Cataract Surgery & Lens Implants at 80

Question: Is it practical for me at 80 years to pursue Cataract Surgery and Lens Implants for astigmatism? I do take medication for enlarged prostate.

Answer: If you have Cataracts and the decrease in vision they cause negatively impacts your being able to do the things you want to do safely and comfortably, there is no reason that you cannot have Cataract Surgery and Lens Implants as long as your general health is good and the overall health of your eyes-especially the Retina and Macula, is in reasonable shape. If you have a significant degree of astigmatism then having a toric lens implant-if recommended by your Cataract Surgeon would be a good choice for your vision correction at distance after the Cataract removal. Be certain to advise your Cataract Surgeon of the exact medication that you take for an enlarged prostate as well as any other medications you might be taking as these could require that he or she modify the actual cataract procedure in order to get you the best results.

Important Note: The information presented on the About Cataract Surgery Blog or provided in response to a request for information in the Ask Cataract Surgeons section on www.aboutcataractsurgery.com is not intended to diagnose or treat eye problems, eye conditions or eye diseases including appropriateness of treatment, risks, complications or side effects as related to Cataracts, Cataract Surgery of Lens Implants. In particular a response to an inquiry made on the Ask Cataract Surgeons section of www.aboutcataractsurgery.com is not meant to take the place of the professional medical care provided by your eye doctor, ophthalmologist and Cataract Surgeon surgeon. Contacting us via e-mail or any other means is not a substitute for medical care.

Double Vision after Cataract Surgery

Question: I recently had cataract surgery on both of my eyes and had lens implants as well. The first surgery went very well but the second surgery left me with double vision. I have found out that I have a prism, but never had double vision. My doctor said there was nothing he could do and told me I would have to always wear glasses.
Answer: It is not obvious from your question whether you were wearing a prism in your glasses before your Cataracts were removed. If you have a long term history of wearing a prism, then you may very well need to continue to wear the prism in eyeglasses. If, you were not wearing prism, and if the onset of the double vision has been recent, then you need to find out why. It is possible, but not likely that Cataract Surgery for the second eye caused you suddenly develop diplopia or double vision, but rather the diplopia is due to some underlying cause that needs examination and diagnosis. Again, if prior to Cataract Surgery you had a prism prescription to compensate for a muscle imbalance then having Cataracts removed would still require that you wore the prism. You best course of action is to consider a second opinion with a top Cataract Surgeon to evaluate whether there is anything that might be slightly out of line with the Cataract Surgery, the Lens Implant or perhaps the Retina that could be contributing-or whether there is some other underlying issue.

Important Note: The information presented on the About Cataract Surgery Blog or provided in response to a request for information in the Ask Cataract Surgeons section on www.aboutcataractsurgery.com is not intended to diagnose or treat eye problems, eye conditions or eye diseases including appropriateness of treatment, risks, complications or side effects as related to Cataracts, Cataract Surgery of Lens Implants. In particular a response to an inquiry made on the Ask Cataract Surgeons section of www.aboutcataractsurgery.com is not meant to take the place of the professional medical care provided by your eye doctor, ophthalmologist and Cataract Surgeon surgeon. Contacting us via e-mail or any other means is not a substitute for medical care.

Streak of Light after Cataract Surgery

Question: I've had cataract surgery and two IOLs implanted The left in July 2011 and the right in October of 2011. I have experienced a "streak" of light in the vision of my left eye ever since the implantation. It runs at a 45 degree angle through any concentrated light source and is particularly bothersome at night, making night-driving difficult and dangerous. Can this be corrected?

