A cataract is a clouding of the eye’s natural lens. Cataracts can affect vision in many ways, including:
Blurred, foggy, or hazy vision
Sensitivity to glare and bright lights, especially driving at night or towards the sun
Difficulty reading or seeing details, especially in dim light
Double vision or “ghost” images
Eye strain or fatigue
Take our Visual Function Assessment questionnaire to see if your cataracts may be affecting your vision.
Cataracts develop as part of the normal aging proess, but affect people at different rates and degrees. Risk factors for cataracts include a family history of cataracts, eye injury or disease, smoking, and use of certain medications such as steroids.
For people whose vision is affected by cataracts, cataract surgery may be recommended. During cataract surgery, the cloudy lens is removed and replaced with a clear artificial lens called an intraocular lens (IOL).
Advanced cataract surgery
Advances in cataract surgery have made surgery safer, more precise, more comfortable, and provided better and faster vision recovery than traditional techniques. Coastal Eye Specialists has long been at the forefront of these advances, and has been recognized as the leader in our community in introducing and popularizing many of the latest surgical techniques, equipment, and lenses that are now considered state-of-the art. Coastal Eye’s Medical Director, W. Lee Wan, MD, is also a respected and popular teacher of modern cataract surgery to colleagues as well as ophthalmologists-in-training at USC and globally.
Advanced cataract surgery uses a technique known as phacoemulsification, in which a small ultrasonic probe is used to liquefy and aspirate the cataract. This demanding, technically sophisticated technique allows “minimally-invasive” cataract removal, which provides a greater margin of safety, faster healing, less distortion of the eye, and quicker visual recovery. Today, phacoemulsification has become the standard cataract removal method for most cataract surgeons. Modern foldable intraocular lens (IOL) implants are made of soft, flexible materials (silicone, acrylic, or collagen) that can be inserted through tiny, self sealing incisions. Stitches are usually not required, and these micro-incisions reduce the risk of bleeding, scarring, and irritation, and allow a more rapid return to normal activities and good vision.
More recently, expensive, programmable lasers known as femto lasers have been applied to assist in certain steps of cataract surgery. While helpful in certain specific situations, the advantages of femto lasers in cataract surgery remain unproven, and it unclear whether they justify the added expense and complexity they add to advanced cataract surgery. Although Dr. Wan uses the femto laser in selected cases, he does not rely on it for most routine cataract surgeries.
Advanced cataract surgery techniques allow most procedures to be performed using topical (eye drop) anesthesia, eliminating the need for injections around the eye. This also allows patients to use the eye immediately after surgery (although vision may still take time to recover), and reduces the need for patching the eye after surgery.
The Surgical experience
Before surgery, a pre-op exam is needed to obtain measurements that help the surgeon select the optimal IOL for your eye, and review the specifics of your surgery. Drops are often started a day before surgery. Routine pre-op testing and a recent evaluation from your primary care physician is usually needed. Cataract surgery is performed as an outpatient at one of our affiliated Medicare-approved outpatient surgery centers.
When you arrive at the center, you will be given drops to prepare the eye. The actual surgery typically takes 10-15 minutes, but you will be at the center for a few hours for pre- and post-operative care. Surgery is usually done with sedation, given intravenously, to help you feel relaxed and comfortable. Most patients are given sedation so they are relaxed and comfortable, but not completely unconscious, during the brief procedure. During the surgery, you may hear noises and feel some touch around the face and eyes, but there is rarely any pain or unpleasant sensation.
After surgery, you will relax for 15-30 minutes to allow the sedation to wear off. You will be sent home with sunglasses to help reduce light sensitivity (which is common for the first few days), and a protective shield to cover the eye when you are sleeping. You can bend over and lift things immediately after surgery, as long as you don’t strain excessively or allow blood to rush to your head. Avoid rubbing or bumping the eye, and keep it clean and dry for the first week. You will be on eye drops for several weeks after surgery to speed healing.
