ReSTOR® Lens Implant for Cataracts

Question: Does a ReSTOR® lens implant in cataract surgery have significant adverse possible results that may warrant foregoing near and far capabilities it provides? My eye doctor says he under sells it due to increased cost that may not be covered by insurance.



AcrySOF ReSTOR Lens

 Answer: The AcrySof®ReSTOR® Lens Implant for Cataract Surgery is a Multifocal Lens Implant that is designed to provide a greater range of clarity after a cataract is removed so that patients can be less dependent or independent of eyeglasses for seeing near and far. Typically, when patients have a Monofocal Lens Implant they must wear glasses to see at arm's length and near after Cataract Surgery. All Lens Implants require excellent Cataract Surgery in order to get the best results. In addition, success with Multifocal Lens Implants require CAREFUL patient selection based on may factors including patient expectations and goals, sometimes pupil size, sometimes aberrations in the eye, a healthy and normal tear film and on and on. Multifocal Lens Implants are not like shoes where a consumer or patient asks a Cataract Surgeon for "black slip on's in a size 9 please". They require careful measurement and meticulous implantation. So the question of "significant adverse events" really dependents on the skill of the Cataract Surgeon and not solely on the Lens Implant. That said, Multifocal Lens Implants are very complex optical designs and it does take some time to fully adapt to the vision characteristics they provide. In addition, some designs may cause patients to see glare, haloes and other optical disturbances that typically diminish over time. It is not really up to the patient to ask for a ReSTOR® or any specific type of Multifocal Lens Implant but rather to express to their Cataract Surgeon their desire to be less dependent or independent of glasses after Cataract Surgeon and then let the cataract Surgeon which type of lens Implant will best suit that particular patient's vision and lifestyle needs.

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.

Flashing Lights after Cataract Surgery

Question: My wife, age 89 had cataract surgery and since that time she sees motion similar to the old fashioned kaleidoscope with various colors and objects flashing before her. What is this and is there anything that can help her?


Answer: Hopefully you have discussed this with her Cataract Surgeon and she has had a thorough examination indicating that her Retina and Vitreous are normal and healthy. If that is the case then you might want to see her Cataract Surgeon and discuss the possibility of a phenomenon called dysphotopsia that can occur in some patients who have had Cataract Surgery and Lens Implants. Dysphotopsia is generally thought to occur as a result of the Lens Implant and it optical characteristics that are quite different from the natural crystalline lens. In a limited number of instances if it is extremely disturbing it may necessitate the removal and exchange of the Lens Implant with a different type-but this is for extreme cases only as in most patients it just becomes unnoticeable over 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 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 Specialist Recommends Surgery

Question: I just turned 50 and have been to a cataract specialist and he recommends cataract surgery since I'm having a lot of trouble seeing close. Apparently the cataracts are mostly in the bottom of the lens. I have worn glasses for distance since I was 12 but, just started needing them for reading. I really would like to wear no glasses but am not sure which upgrade lens to go with or my percent chance of not needing glasses.


Answer: We are unable to reconcile some of the information you have provided. First, is the formation of a Cataract interfering with your vision or is the fact that you are presbyopic and thus having near vision focusing problems what is causing your complaint? Developing a Cataract at the "bottom" of the crystalline lens is not likely to cause a disturbance beyond the presbyopia as it would probably be off the visual axis. You do not state what type of refractive error you had that necessitated the wearing of glasses from the age of 12. Depending on the degree of correction required, if you were simply nearsighted or farsighted then having a Cataract or even a clear lens extraction with implantation of a near vision presbyopia correcting Lens Implant is one of the possible options to help you achieve a "glasses free" form of vision correction. If you have even the beginning of a Cataract in any location, one would not recommend Monovision LASIK due to the generally progressive nature of the Cataract. Now, there are really two types of near vision presbyopia correcting Lens Implants-Multifocal Lens Implants and Accommodating Lens Implants. Each of these is actually available in different designs with different optical characteristics. Thus, the choice of which type of Lens Implant to use is really dependent on how you use you eyes each day and what types of activities you engage in as these activities. This will determine the distances of clarity that you require and the type of functionality that the Lens Implants needs to provide to help you be "glasses free". In order to have a proper selection of a Lens Implant type it requires a thorough set of measurements and a discussion with your Cataract Surgeon about what activities you need clarity for and how you use your eyes.

