Cataracts
Common Symptoms
- Cloudy or blurry vision
- Colors seem faded
- Glare and haloes. Headlights, lamps, or sunlight may appear too bright.
- Poor night vision
- Double vision or multiple images in one eye.
- (This symptom may clear as the cataract gets larger.)
- Frequent prescription changes in your eyeglasses or contact lenses
Surgery Process
The eye functions just like a camera – it has a natural lens inside the eye to help focus light clearly onto the retina (like the film of a camera). A cataract is the clouding of the natural lens in the eye; so when something is disrupting the lens, it is hard to get a clear picture.
Cataract surgery involves removing the natural lens of the eye that has become cloudy and opaque, and implanting an artificial lens, typically made of acrylic. Today, cataract patients have many options and choices! Patients can choose how they want the cataract removed and how they want to see after surgery.
Questions to Ask Yourself
HOW DO YOU WANT YOUR CATARACT REMOVED?
Simply put, the method of removing a cataract has advanced tremendously. Patients are now able to choose between the standard, traditional method of cataract surgery involving handheld blades and instruments or an advanced laser-assisted, bladeless surgery, known as ReLACS.
Traditionally, incisions in the cornea are made using handheld blades to access the cataract. ReLACS (Refractive Laser-Assisted Cataract Surgery) uses femto-second laser technology to precisely create all incisions, a perfectly circular opening in the lens capsule, break-up and soften the hard cataract, and reduce astigmatism. Patients do very well with both procedures, however the accuracy and reproducibility of the femto-second laser allows for a more predictable and precise visual outcomes. The traditional approach is a tried-and-true technique that allows patients to do very well after surgery and is covered by insurance companies.
ReLACS allows for a quicker recovery and reduced dependence on glasses; this method however is not covered by insurance companies at this time.
HOW DO YOU WANT TO SEE AFTER SURGERY?
At the time of your cataract surgery, you will receive an intraocular lens implant (IOL) during the operation. The type of lens implant you choose will, in part, determine how you see after surgery. Traditionally, the need for glasses was almost a given after cataract surgery.
Over the past five years, however, technology within cataract surgery has experienced tremendous leaps and bounds; now, we are not only able to correct your cataract, but we are able to correct your vision at the same time. A variety of lens choices allow patients to customize their visual outcome! Choices include a standard monofocal IOL, a Toric IOL, a Multifocal IOL, an Extended Depth of Focus (EDOF), and an Accommodating IOL.
The standard monofocal design is a single-vision lens and thus most patients will need glasses to optimize their vision for near, intermediate, and far distances. The standard monofocal lens is covered by insurance. For patients with astigmatism, the Toric IOL significantly reduces and may even eliminate this type of refractive error; patients who receive this implant may simply need over-the-counter reading glasses for near vision and benefit from sharp, clear distance vision.
For patients desiring the least dependence on glasses, the Multifocal and EDOF IOLs are today’s best options when considering cataract surgery. For the right candidate, these lenses give great, “get-around” vision – near, intermediate, and far vision all without the need of spectacles. Occasionally, a cheap pair of “cheaters” may be necessary for very fine print, but most patients are amazed at their newfound independence.
Cataract Lens Guide
Once your cataract is removed a new lens implant is inserted into the eye. There are several IOL (intraocular lens) options available. It is important to familiarize yourself with the options you have, so that we can make the best decision for you and your vision going forward.
MONOFOCAL ASPHERIC
These lenses correct vision for a single distance, either distance or near. The majority of patients with this lens implant will need glasses to see clearly. This lens does not correct for astigmatism (misshaped surface of the eye that causes distorted vision) or presbyopia (loss of near vision that occurs with age). These lenses are the only IOLs covered by medical insurance. Examples include: Alcon SN60WF and Tecnis ZCB00.
