Cateract Surgery and Modern IOLs

If you have cataracts and need surgery to restore your vision, fear not — cataract surgery is one of the most frequently performed surgeries, and modern cataract surgery is safer and produces better visual outcomes than ever before.

Still, you should be well informed about what to expect before, during and after your cataract surgery, and which of the many types of intraocular lenses available these days is the best choice for your needs.

Cataract Surgery Basics

In cataract surgery, the cloudy lens inside your eye is removed and replaced with an artificial lens — called an intraocular lens, or IOL — to restore clear vision.

Cataract surgery typically is performed on an outpatient basis and you are awake throughout the procedure, which takes only about 15 minutes.

Modern cataract surgery requires only a small incision in the eye, because the cloudy lens is broken up into small pieces with an ultrasonic probe before it is removed from the eye. This small-incision technique reduces the risk of complications and promotes faster healing and vision improvement.

After all remnants of the cloudy lens have been removed from your eye, the cataract surgeon inserts a clear IOL behind the iris and pupil, in the same location your natural lens occupied. (In special cases, an IOL might be secured to the front of the iris, but this is less common.)

The surgeon then completes the procedure by closing the incision (a stitch may or may not be needed), and a protective shield is placed over your eye to keep it safe in the early stages of recovery.

Recently, lasers (similar to those used in LASIK vision correction surgery) have been approved for certain steps in cataract surgery. These “femtosecond” lasers provide even greater precision for these tasks and may make cataract surgery outcomes even more accurate and predictable.

Laser-assisted cataract surgery, however, usually is significantly more costly than a conventional cataract procedure. Ask your eye doctor or cataract surgeon for more information about this new technology.

Choosing the Best IOL

During your pre-operative exam, your eye doctor or cataract surgeon will discuss the latest IOLs that are available for cataract surgery and help you choose the right lens for your needs and budget.

With many premium IOLs to choose from these days, it’s important to consider your priorities and visual expectations after your procedure.

Generally, ask yourself these questions:

  1. Do I want good distance vision but also the most economical solution, so I have the lowest possible out-of-pocket expenses after insurance or Medicare coverage for my cataract surgery?
  2. Am I willing to pay an out-of-pocket premium to get the latest IOL technology that might provide slightly sharper vision than a conventional IOL or decrease my need for glasses after surgery?

If you want to keep costs down, ask your surgeon which IOLs will result in the least amount of out-of-pocket expenses for your cataract procedure. Standard IOLs of this type provide excellent vision for most patients, and your surgeon can advise you about your expected visual outcome with this choice.

For some patients, a premium IOL may provide noticeably better vision after cataract surgery than a standard IOL.

Examples of premium intraocular lenses include aspheric IOLs that correct visual aberrations that can cause halos around lights and other vision problems, and toric IOLs that correct astigmatism as well as nearsightedness or farsightedness.

Also, consider which of the following is your highest priority after surgery:

  1. The sharpest distance vision possible (knowing this means you will likely need reading glasses).
  2. The greatest freedom from glasses after surgery (knowing this means your distance vision without glasses will likely be less clear than with option 1).

If the sharpest possible distance vision is your top priority — so you can see clearly without glasses for driving, sports and other activities — your best option may be a premium IOL designed for distance vision only. Though this option means you will likely need reading glasses, most people who choose these IOLs are very pleased with their distance vision after cataract surgery and find that wearing reading glasses when needed is worth the trade-off.

If you want the greatest freedom from glasses after cataract surgery (and are willing to put up with a slight decrease in the sharpness of your distance vision to get it), your best choice may be a presbyopia-correcting IOL.

There are two types of presbyopia-correcting IOLs, which are designed to provide good vision at all distances:

  • Multifocal IOLs. These IOLs, like multifocal or progressive eyeglass lenses, have several lens powers to help you see quite clearly at multiple distances — far away (for driving), at arm’s length (for computer use), and close up (for reading).
  • Accommodating IOLs. These presbyopia-correcting IOLs have only one lens power, but have the ability to move slightly within the eye in response to focusing effort, thereby mimicking the eye’s natural focusing ability prior to the onset of presbyopia.

Most people who choose presbyopia-correcting IOLs are very pleased with their vision without glasses. However, many still require glasses occasionally for better driving vision (especially at night) and for reading small print.

It’s also important to know that whether you choose a distance-only or a presbyopia-correcting IOL, it’s not unusual for you to still have some minor blurred vision without glasses.

If you want the best possible vision without glasses after cataract surgery, ask your eye surgeon if you are a good candidate for LASIK or other vision correction procedures to enhance or “fine-tune” your eyesight a few months after surgery.

Be sure to ask plenty of questions during your pre-operative exam so you are completely comfortable with your choice of IOL and your decision to proceed with cataract surgery before signing surgical consent forms.

Cataract Surgery Recovery

An uncomplicated cataract surgery typically lasts only about 15 minutes. But expect to be at the surgical center for 90 minutes or longer, because extra time is needed for final measurements and a brief exam and consultation with your surgeon before and after the procedure.

You must have someone drive you home after cataract surgery; do not attempt to drive until you have visited your eye doctor the day after surgery and he or she tests your vision and confirms that your visual acuity is adequate for you to drive safely without glasses.

You will have several follow-up visits after surgery to monitor the health of your eye and the quality of your vision. Be sure to use all medications as directed to promote healing and reduce the risk of complications, and follow all other instructions your eye surgeon and eye doctor give you.

Finally, be patient — it can take several weeks or even months for your vision to peak after surgery. Your eye doctor will keep you informed of your progress and prescribe glasses or recommend an additional vision correction procedure if needed.