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 Cost: A Dog’s World

The cost of cataract surgery today is an incredible bargain given how the safety, effectiveness and predictability of removing a Cataract can positively impact one’s quality of life-AND NOT JUST HUMANS! Cataracts are the most common cause of treatable blindness in dogs and can have a debilitating impact on how they function and get around. In fact, the American College of Veterinary Ophthalmology (ACVO) shares a great deal of information about Cataract Surgery for dogs. In humans, Cataracts are the leading cause of vision loss among people over 55 years of age and Cataract Surgery with an Intraocular Lens Implant (IOL) is one of the most frequent types of operations performed.

“Just as I advise my patients that when their quality of life is diminished by Cataracts it is time for us to discuss having Cataract Surgery, when I can sense that the quality of life for Buck and Scout becomes diminished I know it will be time for them to have Cataract Surgery with a Veterinary Ophthalmologist,” stated Fairfield County Connecticut Cataract Surgeon Leslie Doctor, M.D. of Doctor & Associates.

Cataract eye surgery for dogs and people are performed with the same types of microscopic instrumentation and procedures. Cataract Surgery for dogs as well as Cataract Surgery for people both utilize the same advanced eye surgery technique called “phacoemulsification” with ultrasound to “chop” up the cloudy material of the crystalline lens-and both dog Cataract Surgery and human Cataract Surgery typically include the implantation of a permanent intraocular lens implant (IOL) to correct vision.

“It is interesting how similar the actual eye surgery techniques and procedures are for cataract surgery on dogs and humans,” remarked Fall River Massachusetts Cataract Surgeon Greg Hofeldt, M.D. of Center for Sight. “One of the differences is that when I perform cataract surgery I can typically use eye drops for anesthesia rather than any type of needles or injections and this helps human patients have a quick and comfortable recovery from cataract surgery.”

“Our Pokey is worth every dollar to make sure she has the best Veterinary Ophthalmologist when she needs cataract surgery-after all she is a real part of our family,” quipped Dr. Hofeldt.

Cataract Surgeon for Extreme Myopia

Question: Do I need a cataract surgeon who is a specialist to perform my cataract surgery as I have extreme high myopia, astigmatism, dry eyes and now cataracts. Currently I am 58 years old, have been wearing corrective glasses since age 10 and currently rigid gas permeable contact lenses since age 16. I also have had a detached retina and have 2 buckles, encircling and scleral in my right eye. I also have been wearing Monovision contact lenses for the past 10 years. Another question is can I have Monovision IOL's?


Answer: Cataract Surgery after a Retinal Detachment can be a bit more risky than a routine Cataract operation depending on the stability of the Retina and the condition and health of the Vitreous. That said, you should find the best Cataract Surgeon in your area and have a frank discussion with them regarding any increased risks of surgery in your specific case-especially with regard to the stability of the Retina. It may be necessary and prudent to have a consultation with the Retinal Specialist who did your detachment surgery in order to get his or her approval and as a second opinion regarding possible risks and complications. Clearance from the Retinal Specialist would be important.

Further, the fact that you wear Rigid Gas Permeable Contact Lenses must be dealt with in terms of discontinuing them for some time to allow the Cornea to stabilize in terms of curvature and thickness as this will impact the precision and accuracy of the biometry measurement used to calculate the Lens Implant prescription. Regarding Monovision Lens Implants, there should be no reason that if you have been successful with Monovision Contact Lenses, that you can't have the same success with Monovision Cataract Surgery. Find a top Cataract Surgeon if you do not have one and allow them to carefully guide you through the process.

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.

Types of Cataracts & Surgery

Question: Is the success of a cataract operation more likely in the early stages of a cataract development or would it be more advisable to wait for the cataract to grow fully. Are there different types of cataracts?

Answer: Cataract Surgery is technically complex and requires a fair amount of surgical skill of the Cataract Surgeon. As the development of a Cataract progresses it is often the case that the cloudy crystalline lens material actually hardens. It can become more difficult to remove "hard" dense Cataracts as compared to "soft" Cataracts. The "hard" dense Cataract may require more manipulation and take longer to fully extract than an early soft Cataract. For that reason most Cataract Surgeons would prefer to perform the Cataract operation earlier rather than later as a quicker procedure with less need for aggressive maneuvering can lead to lower risk.

There are many different types of Cataracts with each being described by their severity, tendency to progress and location. Some types develop slowly due to their location and may only cause a slight disturbance of vision. Others, may progress more rapidly and are quick to decrease vision. The decision on when to have Cataract Surgery is really based on each individual patient's judgement as to how much their vision has been compromised and prevents them from living their lives in a safe and comfortable manner. Generally when the patient feels that either safety or mobility are at risk then it is time to consider having the Cataract removed. There is no need to wait for the Cataract to "grow fully" as this reflects the past use of older methods of 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.

