driving, going to a movie or going to a ballgame, a monofocal lens implant will provide the vision you need to see clearly. But with a monofocal lens implant you will most likely need to wear glasses for any type of near vision activity-for example reading, knitting, sewing, playing cards or keeping your golf score will require you to wear glasses.
Today, your cataract surgeon is able to offer you the choice of a multifocal lens implant. A multifocal lens implant provides excellent vision after cataract surgery at a variety of distances. ReSTOR, ReZoom and Crystalens are types of multifocal lens implants your cataract surgeon might suggest. Multifocal lens implants correct both your distance vision and your presbyopia after cataract surgery. For the vast majority of patients, having a multifocal lens implant means that you will be able to see at distance and up close without being dependent on glasses. So, patients choosing to have a multifocal lens implant will likely find that they can drive, watch television, read or do crafts-without the need for glasses.
Will I Need Glasses After Cataract Surgery?
In general, patients who choose to have monofocal lens implants will be dependent on glasses either some or most of the time in about 70% of cases. Patients who choose to have multifocal lens implants will only be dependent on glasses either some or most of the time in about 15% of cases. So, patients choosing multifocal lens implants typically experience a greater overall freedom from glasses allowing them to participate in most everyday activities without dependence on, or the hassle of glasses.
How Should I Choose the Type of Lens Implant?
As with any surgical procedure, there are risks as well as benefits.
During your consultation, examination and cataract surgery scheduling your cataract surgeon and their staff will the spend the time necessary to review what typical daily routine activities are most important to you-and whether being independent of glasses for those activities is something that you would like to achieve. As you prepare for your visit to our office, you may want to begin thinking about what those activities are so that you can discuss them with the staff.
In addition, if you decide to have a multifocal lens implant, the staff will take the time necessary to fully explain any additional fees related to the multifocal lens implant that you might be responsible for. Medicare and most insurances cover the cost of the cataract surgery, the surgical facility fee for cataract surgery, the surgeon's fee for cataract surgery-but not the cost of the multifocal lens and its implantation. In most cases, the additional cost of the multifocal lens is the responsibility of the patient. The cataract surgeon's staff will be able to review the cost as well as the payment options, should you decide that the multifocal lens is the best choice.