TORIC MONOFOCAL
These lenses correct vision for a single distance, either distance or near, while also correcting for astigmatism. Remember, astigmatism is the misshaped surface of the eye that causes distorted vision. The result is clear, crisp distance vision. Many patients simply need over-the-counter reading glasses for near vision, and some may opt for mono-vision to reduce the need for readers. Mono-vision is the term used when one eye is corrected for distance and the fellow eye is corrected for near; the result is a blended vision which significantly reduces the need for glasses. Examples include: Alcon AcrySof Toric IOL and Tecnis Toric IOL.
MULTIFOCAL IOL
These types of lenses are designed to be able to provide patients the ability to see objects clearly at different distances without glasses—near, far, and in between. The lens material distributes light to different distances, which the eye can focus on for sharper vision. For people who are active and find wearing glasses inconvenient, this lens may be the optimal choice. This lens corrects presbyopia, and may also correct for astigmatism, if needed. A con of this lens design is potential nighttime glare and halos. This lens type may not be appropriate in patients who have had vision correction in the past, such as LASIK, PRK, or RK. Examples include: Tecnis Multifocal IOLs, Alcon Restor IOL, and the newest Alcon Panoptix IOL.
EXTENDED RANGE OF VISION IOL
This newest design of lenses provides high-quality continuous vision so patients can see clearly at near, intermediate and far-away distances, and points in between, while wearing glasses less. The lens material allows distribution of light to different distances, similar to the Multifocal IOLs, but newer technology allows improved continuity of vision between daytime and nighttime as well as having a low incidence of halo and glare. This lens corrects for presbyopia and astigmatism, if needed. As above, this lens may not be appropriate in patients who have had vision correction in the past, such as LASIK, PRK, or RK. Example includes: Tecnis Symfony IOL.
ACCOMMODATING IOL
This lens implant uses the eye muscle to flex and accommodate in order to focus on objects in the environment at all distances. The lens platform is similar to a monofocal IOL in that it will allow all of the light to focus within the eye, provide great nighttime vision, and great contrast vision, while also dynamically adjusting to a range of your visual needs. This lens corrects for presbyopia and astigmatism, if needed. This IOL is a good option for post-refractive (history of LASIK, PRK, RK) patients who want an extended range of vision. Examples include: Bausch and Lomb Crystalens AO and Trulign Toric IOL.
Special Considerations
DO YOU HAVE A HISTORY OF VISION CORRECTION SURGERY (LASIK, PRK, RK)?
Patients with a history of vision correction surgery (LASIK, PRK, RK) do very well with cataract surgery, however there are a few considerations to keep in mind. Vision correction surgery changes the shape and contour of the cornea to allow patients to see well at the time of surgery. At the time of cataract surgery, however, the prior surgery reduces the accuracy and predictability of not only the pre-operative measurements, but also the surgical outcomes. Additionally, patients with a history of vision correction ARE NOT good candidates for advanced lens implants, such as the Multifocal or Extended Depth of Focus IOLs; implanting these types of lenses will result in increased glares and haloes, and may reduce the quality of vision.
HOW DO WE OVERCOME THESE ISSUES IN PATIENTS WITH A HISTORY OF VISION CORRECTION?
There are three primary procedures our office implements to give patients with a history of vision correction the highest chance of visual success:
- Pre-operative discussion: In our experience, the most important part of the surgical process in patients who have a history of vision correction surgery is a lengthy and detailed pre-operative discussion. It is important to understand that the measurements taken prior to surgery may not be as accurate and predictable; these patients may still need some level of spectacle correction after surgery. Identifying obstacles prior to surgery puts patients more at ease and they are much more comfortable throughout the process as they will know what to expect.
- ORA (Optiwave Refractive Analysis): This is a device that allows on-demand power calculation and is used to ensure proper implant power, IOL placement, and/or determination of the magnitude and direction of astigmatism. The device takes 40 real-time measurements to validate the correct targeted IOL (intraocular lens). The measurements are taken after your cloudy cataract is removed and prior to implantation of the lens. This device may be used during any type of cataract surgery, but is most helpful in patients who have a history of vision correction surgery. In order to achieve the highest level of success, all patients who have a history of vision correction will undergo this measurement at the time of cataract surgery. Since this is a custom option, the use of this device is not covered by your insurance, and the additional out-of-pocket fee is $250.
