Recent Advances In Cataract Surgery

By Michael J. Dodd, MD

A cataract is a cloudy lens in the eye, which causes painless progressive loss of vision. If people live long enough, virtually everyone will develop a cataract. The change in vision is gradual. People can get a cataract with minimal change in vision and not realize there is an effect of the cataract on their vision.

Often the first sign of a cataract is a change in glasses; typically the patient will get slowly more nearsighted. Most patients over the age of 60 have some degree of cataracts. The presence of a cataract does not mean that immediate surgery is necessary; it is not like a cancer, which must be removed quickly. The usual threshold to justify consideration of cataract surgery is 20/40 or worse. Many patients with this vision level are comfortable and functioning well and do not want surgery. Other patients who may require fine, precise vision (accountants or surgeons) may desire cataract extraction at the 20/40 level. There is no need to rush into surgery. If a patient is encouraged to have surgery and they are comfortable and having no problems, they may consider a second opinion.

Today, cataract surgery is dramatically better than 15 years ago when your parents had the operation. Essentially all cataract surgery is done as an “out patient;” no overnight hospital stay.

The majority of cataract surgery is now done in Ambulatory Surgery Centers. The actual procedure typically takes 10 to 15 minutes. Patients are sedated and the eye is numbed by topical anesthetic drops. Post operation, there is minimal pain and eye drops are required for several weeks.

With today's modern implants, patients will typically see 20/20 for their distant vision. The standard implants focus at distance but not at near. So drug store magnifiers are needed to read. The newer lens implants have the ability to give excellent distance vision and quite good intermediate (computer distance) and near vision.

These newer “high tech” or “premium” lens implants are not fully covered by insurance companies or Medicare. There is an out of pocket cost by the patient.

Another premium lens implant is known as a “toric implant.” This is designed to correct any astigmatism in the patient's eye. Without a toric implant patients with astigmatism will be required to wear glasses for both distance and near after cataract surgery. This may not concern some patients, but for those who golf or boat, good vision without glasses is a huge benefit.

The most recent innovation in cataract is the use of a femtosecond laser to perform part of the operation. The laser can make the surgical incision, open the front capsule of the cataract and soften a hard cataract. The goal is to make the operation more precise.

This, however, comes with an additional cost not covered by Medicare or insurance carriers. Adding up these extras can create several thousand dollars in out-of-pocket fees. Discuss with your surgeon which option may be best for your individual case.