Answer: Without actually examining the eye and vision after your Cataract Surgery and Lens Implants it is not possible to be certain, but there are several possibilities to be considered, as the cause-each with somewhat different methods of resolution. One possibility is that you have some degree of uncorrected astigmatism. This should easily tested by your Cataract Surgeon and a resolution demonstrated with some trial lenses in the office if it is actually the problem. Another, somewhat remote possibility is an optical irregularity in the Lens Implant itself. This would be quite unusual. A more likely cause is a very fine crease in the posterior capsule of the crystalline lens that is typically left in place to support the Lens Implant after Cataract Surgery. A very fine crease can produce exactly what you are describing. If this is the case your Cataract Surgeon can perform a YAG Laser Capsulotomy which is a quick laser procedure to create an opening in the capsule along the visual axis-typically the results are immediate and achieved without pain, discomfort or recovery time.

Important Note: The information presented on the About Cataract Surgery Blog or provided in response to a request for information in the Ask Cataract Surgeons section on www.aboutcataractsurgery.com is not intended to diagnose or treat eye problems, eye conditions or eye diseases including appropriateness of treatment, risks, complications or side effects as related to Cataracts, Cataract Surgery of Lens Implants. In particular a response to an inquiry made on the Ask Cataract Surgeons section of www.aboutcataractsurgery.com is not meant to take the place of the professional medical care provided by your eye doctor, ophthalmologist and Cataract Surgeon surgeon. Contacting us via e-mail or any other means is not a substitute for medical care.

No Bifocals after Cataract Surgery

Question: I am a candidate for cataract removal and I have myopic astigmatism. After cataract surgery I still require bifocal glasses?


Answer: If you wish to be less dependent or even independent of bifocal glasses after Cataract Surgery there are some options that might be suggested by your Cataract Surgeon if they are appropriate. There are three possible options for correcting your near and far vision after Cataract removal. First, you might be a candidate for Monovision Astigmatism Correcting Lens Implants (IOL). Second you might be a candidate for Presbyopia Correcting Multifocal Lens Implants (IOL) such as the AcrySof ®ReSTOR® Multifocal Lens Implant (IOL) or the Tecnis® Multifocal Lens Implant (IOL). Third, you might be a candidate for Accommodating lens Implant (IOL) such as the Crystalens® Lens Implant (IOL). Whether one or more of these options is appropriate will really depend on your lifestyle and expectations as well as the information gathered by your Cataract Surgeon during your examination and consultation.

Important Note: The information presented on the About Cataract Surgery Blog or provided in response to a request for information in the Ask Cataract Surgeons section on aboutcataractsurgery.com is not intended to diagnose or treat eye problems, eye conditions or eye diseases including appropriateness of treatment, risks, complications or side effects as related to Cataracts, Cataract Surgery of Lens Implants. In particular a response to an inquiry made on the Ask Cataract Surgeons section of aboutcataractsurgery.com is not meant to take the place of the professional medical care provided by your eye doctor, ophthalmologist and Cataract Surgeon surgeon. Contacting us via e-mail or any other means is not a substitute for medical care.

Cataract Surgery and Lens Implant Surprise

Question: I had cataract surgery and a lens implant on my right eye 2 months ago. Before surgery, I was farsighted in this eye. Now I am profoundly nearsighted and need glasses for any distance vision at all. The distance vision is markedly worse than before the surgery. What could have caused this? Was the "wrong" IOL implanted? Was the IOL the right one but displaced from the original site in the capsule? Any other possibilities?


Answer: The measurement and computation of the Lens Implant (IOL) power for Cataract Surgery is actually quite complex and depends on the interaction of many factors. Most likely what has happened here is a "refractive surprise" in that the measurements and calculations performed during your Cataract examination, for whatever reason, did not fall within the statistical norms of the calculation. This resulted in "surprise" with regard to the refractive outcome. In you case it does not sound as if it is even close to being satisfactory and thus you need to discuss the options with your Cataract Surgeon. These may include a Lens Implant Exchange or even a LASIK Surgery procedure depending on the overall health and condition of your eyes. In any event, if you are not happy with the result it is time to discuss this with your doctor.