- Post-cataract surgery enhancement: Despite a thorough pre-operative discussion and use of ORA technology, some patients still fail to reach the target correction after surgery. In these patients, the initial management is observation for up to 3-6 months; oftentimes, the target will drift back to the expected correction. If this does not occur, Dr. Patel can perform an enhancement using PRK (photorefractive keratectomy) to correct the residual refraction. This procedure is similar to your vision correction surgery you had many years ago and allows patients to achieve the target visual outcome. If a patient does not want an additional enhancement, many patients can be correct with a pair of prescription glasses. It is important to know that enhancements are rarely needed. If required, the enhancement is a separate, non-covered, procedure and the out-of-pocket fee is $1200.
HOW DOES DRY EYE SYNDROME AFFECT CATARACT SURGERY?
Dry Eye Syndrome is a very common condition that affects the ocular surface as a result of not having enough tears to lubricate the eyes or simply having poor quality tears. During every cataract evaluation, we look for signs and symptoms of dry eye. Treating dry eye before cataract surgery will stabilize the ocular surface and increase the accuracy of the preoperative IOL measurements. If the dry eye is severe, punctal plugs or a prescription drop (Xiidra or Restasis) can be used a few weeks before surgery to improve the ocular surface. While there may not be an actual cure for dry eye, preparing your ocular surface prior to anticipated cataract surgery will certainly minimize post-operative complaints and maximize results.
WHAT IS MONOVISION (BLENDED VISION)?
Most people have a dominant eye (one that you prefer to see with if you had to close one eye). With monovision, the vision in your dominant eye is corrected for distance vision, while your other eye is intentionally left somewhat nearsighted to allow you to see close objects. Both eyes still work together, allowing you to see clearly at any distance. While this way of seeing may sound complicated, many people find they adapt well to this technique. In fact, with both eyes open, they may not be able to tell which eye is set for distance and which is set for near.
However, monovision is not for everyone. Some people find they simply cannot adapt to it. This is why Dr. Patel usually recommends trying monovision with contact lenses first before committing to surgery for presbyopia with monovision IOLs as part of cataract surgery.
If you are considering monovision—or blended vision—keep in mind that because one eye is focusing at one distance while the other is focused at another, you may lose some depth perception. Also, you might still need to use reading glasses in certain cases, such as reading small print.
Cataract Surgery Choices
Fortunately, cataract treatments have evolved dramatically over the past 20 years. In fact, it has changed into an even more sophisticated procedure within the past year alone.
These decisions can often become difficult, but as I tell all of my patients prior to explaining the options, “There is no bad choice!”
FEMTOSECOND LASER PACKAGES
The Femtosecond Laser automates the most critical portions of the surgery including incisions with the use of a laser that is a millionth-of-a-billionth of a second fast.
- Laser with Standard Lens: $1500 per eye
- Laser with Toric Lens (Astigmatism): $2200 per eye
- Laser with Multifocal Lens/Accommodating IOL: $3200 per eye
STANDARD SURGERY PACKAGES
Manual surgery has been the tradition for many years. Although manual surgery with blades is not as accurate as a laser, Dr. Patel has optimized his results using micro-incisions to ensure the best outcomes.
- Standard Surgery with Standard Lens: No out of pocket cost
- Standard Surgery with Toric Lens/LRI (Astigmatism): $1000 per eye
- Standard Surgery with Multifocal Lens/Accommodating IOL: $2000 per eye
INSURANCE COVERAGE
Cataract surgery costs are generally covered by Medicare (if you are Medicare eligible) as well as by most private insurance plans. Your cataract surgery costs will be covered by your health insurance as long as your vision tests at a certain level of acuity or clarity.