Cataracts & Monovision Lens Implants

Question: I have astigmatism and nearsightedness and now have cataracts. I have worn glasses since grade school. If I have toric lens implants with monovision lens implant for cataract surgery will I continue to require glasses?

Answer: Monovision Lens Implants for Cataract Surgery are an option for correcting distance vision, some intermediate vision and near vision for many patients who have Cataracts. Monovision Cataract Surgery can be performed with Toric Lens Implants to correct astigmatism as well. Depending on the degree of near vision correction that you require as well as your "tolerance to defocus", it is possible that a monovision correction can be prescribed that will leave you glasses free for most if not all activities except for fine detailed reading or work. The most reliable way to determine if you are suitable and if this might work for you is to schedule a consultation with a top Cataract Surgeon and have the necessary testing, measurements and trial of monovision.

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.

Cataracts, Toric Lens Implants & Retinal Tear

Question: I had a retinal tear in my left eye and have cataracts in both eyes and need cataract surgery. I still see showers of black dots and haziness. I have astigmatism and need glasses for reading and distance vision. Does this situation increase my risk of having problems with cataract surgery? Should I consider not getting a toric lens implant to correct astigmatism and get a different type of lens implant?


Answer: The fact that you had a retinal tear that sounds like it has healed and is stable is not a contraindication to cataract surgery as long as in the opinion of your Cataract Surgeon your retina is indeed stable. If there is any question he or she may elect to ask you to have a consultation with a retinal specialist. What you are describing relative to the dots and haziness suggests that you had a vitreous detachment that may have actually caused the retinal tear. In the majority of instances the dots and haziness from the vitreous detachment do settle down and become less annoying. They may temporarily get worse after your Cataract Surgery and Lens Implants but then over time they do settle. There is no current opinion that indicates having a toric lens implants to correct astigmatism increases risks or complications of Cataract Surgery, so if you would like to be less dependent or even independent of glasses after your Cataract Surgery, you and your eye surgeon should make the choice of the toric lens implant.

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.

Blurry Vision after Cataract Surgery

Question: I have a question about blurry vision after cataract surgery. Is it normal to have more blurry vision 22 or 23 feet away from the body after surgery than before cataract surgery? Is it unusual for the lens to be defective to cause significant blurriness?


Answer: It is really not possible to answered your question without knowing some additional information about your eyes and Cataract Surgery.

First, we do not know how blurry your vision is quantitatively. Depending on the length of time since your Cataract operation, it is possible the they eye is still healing and this can affect the quality of the vision.

Second, we do not know whether you wore eyeglasses and of what prescription prior to your eye surgery. If you were in fact near "emmetropia" and required little or no eyeglass prescription to see at distance, and your Cataract Surgeon measured and calculated a Lens Implant so as to render you mildly nearsighted, you could in fact be blurrier now at 20 feet than prior to your surgery. Your Cataract Surgeon might have done this intentionally if most of your daily activities were centered around near or intermediate arm's length vision rather than for distance. It is also possible that the Lens Implant measurement and calculation did not turn out exactly as planned and you are slightly nearsighted as a result as well. It is highly unlikely that the Lens Implant is defective but rather your blur is due to some other reason that should be explored and discussed 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 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.

Spanish Cataract & Eye Surgery Help

Providing cataract, eye surgery, eye disease and eye care problem information in Spanish is recognized as an important part of today’s eye health and vision patient education process. According to results from the Los Angeles Latino Eye Study (LALES), Hispanics have higher rates of developing visual impairment, blindness, diabetic eye disease, and cataracts than non-Hispanic whites. The risk for glaucoma in Latinos is four times higher than it is in whites, and three times higher in Latinos who have siblings with glaucoma compared to those without any family history of glaucoma. Most importantly, the study found 75 percent of the Latinos with glaucoma were unaware of their eye disease, and almost half of all Latinos with diabetes had diabetic retinopathy.

“Recently, the American Academy of Ophthalmology launched a Spanish eye health web site to help combat eye disease in Hispanic communities,” remarked Fairfield County Cornea, Cataract & LASIK Surgeon Leslie Doctor, M.D. “This is a pretty good indication of how important it is for us to provide Spanish language information about eye diseases, eye surgery and eye health conditions that have a higher predilection for the Hispanic community. From our reception desk to our associate Ophthalmologists, we have simply integrated Spanish speaking staff to make these discussions about cataract surgery, diabetic retinopathy and glaucoma that much more effective.”