If your other eye needs surgery, it can as soon as the next week, once we see that the first eye is healing as expected. Glasses, if needed, can be prescribed anytime after surgery, but we usually encourage waiting several weeks to ensure that the prescription is stable
Advanced IOl implants
Aspheric monofocal iols
These advanced lenses have optically-corrected designs to reduce aberrations in vision after cataract surgery. These IOLs compensate for imperfections in the eye’s optics, and provide better vision in low-contrast or low-light situations than traditional non-aspheric designs.
Astigmatism-Correcting (Toric) IOLs
Toric IOLs, designed to correct astigmatism (uneven, football-shaped curvature of the eye), were introduced in 1998, and Coastal Eye pioneered the use of these specialty IOLs since then. For patients with astigmatism, use of a toric IOL can result in better, sharper vision and less need for glasses than standard IOLs. More recently, Toric IOLs that combined near correction (presbyopia-correcting IOLs) have also become available that can correct both astigmatism and near vision.
Presbyopia correcting iols
Presbyopia-correcting IOLs can provide close as well as distance vision. Presbyopia is the age-related loss of close focus that affects most people in their 40’s. The first presbyopia-correcting IOL was approved in 1997 and Coastal Eye has had extensive experience with them since that time, with excellent results. Updated designs have been introduced since then, which have significantly improved the results and broadened the applicability of this class of IOLs. Presbyopia-correcting IOLs are an increasingly popular choice among patients who want to reduce their need for glasses after surgery, for close as well as distance.
Presbyopia-correcting IOLs come in different designs, including the ReStor IOL, the Tecnis® Multifocal IOL, the Symfony® Extended Depth and Extended Depth Toric IOLs, and the Crystalens and Trulign® Toric IOLs. These implants are designed to provide both distance and close vision, and can also correct for astigmatism. Each design has pros and cons, and may not be suitable for all patients; none of them yet re-create the vision of a perfect 20 year-old eye. But for the right patient, these are the “best” and most advanced IOLs available and can provide the fullest,most natural and useful range of vision possible for many patients. Dr. Wan is one of a rare group of elite surgeons who have experience and expertise with all of these sophisticated and demanding IOLs, making he and Coastal Eye’s team the experts in determining which of these specialty IOLs might be best for you.
Which iol is right for me?
Advanced astigmatism- and presbyopia- correcting IOLs are an excellent option for patients who wish to reduce their need for glasses or contacts at the same time they have cataract surgery. A complete eye exam and consultation with the surgeon are needed to determine which type of IOL will best meet your needs, lifestyle, and budget. Not everyone is a candidate for these advanced IOLs. Most patients will get satisfactory results with a standard IOL, but for those who are appropriate candidates, these advanced IOLs offer a unique, once-in-a-lifetime opportunity to optimize their vision and reduce their need for glasses at the same time they have their cataract removed.
Toric and presbyopia-correcting implants are considered specialty IOLs; extra measurements, calculations, planning, and post-op care are essential for optimal results with these lenses. If cataract surgery is considered “medically necessary,” medical insurance will usually approve the costs of the basic surgery and a standard or aspheric monofocal IOL. Patients are then responsible for the difference between the cost of the specialty IOL surgery and standard IOL surgery. The out-of-pocket cost difference will depend on the type of correction desired, and can only be determined after a surgical consultation. When considering costs, remember that the IOL you choose is permanent and lifelong, and you will look through it for every waking minute for the rest of your life. There are very few things that you can invest in that will provide as much benefit as your future vision.
Refractive Lens Exchange
Refractive lens exchange is a surgical procedure that replaces the natural lens with an intraocular lens (IOL) to correct farsightedness, nearsightedness or astigmatism. Available as an alternative to laser vision correction, this procedure avoids the need for corneal surgery done during laser vision correction, and instead involves the same procedure used in cataract surgery. Generally, it is reserved for patients who may not be candidates for laser vision correction, often with higher degrees of nearsightedness or farsightedness, or for patients who may have early cataracts but do not wish to wait for the cataracts to become disabling.
Patients who choose to undergo refractive lens exchange have many options, similar to cataract patients, when it comes to the IOL that will be implanted into the eye, depending on their visual needs.