If you have a private insurance plan, they too may have similar vision requirements that you must meet in order to have your surgery covered.
Even if Medicare or private insurance covers your cataract surgery, there may be some costs you would still be responsible for, such as an upgraded intraocular lens (IOL) of your choosing or having cataract surgery before your vision has deteriorated enough to be eligible for Medicare or insurance coverage.
OUT-OF-POCKET COSTS
It is important that you know the full spectrum of your potential costs. Your out- of- pocket costs may include copays, co-insurance, surgery center co-pays, anesthesia fees, as well as any upgrades you may choose. The total amount can vary depending on the details of your particular plan.
You should contact your provider for the most accurate estimates. Our office will always be available to assist you in this process.
Appointment Expectations
PRE-OPERATIVE EYE EXAM WITH DR. PATEL
During this visit, intra-ocular lens measurement and power calculations will be performed. Contact lens wear may cause an error in the results of the implant power measurement. Because of this, soft contact lenses must be removed one week prior to appointment and hard contact lenses must be removed two weeks prior to appointment.
You and Dr. Patel will decide on the best method of cataract surgery, as well as the best type of lens for the vision you desire. (Come prepared with questions!)
PRE-OPERATIVE CLEARANCE
Physical examination and EKG with your Primary Care Physician (PCP) and/or Cardiologist (if you have any history of heart conditions). Schedule this appointment as soon as possible with your primary physician and/or cardiologist. Your pre-surgical clearance needs to be completed within thirty days of surgery.
SURGERY
Your surgery will be performed at one of three locations: AdventHealth East Surgery Center, AdventHealth Winter Park, or Orlando Ophthalmology Surgery Center. The date and time of your surgery will be scheduled at our office. Prompt arrival to the appropriate center will ensure a smooth day of surgery.
POST-OPERATIVE APPOINTMENTS
All post-operative appointments will be at our office. You will be seen a day, a week, a month, and three months after your surgery. These appointments are very important to ensure that the healing process is progressing appropriately.
TRANSPORTATION
Arrange transportation to and from the surgery center for the day of surgery and the day after surgery. Please be flexible, it may be necessary to adjust your arrival times.
Pre-op Instructions
- Do not eat or drink anything (including coffee) 8 hours prior to surgery.
- Any oral medicines that you normally take in the morning may be taken with a very small sip of water, on the morning of your surgery. All diabetics should contact their internist on how to manage their insulin on the day of surgery.
- Do not wear makeup the day of your surgery.
- Report to the hospital two hours prior to your scheduled surgery time. The hospital will tell you the exact time to arrive when they call to remind you the day before surgery.
- You must have a driver to drive you home after surgery.
- Keep tip of eye dropper clean and do not touch tip to the eye or any other
object. - Wait five minutes between each different eye medication. 8. Each medication has refills if needed.
Post-op Instructions
- Day one of your eye medications starts immediately after you arrive home from surgery.
- Wear shield at night for one week.
- Use warm water or warm soapy water to cleanse around eye.
- Do not rub eye for one week.
- Keep eye closed while showering for one week.
- Do not get water in the eye for one week.
- No make-up around eye for one week.
- You may NOT bend at the waist or perform strenuous activity for approxi- mately 1 week after the surgery.
- You have no restrictions after one week.
- You may drive when you feel your vision is adequate. No vigorous
exercise (including swimming) for one week. - You may return to work five days after surgery. Ask doctor if you wish to return sooner.
- Keep tip of dropper clean and do not touch tip to eye or any other object.
- You will experience a foreign body sensation in the eye for several weeks
after surgery. - It takes approximately one month to get your best vision. Your vision will be blurred while your eye is healing.
- Your eye may be dilated for 2-3 days after surgery.
Surgery Centers
We participate with three surgery centers to give each patient a variety of options from location, time of surgery, and insurance coverage. Below you will find the name, address, and contact information for each of our surgery centers. Be sure to confirm which center your surgery will be performed at.