“At The Eye Clinic of Texas, we too have a number of staff members on our clinical team who routinely educate patients about their eye problems or conditions in Spanish,” added Bernard Milstein, M.D. a Galveston and Houston Cataract & LASIK Surgeon. “We tend to be pretty fluent in Spanish presentations about their eyes and especially when we are discussing eye surgery such as cataract surgery and lens implants, LASIK or glaucoma treatment. Even for routine eye exams for Houston patients, if we can help patients be better patients by engaging them in clinical decisions we find it to be quite beneficial.”

“Our practice serves a south Florida population that draws cataract patients from throughout greater Ft. Lauderdale, Miami and also Palm Beach County,” noted Ft. Lauderdale Cornea, Cataract & LASIK Surgeon Ray Gailitis, M.D. of Ophthalmology Consultants. “We have Spanish speaking staff members well trained in patient education for those who prefer learning about LASIK in Ft. Lauderdale in a familiar Spanish language discussion. Now, as more and more of our cataract surgery is being performed with astigmatism correcting toric lens implants as well as near vision correcting multifocal lens implants, our need to provide patient education and counseling for our cataract surgery patients in Spanish has increased quite a bit as well.”

Best Multifocal Lens Implant Brand

Question: Which brand of multifocal lens implant is best?


Answer: Patients having Cataract Surgery and considering Multifocal Lens Implants are often confused in thinking that they are "buying" a brand of surgical medical device that can be rated in its performance like tires for an automobile. Whether a Multifocal Lens Implant performs successfully depends on

1. careful patient selection to be sure that the optical design is appropriate for the patient identified needs and optical requirements,
2. the skill of the Cataract Surgeon and,
3. the precision and accuracy of the measurements and calculations used to select the Lens Implant power-among other considerations.

One might see a great PR piece or read about a Lens Implant brand and conclude that it is exactly what they want-only to be disappointed when the Lens Implant doesn't work for them because they needed a different design that wasn't dependent on pupil size for example, or one that worked by refractive rather than diffractive optics as they were sensitive to low contrast image degradation. THERE IS MUCH MORE TO THE SELECTION OF THE BEST MULTIFOCAL LENS THAN READING MANUFACTURER'S MARKETING NONSENSE! There is NO best brand of Multifocal Lens Implant as it is entirely dependent on your eyes and your needs AND can be right on the mark if the "best brand of multifocal lens implant" is properly implanted OR can not work at all if implanted improperly-for example if it is implanted off center by 1.0 mm! Thus the skill and the experience of the Cataract Surgeon is want makes these Lens Implants work or fail...not the brand!

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.

Vision Change after Cataract Surgery & Lens Implants

Question: I had cataract surgery and lens implants some 12 years ago and had perfect vision until 6 months ago. The distance vision in my right eye decreased to where I would need a +2.50 D eyeglass correction. This happened with no particular event. I was examined by two different Ophthalmologists who had no explanation for the vision loss and agreed that the lens implant was clear, properly in position and there was no disease process. One of the eye doctors thought that the lens implant might have moved slightly but he has only heard of this happening one other time in 15 years. Is there some other explanation or a way to correct the problem with a new lens implant?


Answer: It is very unusual to have a large refractive shift like this 12 years after successful Cataract and Lens Implant Surgery. Without an examination it is only possible to speculate about some things you may wish to consider with your Cataract Surgeon. First, you did not specify whether the vision in the affected eye was actually correctable to close to 20/20 with the +2.50 D eyeglass lens. If the vision could not be restored with the eyeglass prescription to a near normal level then one must consider whether there was at one time a fluid accumulation or swelling or other disruption of the Macula.

If the vision could be restored to near normal, than the likelihood of a Macula problem is greatly reduced and it is most probable that the Ophthalmologists who examined you carefully looked for this possibility and ruled it out. Another possibility that can cause the late onset of a shifting of a lens Implant is a disease process called Pseudoexfoliation Syndrome in which the zonules that normally hold the capsular bag firmly in place begin to weaken allowing the capsule to shift and move the lens implant. Typically when this occurs there is a white flaky material that can be observed on the front surface of the Lens Implant, often way out in the periphery of the IOL. Also, it is often accompanied by a high pressure in the eye causing Glaucoma. PXF occurs more commonly in older patients of Scandinavian and Mediterranean origin. Again, it is highly likely that your Cataract Surgeon has thoroughly examined you for this disease process.

