Cataracts

At birth, the natural lens of your eye is crystal clear—allowing light to pass through easily. As you age, your lenses yellow and harden and may become cloudy—blocking the passage of light through the eye, which makes your vision more and more blurred. This natural part of the aging process, which you unfortunately cannot control, is called a cataract.

Because this change happens so gradually—and usually over a long period of time—many people do not notice a significant change in their sight until vision loss has occurred.

Although most commonly seen in adults over the age of 60, cataracts can occur at any age. The condition may be present at birth or caused by an injury to the eye. Infections and other eye diseases, such as glaucoma and eye tumors, may cause the development of a cataract.

The following symptoms can indicate the presence of a cataract:

  • Cloudy, dimmed, or blurred vision
  • Double vision
  • Presence of halos or glare around lights
  • Presence of halos or glare around lights
  • Colors appear less vivid or yellowed
  • Frequent need to change glasses or contact lens prescription
  • Feeling of “film” over the eyes

WHAT CAN I DO ABOUT MY CATARACTS?

Surgery is the only solution for cataracts.

You should consider surgery when changes to your vision affect your daily activities.
During cataract surgery, your clouded or hard natural crystalline lens is removed and replaced with a new artificial lens. This new lens is known as an intraocular lens (IOL).

There are several types of intraocular lenses (IOLs) Dr. Leonard can use when correcting your cataract, depending on your vision impairment and needs.

A monofocal IOL, or single-focus lens, provides clear vision for far away objects. After surgery using this type of lens, you will still need glasses for reading or other activities that require you to see clearly up-close.

Dr. Leonard will use New Technology Intraocular Lenses (NTIOLs) to compensate for the way your eye focuses light.

Depending on the geometry of your eye, she will select the individual lens best suited for your specific eye shape.

Astigmatism is a common condition in which the cornea of the eye, which is usually perfectly round (like the side of a basketball), is instead curved more in one direction than the other (like the back of a spoon). When images enter the eye of a patient with astigmatism, they become distorted.

Dr. Leonard can reduce astigmatism during lens replacement either by reshaping the cornea with a laser or by implanting an IOL that not only enhances your vision, but also corrects your astigmatism. A lens implant called a Toric lens compensates for specific deficiencies in your vision if you have both cataracts and astigmatism. The Tecnis Toric and the Alcon Toric lenses greatly reduce the likelihood of needing additional surgery to correct astigmatism after your lens replacement. Keep in mind—you may still need to wear reading glasses if you have astigmatism correction.

If there is a lesser degree of astigmatism, Dr. Leonard can use a standard monofocal IOL with laser relaxing incisions to reshape the cornea and reduce the astigmatism.

Once Dr. Leonard fully understands your level of astigmatism, she will recommend the best lens and surgery plan for your individual needs.

Recent advances in technology have created multifocal lenses that make it possible for you to see clearly both up-close and at a distance. A multifocal lens is your best option if you would like to be glasses-free the majority of the time. For patients who would like to improve their vision at all ranges, Dr. Leonard offers several options.

The Tecnis and ReSTOR Multifocal IOLs are designed to improve vision at all ranges from distance to near.

Tecnis Symfony® Extended Depth of Focus IOL . This revolutionary lens is the first and only presbyopia correcting IOL that provides a continuous full range of high quality vision. These lenses allow you to see clearly at near, intermediate and far distances. These IOLs also minimize side effects associated with multifocal IOLs like glare and halos around lights.

The Symfony Toric Extended Depth of Focus Vision IOL provides enhanced distance and intermediate vision, with improvement in near vision as well, in patients who have significant astigmatism.

New technology has made it possible to replace the manual instruments and blades used in traditional cataract surgery. Laser cataract surgery—first performed in the United States in 2010—takes an already safe and effective procedure and makes it even more precise. The vast majority of patients undergoing cataract surgery today are candidates for laser cataract surgery. In non-laser basic cataract surgery, the surgeon makes incisions and removes the cataract using surgical instruments and blades. However, during laser cataract surgery, Dr. Leonard uses the Catalys femtosecond laser system to assist with many parts of the procedure. The laser can create a corneal incision, form an opening in the capsule of the lens, and soften the cataract. This computer-controlled surgery is performed at a level of customization not attainable with other traditional surgical methods. Laser surgery can also precisely place surface incisions to reduce and eliminate corneal astigmatism.

Laser cataract surgery, when paired with the latest lens technology, enables patients to see clearly at all distances—with the least reliance on glasses or contact lenses. Laser cataract surgery can be used for all of the previously mentioned lens types:

  • Monofocal for distance vision
  • Toric for distance vision and astigmatism
  • Multifocal for near and distance vision, with or without astigmatism

Which cataract surgery is a good fit for you?

