Multifocal Lens Implants for Musicians

Question: I am scheduled to have cataract surgery in a couple of weeks.  I am thinking about multifocal lens replacement with ReSTOR® Multifocal Lens Implants, which is the only multifocal, type my cataract surgeon recommends and will use.  It will cost an additional $2,000 per eye.  My concern is whether the implants will improve my vision enough to be able to focus on reading music from a little more than arms length to twelve inches or so without any distortion.  I wear progressive lenses and I'm having difficulty reading music now.  Progressive lenses don't work because as I move across the page, the focus wavers.  Mono lenses are a problem because I have to read at different distances and I can't maintain my focus.  Are the ReSTOR® Multifocal Lens Implants going to solve my problem reading music?  What have you heard from musicians who have had this surgery?

Answer: If you are seeking clear vision at 12 inches through arm’s length, you are attempting to optimize the clarity for an intermediate range of vision. The ReSTOR® Multifocal Lens Implants might be able to provide you with this, but it may also require some adjustment of your distance vision and absolutely complete correction of any preexisting astigmatism that you have. Might is the  operative word here as the ReSTOR® Multifocal Lens Implant is not typically recognized as having its nest performance in the  intermediate range of vision. You really need to carefully discuss with your cataract surgery including providing him or her with the precise distances that are you seeking clear vision for. Regarding the other issue of distortion, it is not likely to be a problem with this lens.

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.

Cataract Surgery after RK

Question: In 1994 I had RK (extensive - 16 cuts in right eye). I recently had cataract surgery on right eye but vision correction, even using the ORA System, was not totally successful.  My cataract surgeon is now suggesting "piggyback" IOL to further correct vision.  Should I consider this and what are the possible complications?

Answer: Cataract surgery and lens implants after RK is more complex than routine cataract surgery where there has been no previous corneal surgery. The complexity of the measurements and calculations diminishes the precision of the lens implant calculations and should there be a need for an adjustment and refinement of the final prescription, the previous RK incisions may limit the options. Certainly the use of intraoperative measurements such as ORA can be helpful but still the precision isn’t perfect. Generally there are a few options for achieving the desired refractive outcome including wearing eyeglasses, corneal laser eye surgery such as LASIK or PRK, a lens implant exchange or a piggyback lens implant. Your previous RK may preclude you from LASIK for sure. You do not state whether the residual refractive outcome requires correction for nearsightedness, farsightedness and/or astigmatism. This too will be part of the decision on the likely usefulness of a piggyback lens implant as if there is irregular astigmatism-somewhat common with RK-you may not achieve your desired outcome. It is also not clear from your description why one would choose a piggyback over a lens exchange-either could be appropriate but your description precludes knowing the best choice. So-the best advice and opinion is to follow your cataract surgeon’s suggestion. That said, the complications of piggyback IOLs are similar to primary lens implants with the added risks of a second surgery-as long as the primary was uneventful.

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.

Multifocal Lens Implant for Bifocal Eyeglasses

Question: I am 58 and wear bifocals. It has been my dream for decades to be free of eyeglasses. This summer I am going to do it. It appears I have a choice of two methods to correct my vision:
Should I get a corneal transplant? Or should I get a multifocal lens implant? What are the risks and benefits to each?

Answer: Being free of eyeglasses is an admirable goal however you need to get more information about you vision correction options. Multifocal Lens Implants could very well correct your near and far vision-however it may depend on your prescription and exactly what your expectations are for seeing up close and intermediate distances. Further, for some reason you have stated that you are considering a corneal transplant for vision correction. Do you have some underlying corneal disease or problem that makes a corneal transplant medically necessary or are you simply confused? Before doing anything you need to go find the best cataract & lens implant surgeon you can and if you have some other corneal problem you probably want that surgeon to also be a corneal specialist. Schedule a consultation and absolutely take the surgeon’s advice on what your options might or might not be.

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.

Cataracts with Astigmatism

Question: I have cataracts and astigmatism in both eyes. I have heard there is a procedure that can fix both. I am 65 and have health insurance. How much should I expect to pay after insurance pays?  What is the success rate of this procedure?

Answer: If you have cataracts and astigmatism, and are in need of cataract surgery there are actually two ways to correct the astigmatism as part of the cataract surgery procedure. One way is to use an astigmatism correcting toric lens implant and the other is to have Limbal Relaxing Incisions (LRI). Most insurances, as well as Medicare do not pay for astigmatism correction and ask the cataract surgeon to charge for the incremental cost of the toric lens implant or the LRI procedure. In order to get the best results your cataract surgeon will need to take additional measurements that might include a corneal topography measurement, corneal thickness measurement, aberrometry and ocular coherence tomography-most or all of which should be part of the additional fee charged for the astigmatism correction regardless of which method is chosen. 

Which method is better in your particular case can only be determined by the cataract surgeon after your examination and consultation as it may depend on the degree and orientation of the astigmatism correction you require as well as other factors regarding the health and stability of your cornea. Further, it is not possible to tell you what the out of pocket costs might be as they vary by cataract surgeon, geography and procedure as well as by your insurance co-pay ad deductible allowances as well. The best thing to do is schedule an eye exam and consultation with a cataract surgeon and they should be able to advise you of the scope of options and the fees involved.

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.

Glare after Cataract Surgery

Question:  My mother had cataract surgery about 5 years ago and to this day she has a lot of problems with glare and she can't stand going in the sun or into rooms with too much light. She has gone back to her cataract surgeon numerous times, but he has not been able to help her. I keep mentioning contact lenses to see if that would help.  Do you think that contacts might help her?

Answer: First, it is important that you and your mother understand why your mother has continuing glare 5 years after her cataract surgery. The degree of glare disability you describe is not typical and should be evaluated. If you have been unable to get a satisfactory answer from her previous cataract surgeon then you need to find a top cataract surgeon in your area and schedule an examination for a second opinion. There are many reasons that there might be persistent glare problems after cataract surgery and with a thorough exam it should be possible to determine the cause and find possible solutions.

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.

Multifocal Lens Implants & Halos

Question: I have read that having a multifocal lens implant installed would lead to "halos" around lights when driving at night. First, how bad are the halos-do they impair your vision enough to make driving at night difficult? Second, if I get a lens that corrects my astigmatism and to see distance and near vision (computers, etc.) but I need glasses for reading, would that be considered multifocal enough to produce halos at night? If it does not produce halos-what type of lens implant would you suggest I use to accomplish-far vision, near vision and correct astigmatism and use glasses for reading? I am 76 years old.

Answer: First, multifocal lens implants are a very specific type of lens implant in terms of design. There are a few different designs produced by different manufacturers-each of which has somewhat different optical characteristics and thus differing tendencies to produce halos. Further, depending on your pupil size in bright vs. dim illumination, your results could be better or worse than what you have read-and could differ with each type of multifocal lens design. In addition, the shape of your cornea and its aberrations could also cause halos. 

So, there is no simple answer. In order to choose the best multifocal lens implant for your vision requirements and the distances you wish to see clearly at requires a VERY thorough eye exam and consultation and measurements and cannot be accomplished by discussing pros and cons of the designs. So-your best bet is to schedule a consultation and examination with the best cataract surgeon who is also a refractive surgeon and FULLY explain that you do NOT want halos. Then be prepared to provide the measured distances that you wish to see clearly for…i.e. the actual distance of where your computer sits and where you hold reading material. From this information a refractive cataract surgeon should be able to offer you options that might be the most desirable for you.

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.