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 and Welding

Question: I have eye lens implants after cataract surgery, being a welder I have become aware of a problem with high frequency current and the wires on the lens implants. Can you tell me if it is safe to continue in the welding trade?


Answer: Lens Implants used for the past few decades do not have wires-except for perhaps some very unusual cases that might have necessitated the use of a suture to stabilize them many years ago. Even then, the sutures were not metallic. If you are referring to the "haptic' or the "feet" of a Lens Implant that assist it in positioning or stabilization, there is really no risk that we are aware of from welding. The Lens Implants used today are made entirely of acrylic, silicone or collagen polymers and copolymers without wires. If there is any question regarding whether an older style Lens Implant has been used, or perhaps if you had your Cataract Surgery in a part of the world and at a time when only older style Lens Implants were available, you should have a consultation with a local Cataract Surgeon who can then determine the type of Lens Implant and advise you of any potential risk

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 & Laser Eye Surgery

Question: I have a question about cataract surgery and lens implants after laser eye surgery for farsightedness. I am 57 years of age and had laser eye surgery for farsightedness 8 years ago.(+4.00 D and +4.50 D). I needed a redo as my vision in artificial light was very poor. The redo did help but I have been left with poor night vision. I now have some cataracts and my eye surgeon wants to do a lens implant IOL. He has told me that I will still need glasses after for close work. At present I need them also for distance. We also have a family history of glaucoma. Do you think I should go ahead now or wait for perhaps new technology?


Answer: The overall success of Laser Eye Surgery for higher degrees of farsightedness is somewhat limited as most patients find that there is poor stability of their prescription and vision and that they do in fact require repeated laser procedures-after which the vision still may not be satisfactory. Today-for someone 57 years old-most Refractive Surgeons who are also Cataract Surgeons would opt to perform a lens based procedure by removing the crystalline lens and replacing with a Lens Implant as the primary procedure for prescriptions in the range you describe. At 49 years of age when you had your Laser Eye Surgery it might not have been recommended at that time. NOW, without an examination it is impossible to tell whether your difficulty with night vision is a result of the formation of the Cataracts or due to a loss of contrast sensitivity from the laser treatments for your hyperopia and the possibility of some induced aberrations. This can most likely be determined by a Cataract & Refractive Surgeon with proper measurements and instrumentation. ALSO, the fact that you have had two Laser Eye Surgery procedures for the correction of your farsightedness makes the measurement and the calculation of the Lens Implant power somewhat more complex and this must be done very carefully. That said, if you have the beginnings or even more advancing Cataracts, having any further Laser Eye Surgery is not a good idea and improving your vision will require the removal of the Cataracts and Lens Implants.

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 Implant for Monocular Patient

Question: I have monocular vision in my left eye, and have 2 kinds of cataracts, including posterior sub capsular cataract. My vision is now requiring lens changes to my glasses about every 2 months, so it is likely time for cataract surgery. I have found a good local cataract surgeon, but I wonder what kind of lens implant would be best and safest for my situation. I do have astigmatism, and currently wear lineless bifocal glasses and am 67 years old.


Answer: For most patients having Cataract Surgery and Lens Implants today, the goal of modern Cataract Surgery is to use advanced technology Lens Implants to help them become "glasses free" after Cataract removal-IF this is of importance to them. The decision of the type of Lens Implant to have is really best made after a careful discussion with your Cataract Surgeon regarding your personal vision correction goals. That said, there are some unique considerations in the case of monocular patients.

First, you might want to consider the role eyeglasses play in your eye protection. In monocular patients wearing eyeglasses with polycarbonate lenses offers a good measure of safety against flying objects, fingers and accidents in general. For that reason one could argue that you SHOULD wear eyeglasses after your Cataract operation even if you did not need to wear them. The next consideration is whether you should have a near vision presbyopia correcting lens implant. In general, near vision presbyopia correcting lens implants work best when implanted in both eyes in order to maximize the optical performance of the designs. Having vision in a single eye is likely to decrease the performance of this type of lens implant-thus it is probably not a great idea. On the other hand, if you have astigmatism that needs correction, it is worth considering using a toric lens implant as this will allow you to have the best distance vision even when you are without glasses-such as at night around the house-and thus require mainly a prescription for intermediate arm's length and near vision, which can be accomplished with no line progressive lenses.

