Cataract Surgery Lens Implants & Eye Surgeons for Cataracts Blog

Wednesday, January 29, 2014

Monovision Lens Implant & Distance Vision

Question: I had toric lens put in right eye during cataract surgery with no since I still have to wear glasses for distance. I'm considering monovision lens for left eye so I can still read without glasses. If I do this will glasses enable the left eye to see distance clearly?

Answer: First, if you still need to wear glasses with the toric lens implant for distance, you need to find out why and whether there is a solution to get you seeing better. It is important to know the reason and understand whether it has anything to do with the lens implant, the cataract surgery or the health of your eye-especially the retina. Second, if you now correct the left eye for near-NO-you will not be able to see clearly at distance with the left eye. You need to get better answers from your cataract surgeon and if you are not satisfied seek a second opinion.

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 or 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. Contacting us via e-mail or any other means is not a substitute for medical care.

Friday, January 17, 2014

Multifocal Lens Implant Cost & Decision

Question: Why would a person having cataract surgery settle for monofocal lens implants and still have to use glasses, when he could have a multifocal lens implant? Why are multifocal lenses so expensive? What is the difference between the different brands of multifocal lenses such as AcrySof®ReSTOR®, Tecnis® and the other brand names? Medicare said they would pay for the monofocal lensimplant and if you want an advanced lens such as a Tecnis® Multifocal lens implant, the patient would have to pay the difference. Why would the difference be as much as $2500 dollars per eye difference?

Answer: First some patients having cataract surgery don’t mind wearing eyeglasses and thus don’t really see much benefit in electing to have a multifocal lens implant. Second, in order to have the best success with multifocal lens implants it requires careful patient selection in terms of optical characteristics, previous refractive error and overall expectations and ranges of vision the require. They are NOT for everyone. So NOT all patients get the option or choice of a multifocal lens implant-and thus they have to have a monofocal lens implant. Each multifocal les implant type has an optical design that works best for certain eye characteristics and which one to use is really up to the cataract surgeon-NOT the patient. Medicare DOES NOT pay for the correction of near vision or astigmatism after cataract surgery whether it be with eyeglasses, contact lenses or lens implants. This portion of the correction after cataract surgery is the obligation of the patient and NOT Medicare. The incremental fee for multifocal lens implants is the necessary fee to cover the costs associated with considerable incremental preoperative testing, measurement and calculations, plus the cost of the lens implant itself, plus any costs should a lens exchange or power adjustment be necessary. Most patients find this to be a bargain given the multiple long term cost of buying eyeglasses for their lifetime-to say nothing of the improved convenient day to day ability to see clearly at multiple distances.

Risk of Cataract Surgery after Retinal Detachment

Question: I have had 3 surgeries for retinal detachment with laser, vitrectomy and gas bubble, since have developed cataract. What are the risks to my retina with cataract surgery?

Answer: There is some increased risk of having cataract surgery if you have had prior retinal detachments ad surgery. However, IF the retina is well attached, stable and otherwise free of holes, tears, thinning and other degeneration AND your retina surgeon gives you clearance to have the cataract surgery then you can proceed with the expectation of only minimal increased risk of a recurring retinal detachment.

Crystalens® Near Vision

Question: I have high myopia, -7.25. Without my glasses I have very clear vision at 3-6 inches. I am planning to have Crystalens® Lens Implants, will I lose my clear near vision that I have now?

Answer: The fact that you are rather nearsighted does give you clear near vision at close distances. Once your distance vision is corrected after the cataract surgery and Crystalens® Lens Implants it is not likely that you will have the same level of clear vision at 3-6 inches. This could be overcome by your cataract surgeon intentionally overcorrecting your distance vision rendering you a bit nearsighted, however then your distance vision will not be clear. You need to have a thorough discussion with your cataract surgeon so that he or she can understand your preferences and take this into account in the final lens implant calculations.

Symptoms & Images after Cataract Surgery

Question: Approximately a year ago I had cataract surgery after having had LASIK surgery about 13 years prior. It's been a year now with my new lenses and I still experience the following symptoms at night: 1. all light sources display a flare at 12 and 5 o'clock, and 2. when viewing the moon, I see multiple images at both 12 and 5 o'clock. YAG did not help. What is going on?