After assessing your vision needs and individual situation, Dr. Leonard will determine if laser cataract surgery is a good fit for you.

During your examination, Dr. Leonard will discuss your surgical options and help you choose the type of cataract surgery that is best suited to your needs and lifestyle.

QuestionLens OptionsIs laser
surgery
an option?
Do you need help with seeing things that are far away?
Do you not mind wearing glasses for near vision?
Monofocal IOL:
• New Technology
Intraocular Lenses
Yes
Do you have astigmatism in addition to
cataracts?
Laser Correction of
Astigmatism
Toric IOL:
• Tecnis Toric
• Acrysof Toric
Yes
Would you like to be able to see things up close (labels, smartphones, computer screens, newspapers) and far away (street signs, television screens)? 
 

Do you ideally not want to be dependent on glasses
for sight at any distance after surgery?

Multifocal IOL:

  • Symfony Extended Depth of Focus
  • Tecnis Multifocal
  • ReSTOR Multifocal

Multifocal with
astigmatism:
  • Symfony Toric

Yes

What Results Can I Expect?

After cataract surgery, 9 out of 10 people regain very good vision somewhere between 20/20 and 20/40 according to Prevent Blindness America (PBA).

What Does Lens Replacement Cost?

Aside from your deductible or co-pay requirements, your health care insurance plan or Medicare should cover basic elements of cataract surgery. Costs that will likely be out-of-pocket are the lenses (monofocal, Toric, or multifocal) and any after-surgery care. Pricing for these services will depend on your insurance and surgery center of your procedure. There are also several tests that Dr. Leonard performs before surgery which insurance companies will not cover, as they are considered screening tests. These tests involve obtaining additional measurements of your eye to more accurately select an appropriate lens, examining the curvature of your cornea, and Ocular Computed Tomography (OCT) of the retina to determine the health of your macula. (Most ophthalmologists consider these tests to be very important and would want to have them done on themselves if they needed cataract surgery.)
Medicare and most insurance companies also do not cover pre-existing astigmatism correction or presbyopia (blurred near vision) treatment.

FREQUENTLY ASKED QUESTIONS

Lens replacement is the only permanent vision correction procedure that corrects near and distance vision issues. If your vision is impaired to the point where it is hard for you to go about your daily activities (such as driving), Dr. Leonard will likely discuss cataract surgery with you as your best option.

If you do not have cataracts but would like to reduce or eliminate your dependence on glasses, you may be a candidate for this surgery.  However, in that case it would not be covered by insurance.  For many people, this is a much better option than LASIK, and has the advantage of never needing cataract surgery in the future.

Your lens replacement procedure will be performed in an outpatient surgery center. You will not be asleep for the procedure. You will be given medication to numb your eye, and a local anesthetic will make the operation virtually painless. You will also be given medication to make you relaxed and comfortable throughout the surgery.

The entire procedure takes about 15 minutes but you can expect to be at the surgery center for about 3 hours.

Normally, only one eye is treated at a time. You will need to schedule another surgery at a later time for your other eye. Because the surgery is an outpatient procedure, you won’t have to stay overnight in a hospital or surgery center. Most people are able to return to normal activities the following day.

Though cataract surgery is one of the safest and most successful surgeries performed in the United States, as with any surgical procedure, there are risks involved. These risks may include: infection, retinal detachment, an increase in eye pressure, reactions to medicines, and vision changes. There is a small chance that your vision could be made worse by the operation, especially if bleeding or infection occur. These risks are rare and should be weighed against the potential benefits of restoring your vision. Dr. Leonard will discuss all risks and benefits with you before your surgery.

When the operation is over, a plastic shield is placed over your eye. After a short stay in the outpatient recovery area, you will return home a few hours after the procedure with little or no need for pain medication. You will return to the office for a post-operative visit the next day.

Once you and Dr. Leonard have decided that you will have your lens removed, she will perform a complete eye health exam. During this process, she will assess your vision and measure your eye to determine the proper power of the IOL best suited for your eye.

Common side effects include redness, scratchiness to the eye, and light sensitivity. In addition, you may have glare, rings around lights, and blurred vision. These side effects may make it more difficult to see while driving at night or working in low light for a period of time after your surgery. These side effects generally resolve over time.

Most people notice improvement in their vision by the next day. Your vision will then continue to sharpen over the next 30 days, as you adapt to your new IOL.

Once your cataract is removed, it can’t grow back or form again. Once implanted, changing out an intraocular lens is rare and a significant surgical procedure, which is why Dr. Leonard will help you choose the best option for you.