Important Note: The information presented on the About Cataract Surgery Blog or provided in response to a request for information in the Ask Cataract Surgeons section on aboutcataractsurgery.com is not intended to diagnose or treat eye problems, eye conditions or eye diseases including appropriateness of treatment, risks, complications or side effects as related to Cataracts, Cataract Surgery of Lens Implants. In particular a response to an inquiry made on the Ask Cataract Surgeons section of aboutcataractsurgery.com is not meant to take the place of the professional medical care provided by your eye doctor, ophthalmologist and Cataract Surgeon surgeon. Contacting us via e-mail or any other means is not a substitute for medical care.

Tecnis® Multifocal Lens Implant Glare & Halo

Question: On Aug. 26th I had a Tecnis® Multifocal lens implanted in my left eye. My cataract surgeon also did limbal relaxing incisions as both eyes have substantial astigmatism. The glares and halos are so bad that driving at night feels dangerous. My eye doctor assures me that most patients who experience that find that once the second eye is done, their brains adapt and it's no longer an issue. I'm afraid that if mine doesn't, I will not be able to drive AT ALL at night until I have both removed. We've already talked about going to monovision lens implants and have used contacts to mimic it as best as possible. However, my cataract surgeon says that because I already have the Tecnis® Multifocal in place, it's impossible to get a true monovision test. So, I would really appreciate your thoughts on:


A: The likelihood of the glares/halos becoming non-problematic once the second eye also has the Tecnis® in place;
B: The idea of using monovision IOLs instead, with the right eye having a toric lens implanted to correct the astigmatism.

Answer: Multifocal Lens Implants, including the Tecnis® Multifocal Lens Implant, use complex optical designs to achieve their vision correction properties. For that reason they do indeed require a varying degree of “neuroadaptation” in order for patients to get “used to the vision”. Depending on each individual patient’s “neuroplasticity” this adaptation process can take little time or even a few months. You are approaching 4 months and do not seem to report a notable improvement in sensitivity to the symptoms of glare and halo. Typically, for complete neuroadaptation to occur it does require implantation in both eyes. So, the information being provided to you by your Cataract Surgeon is quite consistent with the experience of others. So, while “conventional and experiential wisdom” would suggest proceeding with the right eye with a Tecnis® Multifocal, it does sound like in your case this would NOT be a prudent path based on the severity and persistence of your complaints. You do not state whether your left or right eye is your dominant eye and this could impact the relative success of monovision Lens Implants. The most conservative approach is to correct the right eye with an astigmatism correcting toric lens implant for full distance correction. Then depending on the residual symptoms of glare and halo, and the degree of satisfaction with your near vision at that time either leave the left alone or possibly have a lens exchange to replace the Tecnis® Multifocal with a single focus lens implant. Again, the conservative approach would be to avoid monovision as you have already demonstrated a less than optimal “neuroplasticity” and monovision does also require adaptation.

Important Note: The information presented on the About Cataract Surgery Blog or provided in response to a request for information in the Ask Cataract Surgeons section on aboutcataractsurgery.com is not intended to diagnose or treat eye problems, eye conditions or eye diseases including appropriateness of treatment, risks, complications or side effects as related to Cataracts, Cataract Surgery of Lens Implants. In particular a response to an inquiry made on the Ask Cataract Surgeons section of aboutcataractsurgery.com is not meant to take the place of the professional medical care provided by your eye doctor, ophthalmologist and Cataract Surgeon surgeon. Contacting us via e-mail or any other means is not a substitute for medical care.

Lens Implants for Congenital Cataracts

Question: I have a question about congenital cataracts and lens implants. I was born with cataracts in 1978. The protocol for cataract surgery at that time was to remove the lens as well as the capsule. I am currently wearing aphakic contact lenses bringing corrected vision to 20/30. Is there any lens implant surgery available for me? And if so what is the risk?