Answer: You do not state whether you had cataract surgery with monofocal, aspheric, toric or multifocal lens implants and this might or might not be relevant. The fact that you had LASIK 13 years prior is possibly relevant in that if you did not have either custom wavefrontor wavefront optimized LASIK it is possible that you have some residual optical corneal aberrations from the LASIK that were not corrected as part of the LASIKtreatment. It could also be that the cataract surgery procedure induced these higher order aberrations including distortions called spherical aberration, coma and secondary astigmatism. Using an in office measuring system called an aberrometer, along with a corneal topography measurement-it should be quite possible to rule this in or out. This is the first place a refractive cataract surgeon can look. As you had a YAG Laser Capsulotomy with no improvement in your symptoms it would also be important to determine whether the lens implant is in the proper position in terms of centration. This too is a pretty quick clinical observation. If neither of these paths identifies the cause, then additional retinal testing might be considered. Now, if you have had an aspheric, multifocal or toric lens implant then it begs other questions that might relate directly to the lens implant design ad positioning. Once the cause is determined then your refractive cataract surgeon should be able to offer you possible solutions.

Friday, January 10, 2014

Halos with Multifocal Lens Implants

Question: I had LASIK surgery over 15 years ago. I have been told by an ophthalmologist that multifocal cataract lens implants may create halos around lights. Have you heard of this? If so, how often and how bad can it be?

Answer: Multifocal Lens Implants are very complex optical designs of several types. Indeed depending on the optical design some do in fact cause haloes, the degree to which they cause haloes depends n the design, the pupil size, aberrations and other factors. However, it is possible that one of the designs may be of minimal if any problem for you. If you are wishing to consider a multifocal lens implant your cataract surgeon advises against it you may wish to get a second opinion and even a third as different surgeons may not be experienced with each and every lens implant design type. Then, you can make an informed decision

Too Old for Cataract Surgery

Question: My mother is 92 years old. She has a little heart trouble, but is generally pretty healthy. Her cataracts have left her vision very poor and getting worse. Is she too old for the cataract surgery?

Answer: The answer simply is NO-she is not too old for cataract surgery. Here is why. First if the health of eyes is otherwise good-especially the center of the retina or the macula-and her overall health is good she will most likely have a good result. But, the results are more than just her vision. Vision loss in seniors is a significant cause of physical and psychological decline. That is, vision loss in seniors really affects quality of life. Find the best cataract surgeon in your area and schedule a consultation for her. If the cataract surgeon feels that she will do well then strongly consider the benefits to her mobility, safety and social interactions improved vision can give her! Best of luck!

Laser vs. Conventional Cataract Surgery

Question: I need cataract surgery and my cataract surgeon performs both traditional surgery and laser cataract surgery with the LenSx. Which is better?

Answer: Both conventional cataract surgery and laser cataract surgery will provide good outcomes and results when indicated and performed by a skilled and experienced cataract surgeon. Lasercataract surgery does give the surgeon the ability to deliver a gentler and precise cataract operation in a reproducible manner by consolidating many manual steps under a surgeon controlled laser procedure rather. For eyes that have some concurrent eye problem, disease or condition such as cornea guttata, Fuchs Dystrophy, glaucoma diabetic retinopathy the ability to use lower energy settings and power to remove the cataract may very well be an advantage. In essence, follow the recommendation of your cataract surgeon.

Glaucoma after Cataract Surgery & Toric Lens Implant

Question: I had cataract surgery and a toric lens implant only in my right eye just over a month ago and at my one month post op exam I was diagnosed with glaucoma in both eyes which I didn't have before the cataract surgery. Is this possible and way if it is and can it be corrected?

Answer: It is highly unlikely that you would get glaucoma in one eye after having cataract surgery and a toric lens implant in only one eye. It is sometimes possible to have a temporary increase in intraocular pressure (IOP) in the operated eye but it is usually transient. You should discuss this with your cataract surgeon ad if still not satisfied seek a second opinion.