Toric lens implants do not pose any additional safety risks, but do require a greater degree of precision in the testing, measurements and calculations. Your best next step is to discuss these considerations-along with your expectations and goals-with your Cataract Surgeon who will be able to assist you in making the best choice.

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.

Driving Safety & Cataract Surgery

For many patients with a cataract, driving safety can be a concern and motivate them to make the decision to have cataract surgery. “Along with the safety issue of cataracts and driving is the stereotype of women drivers being further challenged by poor driving habits”, commented Leslie Doctor, M.D., Cornea, Refractive & Cataract Surgeon at Doctor & Associates in Fairfield County, Connecticut. “After reviewing the data regarding gender differences in crash risk after cataract surgery presented in Clinical & Experimental Ophthalmology I am pleased to note that it would appear that it is much more critical for men to make the decision to have cataract surgery in an earlier timeframe as their crash frequencies were more dramatically improved than women drivers.”

Galveston & Houston Cataract Surgeon Bernard Milstein, M.D. of The Eye Clinic of Texas also weighed in on the topic of driving safety and cataract surgery. “What we are most concerned with is that any patient who is experiencing a challenge to their mobility due to a vision decrease from cataracts just feels free to share this with us. Any increased risk due to their driving or even walking around the house in dim light because of decreased vision from a cataract is something we need to know about in order to help them work through their options-including cataract surgery. Moving around safely and comfortably is not something you have to give up because of a cataract-we can help with this,” stated Dr. Milstein.

If you or someone you know is experiencing a decrease in vision, driving safety or daily activities in general and think you might have a cataract, it is important to schedule a cataract consultation and examination with a top cataract surgeon who can determine the cause of your vision problem and help to present options and make recommendations so you can see your best.

Cataract Surgery & Lens Implant Pseudoaccommodation

Question: My cataract lens implant works BETTER than it should!! I had a Tecnis® 1-piece IOL implanted a few months ago. My surgeon assures me that this was indeed the lens that was implanted and that it is securely seated in the posterior capsular wall. Nevertheless, despite the fact that the Tecnis® 1-piece is a standard monofocal lens, without glasses I can read a newspaper or alternatively clearly see objects far away. In other words I can accommodate using an IOL that was not designed to accommodate! How can this be?


When I posed this question to my cataract surgeon and to Abbott Medical Optics all I received was congratulations on my good fortune but no convincing explanation. I would have thought that my bizarre situation would be of great interest to the ophthalmology community. What is the explanation for this medical miracle?

Answer: Pseudoaccommodation with Lens Implants after Cataract Surgery is a well known clinical and optical phenomenon that has been researched and reported on for quite some time. Your situation is neither bizarre or completely unpredictable. Certain optical factors such as the presence of "against the rule" astigmatism and higher order aberrations such as coma and trefoil are highly predictive of a set of optical circumstances that create an increased depth of focus allowing patients to see clearly BOTH at far and near after Cataract Surgery. This can further be increased through the use of particular types of aspheric lens implants (IOL) that act to synergistically increase the depth of field thus actually increasing the seeming ability to accommodate. In fact, through careful preoperative measurement of higher order aberrations and through planned construction and location of the Cataract incision along with careful calculation and selection of the IOL and its asphericity, it is possible to ACTUALLY CREATE PSEUDOACCOMMODATION for many patients-AND IN FACT there are Cataract & Refractive Surgeons who do this as a matter of course for their patients who are interested in doing so.

It is estimated that as many as 45% of patients who have had certain types of monofocal lens implants are positively affected by the presence of Pseudoaccommodation and even more might benefit through popper measurement, screening and wound construction. Without seeming cynical, it would be quite understandable why Lens Implant manufacturers might not want either Cataract Surgeons or patients to know too much about this as it would then have the potential to be a suitable substitute for the purchase of the significantly more expensive Multifocal Lens Implants that they clearly see as a greater source of profitability. That said, creating and leveraging Pseudoaccommodation requires extensive measurement, calculation, surgical planning and skill of Cataract Surgeons and thus patients exploring this option should be prepared to pay fees associated with the necessary testing that are not typically covered by Medicare or commercial insurances.

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 Lens Implant Complications & Safety

Question: I have astigmatism greater than 2 diopters so could benefit from toric lens implants. BUT I would rather choose the IOL that has a higher success rate and the least complication rate. So, would choosing to have a regular lens implant rather than a toric lens implant be a safer bet?