Answer: Indeed in 1978 you would have most likely had an "intracapsular" Cataract extraction which would have removed the entire lens capsule as well as the cloudy lens material-the Cataract. Today, the typically the lens capsule is left in place in order to support the placement of a Lens Implant. However, the lack of a lens capsule does not preclude you from having secondary Lens Implant IF your eyes are otherwise healthy and in "good anatomical" shape. Depending on the condition of the Vitreous, Iris and other structures it is often possible to have a "secondary lens implant", either an the Anterior Chamber Lens Implant (IOL) in front of the Iris or a Posterior Chamber Lens Implant (IOL) sutured in place in the posterior chamber. The choice and the position of the lens will depend on the anatomy and the condition of the eye as stated previously. As with any intraocular surgery there is always risk, however most likely less risk than the Cataract Surgery itself. The complications of Cataract Surgery and Lens Implants are pretty infrequent. That said, you should consider taking the next step and schedule a consultation with the best Cataract Surgeon you can find and after a thorough examination and consultation, they will be able to advise you of the most appropriate course of action to consider.
Important Note: The information presented on the About Cataract Surgery Blog or provided in response to a request for information in the Ask Cataract Surgeons section on http://www.aboutcataractsurgery.com/ is not intended to diagnose or treat eye problems, eye conditions or eye diseases including appropriateness of treatment, risks, complications or side effects as related to Cataracts, Cataract Surgery of Lens Implants. In particular a response to an inquiry made on the Ask Cataract Surgeons section of http://www.aboutcataractsurgery.com/ is not meant to take the place of the professional medical care provided by your eye doctor, ophthalmologist and Cataract Surgeon surgeon. Contacting us via e-mail or any other means is not a substitute for medical care.

Cataract Removal in Only Eye

Question: I have only one functioning eye and it now has a cataract. I'm considering the removal of a cataract in my right eye. I rarely drive at night anymore and distance vision is a real problem. My concern is that my right eye is my only functioning eye. I understand there are always risks. Should I have it removed?


Answer: The concern and anxiety you express regarding having Cataract Surgery in your only good eye is reasonable and expected-and likely shared by most top Cataract Surgeons. You are correct in that with any surgery there is always the risk of complications, no matter how small. It would not be inappropriate to seek referral from your primary care physician as well as friends regarding finding the best cataract Surgeons in your area and scheduling a consultation with 1-2. Discuss your concerns and inquire what they will propose to endure that you will have an uncomplicated Cataract removal and Lens Implant procedure. Something you should know however is that the longer you wait and the more dense the Cataract becomes-the more difficult it can be to operate on and the greater the potential complication rate. So-if this is something you need to do or are seriously considering, you should proceed and not allow the Cataract to become too dense.

Important Note: The information presented on the About Cataract Surgery Blog or provided in response to a request for information in the Ask Cataract Surgeons section on aboutcataractsurgery.com is not intended to diagnose or treat eye problems, eye conditions or eye diseases including appropriateness of treatment, risks, complications or side effects as related to Cataracts, Cataract Surgery of Lens Implants. In particular a response to an inquiry made on the Ask Cataract Surgeons section of aboutcataractsurgery.com is not meant to take the place of the professional medical care provided by your eye doctor, ophthalmologist and Cataract Surgeon surgeon. Contacting us via e-mail or any other means is not a substitute for medical care.

Cataract Vision Correction after IOL Removal

Question: What is the best method of vision correction when an IOL must be removed some years after cataract surgery?

Answer: If a Lens Implant must be removed-and it is specifically in one eye only-it is entirely possible that the IOL can be exchanged and replaced with another IOL of a different type if the eye is otherwise healthy and the internal structures are intact. This would by far be the best choice if it is an option. If this is not an option due to anatomical or other considerations then the next best choice would be to use a contact lens for the vision correction in one eye. Eyeglasses after Cataract Surgery are only a choice if both eyes are to be corrected and even then these are likely to provide many limitations in terms of vision quality and field of vision. In any event, the removal of a Cataract is almost always best managed optically by a Lens Implant and it would be important to fully discuss the options with your Cataract Surgeon.

Important Note: The information presented on the About Cataract Surgery Blog or provided in response to a request for information in the Ask Cataract Surgeons section on www.aboutcataractsurgery.com is not intended to diagnose or treat eye problems, eye conditions or eye diseases including appropriateness of treatment, risks, complications or side effects as related to Cataracts, Cataract Surgery of Lens Implants. In particular a response to an inquiry made on the Ask Cataract Surgeons section of www.aboutcataractsurgery.com is not meant to take the place of the professional medical care provided by your eye doctor, ophthalmologist and Cataract Surgeon surgeon. Contacting us via e-mail or any other means is not a substitute for medical care.

Cataract Surgery with Toric Lens Implants for Severe Astigmatism

Question: I have severe astigmatism and I am scheduled for cataract surgery. Will the lens implant for astigmatism really improve my vision?


Answer: If your cornea is healthy, and the astigmatism is "regular" allowing your vision to be well corrected with eyeglasses, depending on what you mean by "extreme" the answer is most likely yes. With careful measurement and calculation in conjunction with the proper diagnostic testing, the use of Toric Lens Implants (IOL) to correct astigmatism-even rather significant degrees of astigmatism-is quite successful. The vast majority-even those with 4-6 diopters of preexisting astigmatism-report be able to be independent of eyeglasses for seeing clearly at distance after Cataract Surgery.

Important Note: The information presented on the About Cataract Surgery Blog or provided in response to a request for information in the Ask Cataract Surgeons section on aboutcataractsurgery.com is not intended to diagnose or treat eye problems, eye conditions or eye diseases including appropriateness of treatment, risks, complications or side effects as related to Cataracts, Cataract Surgery of Lens Implants. In particular a response to an inquiry made on the Ask Cataract Surgeons section of aboutcataractsurgery.com is not meant to take the place of the professional medical care provided by your eye doctor, ophthalmologist and Cataract Surgeon surgeon. Contacting us via e-mail or any other means is not a substitute for medical care.

Toric Multifocal IOL Lens Implants

Researchers reporting in the September 2011 Journal of Cataract and Refractive Surgery found that implantation of toric multifocal IOL's in patients with cataract and corneal astigmatism provides good distance and near visual outcomes and spectacle independence. The investigation in the Netherlands looked at patients with cataract, corneal astigmatism and a motivation for spectacle independence. Each patient underwent cataract surgery and implantation of a toric diffractive multifocal IOL. In 90% of the eyes enrolled in the study a residual refractive astigmatism of −1.00 D or less was achieved however moderate glare, halos and star burst symptoms were present in approximately 50% of patients. The authors concluded that toric multifocal IOL implantation enables patients with significant levels of corneal astigmatism to achieve distance and near spectacle independence.

Crystalens® Lens Implant Side Effects & Complications

Question: I am a candidate for cataract surgery and am thinking about the Crystalens implant. However, I've read some horror stories in reviews by people who have had this particular implant, ie, spiderwebs, flashing lights, poorer night and color vision. My questions are: 1) are these problems typical with Crystalens; and are there other accommodating IOL technologies to consider, even if it means waiting a few months?


Answer: First, as authors of peer reviewed digital content for ophthalmology we are constantly shocked by the state of web publishing in which patients, competitors and unknowing content sources are able to simply write unedited, unverified and simply incorrect material and post it as "meaningful" reviews that you and others are apt to take or even consider as factually correct. It is a real shame that Google Places, Bing, Insider Pages, Vitals and thousands of other "review sites" allow reviews to be posted regarding medical practice sites, physicians and medical devices as if they were reviews of restaurants or bowls of pasta. Medicine and the associated outcomes of the practice of medicine are subject to considerable degrees of complexity and influence by factors that "reviews" simply just cannot contemplate.

Second, while it is commendable that you are doing research and have become interested in "selecting" a lens implant-we pose the following question to ALL patients-do you have the breadth of understanding or the appreciation measurement nuances and surgical skill required that TOGETHER with a specific type of lens implant can produce certain results-OR are you looking at selecting a Lens Implant by "reviewing" manufacturers "marketing hype" or online chit chat? Medical devices, especially implantable medical devices, provide their reported outcomes and results when used by experienced and skilled physicians for patients who have been selected as good candidates for THAT DEVICE by that physician.