Answer: We need to separate safety and complications from the actual visual performance when we consider astigmatism correcting lens implants as compared to monofocal lens implants. The safety and complications of astigmatism correcting lens implants is essentially identical to that of monofocal lens implants. In general, they are the fabricated from the same materials and in the same basic styles as one an other and thus the safety and complication rates reflect the experience and the skill of the Cataract Surgeon more so than the actual Lens Implant type. The MOST IMPORTANT DECISION THAT YOU WILL MAKE IS THE CHOICE OF CATARACT SURGEON AND NOT THE TYPE OF IMPLANT. Astigmatism correcting toric lens implants do require a greater degree of precision in the preoperative measurements and calculations in order to obtain the best visual results. In addition they may also require a greater of surgical skill from the Cataract Surgeon in order to obtain the perfect placement and rotation of the Lens Implant for best vision. That said, in our experience with U.S. Cataract Surgeons who are also Refractive Surgeons, the level of success and patient satisfaction is quite high with astigmatism correcting toric lens implants in terms of safety, efficacy and predictability.

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 Lens Implant Blur & Scratched Cornea

Question: I have a toric lens implant that was inserted following cataract removal a couple years ago. Today I had a slip of the hand and scraped my eye. That eye is blurry now and I am wondering if that implant could have been moved out of place or is it more likely that I scratched my eye?


Answer: Two years after a Cataract removal and Lens Implant it is possible, but not likely, that your hand moved the Lens Implant as it tends to become firmly attached to the associated surrounding tissue of the lens capsule left in place to support it. However, there are multiple other reasons you could be experiencing blurry vision from a hand or finger in the eye that could include a scratched cornea as you suggest as well as others. It is important that you schedule an appointment with your Cataract Surgeon promptly in order to determine the cause of the blurry vision and what if any treatment is required at this 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 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.

Complex Cataract & Lens Implant Option

Question: I had cataract surgery in the 1970's for congenital cataracts and now I am considering a lens implant. I have vision in only my right eye, due to congenitial cataracts. I had both of my lenses removed via cataract surgery when I was a child. My question is that I have recently reconsidered the IOL, but during my appointment, my eye surgeon found scar tissue that has attached my iris to my lens capsule. He would like to try and remove the scar tissue using a procedure known as synechiolysis. Is this a feasible option?


Answer: Your Cataract and Lens Implant situation would be considered complex and technically challenging for any Cataract Surgeon. Adhesions or "synechia" can occur between the Iris tissue and Lens capsule in which case they are called "'posterior synechia" or can occur between the Iris tissue and the Cornea in which case they are called "anterior synechia". Synechia are a result of inflammation from infection, surgery and many other reasons. The procedure of Synechiolysis or "breaking the adhesions" is performed in a number of instances where the synechiae interfere with visual functioning. Sometimes it is possible to use a YAG Laser to perform some degree of synechiolysis whereas in other instances it must be performed manually with a spatula or blade. It is all a matter of degree.

Once the Iris has been returned to some state of normal shape and/or functioning it will facilitate the proper placement of a Lens Implant. Depending on the overall condition of the tissues in the "front" part of the eye, your Cataract Surgeon will be able to make the decision regarding what type of lens Implant should be used and what location it should be placed in. In addition to the general complexity of this procedure, the fact that you have vision only in that eye poses an additional need for preoperative diligence and care and meticulous surgical technique. That said, Synechiolysis is an established procedure and used by virtually all Cataract Surgeons as needed to provide optimal 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 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.

Blur Shortly after Cataract Surgery

Question: On January 17, 2012, I had cataract surgery and a Tecnis® Multifocal Lens Implant IOL implanted in my right eye. Since then I have had a uniform, universal blurring of my vision. This persists at any distance or at any light level, both central and peripheral. I can see these wonderful new images of color, brightness, contrast and definition but they are blurred, just as if they are out of focus. Consequently, I cannot drive or read. I have normal eyes and have never had any abnormality or disease except the inevitable presbyopia and then cataracts. My strong gut feeling is that the lens is the wrong dioptric power. What are your suggestions?


Answer: While it is possible that the Lens Implant is the incorrect dioptric power, it may be that other factors are causing the blurry vision. Although it is really impossible to speculate without an examination or additional clinical information, there are a few potential causes to be considered. If the blur were due to refractive error caused by an off power implant, it is not likely that the blur would be uniform-there would most likely be distances at which the vision were clearer-maybe. It is possible that the IOL is slightly off position. One must determine the condition and the transparency of the posterior lens capsule left in place by your Cataract Surgeon to support the IOL. While the post op timeframe would be considered pretty short for posterior capsular opacification to occur, it may be that the capsule is cloudy. A careful Retina exam with specific examination of the Macula needs to be performed to rule out Cystoid Macular Edema which typically occurs within the 90 day post op period. At this time you need to return to your Cataract Surgeon, promptly, to allow the proper diagnosis and remediation as there are a number of possibilities that need to be ruled out.

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 & Retinal Detachment Risk

“As our cataract surgery techniques and the technology for removing cataracts has become quite sophisticated, the frequency and risk of retinal detachment after cataract surgery has decreased significantly,” commented Brad Spagnolo, M.D., Cornea, Refractive & Cataract Surgeon at Baltimore Washington Eye Center. “Nonetheless, we are always extremely cautious when performing cataract surgery for those patients who might be considered at higher risk than the typical person with a cataract.”

“Typically, most cataract surgeons would suggest that patients who are extremely nearsighted and who need cataract surgery at a younger age-especially if they are male-might be considered at higher risk,” noted Ravi Shah, M.D. Cornea, Refractive & Cataract Surgeon in Portland, Maine at Eyecare Medical Group. “As refractive surgeons we may very well have a greater number of very nearsighted patients in our practices as these are the patients who initially seek us out for LASIK.”

“I think this is really the case-a considerable number of moderate to highly nearsighted patients have been coming to us, seeking our advice for LASIK for the past 15 years and now are entering the years of cataract development,” confirmed New Jersey Cataract, Cornea & Refractive Surgeon Joel Confino, M.D. of The Eye Care & Surgery Center. “Being aware of and understanding the higher risks these patients might be exposed to is important-as well as being even more cautious to avoid complications such as a posterior lens capsule rupture.”

Galveston and Houston Cataract Surgeon at The Eye Clinic of Texas Bernard Milstein, M.D. also weighed in. “Having had the opportunity to participate in many carefully controlled clinical studies on cataract surgery and lens implants as well as having had the good fortune to watch a few decades of technique and technology evolution for cataract removal, overall we have a lot to be thankful for," stated Dr. Milstein. “With proper patient selection, examination, consultation and meticulous surgical technique we can really offer our patients the promise of safe, effective and predictable cataract surgery today.”

For a complete review of cataract surgery and retinal detachment risk you can review the January 2012 publication of Current Opinion in Ophthalmology or, better yet, if you are concerned and feel you might be at risk, find the best Cataract Surgeons in your area and schedule a consultation.

Unhappy Cataract Surgery Results

Question: I am not happy with the results of my cataract surgery as my prescription is now distance right eye +1.00-.25 x 135, left eye +1.50-.25 x 088 with a +2.25 for near. What are my options?

Answer: First, when you say that you are not pleased, it is not obvious whether you set and understood possible expectations and outcomes from your Cataract Surgeon. Let's start with your near vision. Anyone who has a Cataract removed must have some optical correction for clarity of near vision. Options for near vision correction with Cataracts include eyeglasses, contact lenses, Monovision Cataract Surgery or Presbyopia Correcting Multifocal Lens Implants (IOL). If you wanted to be "glasses and contacts free" for near vision you would need to have either Monovision Cataract Surgery or Presbyopia Correcting Multifocal Lens Implants. It does not appear as if you were either a candidate for these options, presented with and/or elected to have either of these options. Although it is technically a possible option to have a Lens Implant Exchange with these options and have the current implants replaced, the complexity of the second surgery may not be worth the risk. It really depends on the overall health and condition of your eyes. Regarding your distance vision, you do not state what your uncorrected level of visual acuity is without correction at this moment-and how much it bothers you. Again, the options for correcting your distance vision are the same-glasses, contact lenses or a Lens Exchange. Certainly eyeglasses are the least convenient, but also the least risky. A Lens Exchange could very well provide you with "glasses free" distance vision and if you were a good candidate, Monovision Correction may give you "glasses free" or nearly "glasses free" near vision. Multifocal Lens Implants could technically be used for the Lens Exchange BUT they do require near perfect implantation for the optimum performance which may or not be possible depending on the condition of your eyes and their anatomy. Thus, your best next step is to have a frank discussion with your Cataract Surgeon-who knows the anatomy and condition of your eyes postoperatively and he or she can help assess the risk/benefit ratio of the options so that you can make an informed decision.

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.