It is NOT the other way around-like buying running shoes-where the user or patient decides if the device or product sounds good and then goes and buys it.

The Cataract Surgeon and the Cataract Surgery procedure used by that eye surgeon have a huge impact on the results of the Cataract removal itself as well as the implantation and functioning of the Lens Implant. Further, the preoperative condition of the eye and its internal structures-independent of a type of Lens Implant-also impact results and outcome. These are just some of the reasons believing ANYTHING you read in "reviews" about surgery procedures, devices or products is IRRELEVANT.

With apologies for the long windedness of this response, here is what you need to know about your question. The side effects you noted i.e spider webs, flashing lights, poorer night and color vision are NOT reported any more frequently with Crystalens® than with any other type of Lens Implant including Multifocal Lens Implants. In fact what you are describing may very well be side effects of the Cataract Surgery itself and NOT have anything to do with any type of Lens Implant.

That said, near vision presbyopia correcting lens implants from different manufacturers are fabricated in varying optical designs-some are accommodating like Crystalens® whereas others use complex optics to achieve their "multifocal" effect. Each one has its own set of "tradeoffs" and compromises. Through a careful evaluation, measurements and consultation with a top Cataract Surgeon THEY should be able to discuss your particular lifestyle needs and vision correction goals after Cataract Surgery AND based on the eye examination, suggest one or more types of Lens Implants that can help you get to those goals.

Lens Implants are not like running shoes-you can't pick a brand and then go in and get "sized". They function differently and require matching the performance, optical characteristics of your eyes, your lifestyle and activity requirements. Finally, if you really think you want an accommodating Lens Implant and are concerned about what you are seeing in "reviews", there will be other accommodating Lens Implants available in the coming months or years that may or may not be better than Crystalens®. Only time will tell. In this sense you would be wise to use "best car buying practices" and NOT buy the first model year!

Important Note: The information presented on the About Cataract Surgery Blog or provided in response to a request for information in the Ask Cataract Surgeons section on aboutcataractsurgery.com is not intended to diagnose or treat eye problems, eye conditions or eye diseases including appropriateness of treatment, risks, complications or side effects as related to Cataracts, Cataract Surgery of Lens Implants. In particular a response to an inquiry made on the Ask Cataract Surgeons section of aboutcataractsurgery.com is not meant to take the place of the professional medical care provided by your eye doctor, ophthalmologist and Cataract Surgeon surgeon. Contacting us via e-mail or any other means is not a substitute for medical care.

Shiny Dot on Pupil after Cataract Surgery

Question: I have had successful cataract surgery in both eyes. Since then I notice a shiny dot on my pupil that looks like a small sequin and is present in both eyes most of the time. Sometimes it is quite noticeable and somewhat disconcerting. It seems to reflect light. Other people have the same experience. What is it?

Answer: It is very common after Cataract Surgery for patients who had Lens Implants made from certain acrylic materials to report a shimmering dot like reflection in their pupil. While it is visible if you look at yourself, and possibly noticeable by others, it in no way actually impacts vision or clarity. It is really a simple property of the acrylic Lens Implant material and is completely benign.

Important Note: The information presented on the About Cataract Surgery Blog or provided in response to a request for information in the Ask Cataract Surgeons section on www.aboutcataractsurgery.com is not intended to diagnose or treat eye problems, eye conditions or eye diseases including appropriateness of treatment, risks, complications or side effects as related to Cataracts, Cataract Surgery of Lens Implants. In particular a response to an inquiry made on the Ask Cataract Surgeons section of www.aboutcataractsurgery.com is not meant to take the place of the professional medical care provided by your eye doctor, ophthalmologist and Cataract Surgeon surgeon. Contacting us via e-mail or any other means is not a substitute for medical care.