Cataract surgery is a quick and painless procedure. It is done as an outpatient in a hospital or surgical center. Generally we do not need to use shots, stitches or patches. While the procedure gets getter all the time, the newest advancement in cataract surgery involves the implants inserted at the time of surgery.

These tiny plastic implants have long allowed great distance vision after surgery but now we can correct for near vision too with Bifocal-like implants.

We also can decrease or eliminate any astigmatism you may have with Toric implants. The implant choices available to you depend on your eyes and your visual needs. When you are seen for your cataract evaluation you doctor will explain your possible choices.

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As noted above, we insert a tiny plastic implant into the eye at the time of cataract surgery. Without an implant, your vision would be quite blurred after surgery and you would require thick glasses or contact lenses to see which is the way cataract surgery was done years ago.

There are now three basis types of implants:

• Standard
• Bifocal-like
• Toric

Your options vary depending on whether you have astigmatism or not. Astigmatism occurs when the front part of the eye is curved or football shaped as opposed to being round or baseball shaped.

If your have astigmatism (a football shaped eye) your options are either the Standard or Toric lens implant.

If you do not have astigmatism (your eye is baseball shaped) then your options are either the Standard or Bifocal-like lens implant.

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Your choice depends on how you feel about glasses after cataract surgery. You only have cataract surgery once so this decision is quite important.

THE STANDARD IMPLANT OPTION

If you love bifocal glasses, then stay with the Standard implant. But even if you haven’t really minded glasses in the past, you have to admit that they get in the way, cost money and require that you look down to read. Furthermore, using a computer with bifocals can lead to neck pain. So just because you have always had glasses, doesn't mean you shouldn't at least consider the other options.

THE BIFOCAL-LIKE IMPLANT OPTION

The Bifocal-like implants allow you to see well far away for driving, near for reading and at intermediate distances for computers or counter top activities all without glasses after surgery. With these implants you could play golf with over-the-counter sunglasses and keep score without looking for reading glasses. While we don’t guarantee that you would never use glasses with these implants, it would be rare. This freedom from glasses makes your life simpler and really “turns back the clock” to a time when you did not need glasses. We have many patients who are actually now wanting their cataracts to worsen so they can take advantage of these Bifocal-like implants! They turn something that is potentially negative, a cataract, into something positive: relative freedom from glasses.

Remember, you have to have rounded, baseball shaped eyes for the Bifocal-like implants to work well.

THE TORIC IMPLANT OPTION

If you have astigmatism or a curved shape to the front of your eyes, then sadly the Bifocal-like implants are not available to you but you could take advantage of the Toric implants. They compensate for your astigmatism so you have great distance vision without glasses after surgery. You would still need glasses to read but could probably get by with over-the-counter reading glasses. You would no longer have to hassle with thick bifocal glasses and having to be sure they were adjusted just right to see well.

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Certainly not. You could elect to have your implants set for monovision. This means that you would see well far away with one eye and close-up with the other. Again, you would be relatively free of glasses but would lose some of you depth perception - potentially making driving and activities such as golf a problem. Monovision also sacrifices some of the clarity in your vision because you are only using one eye for each distance. Thirdly, as you only have two eyes, monovision has the disadvantage of only allowing focusing at two distances (usually near and far away).

In contrast, the Bifocal-like implants allow you to use both eyes so they do not compromise your depth perception. In addition with Bifocal-like implants, you can see well at all three distances: near, intermediate and far.

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One disadvantage is that you may require a slight refractive adjustment with a laser to improve your vision after the cataract surgery. There cannot be any residual near-sightedness, far-sightedness or astigmatism after the cataract surgery for the lenses to work optimally.

Another disadvantage is cost. While the fees associated with your actual cataract surgery are probably covered by your insurance or Medicare, the up-grade to a Bifocal-like implant would not be. These extra fees are for the additional testing necessary before surgery, the added cost of the implant itself and any refractive adjustments required to optimize your vision after surgery. The added fees are about $2000 per eye. But if you really dislike glasses, wouldn't it be worth it to be able to read and drive without them?

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With the Toric implants, you would still need glasses to read. Also, you may have too much astigmatism for these implants. Like the Bifocal-like implants, Toric implants are an upgrade from what your insurance covers but do give you the opportunity to maximally improve your distance vision. The added fee for a Toric implant is about $1000 per eye.

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Consider your visual needs and how you feel about glasses. The Bifocal-like implant is ideal for those with active lifestyles who are annoyed by glasses. They allow you to turn a potentially negative condition, cataracts, into an opportunity to expand your vision. Not everyone, however, is a candidate for a Bifocal-like lens implant. You may have too much astigmatism or an abnormal retina.

If you do have significant astigmatism, then the Toric implants work beautifully to improve you distance vision after surgery.

Our staff and doctors will discuss your potential implant options are at the time of your cataract consultation.

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You can't really tell if you have a cataract without a complete examination by an ophthalmologist or optometrist. The symptoms of a cataract are a gradual blurring of you vision, mainly for distance, and problems seeing at night due to glare or halos around lights. But blurred vision can have many causes, thus the need for the examination. Cataracts usually develop slowly so any rapid change in vision, for instance over night, is probably due to a more serious problem and requires immediate attention.

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Cataract surgery is an outpatient procedure that usually takes about 10 or 15 minutes. You are at the surgical facility 3 or 4 hours, however, to prepare for the surgery and recover. Be sure to arrange for a ride home afterwards because we do use mild IV sedation.

Once in the operating room, you lie on your back and look at a bright light during the procedure. Generally no shots, stitches or patches are required. You are relaxed but can hear everything that is going on during the procedure. Dr. Jay or Dr. Cueto will explain what is happening and where you are suppose to look. It is important that you not move or talk during the procedure - just keep looking at the light. Cataract surgery is not generally painful during the procedure or afterwards.

After the surgery, your vision is a bit blurry but improves over the next several hours. There is generally no patch over the eye. You can do just about anything except drive for the rest of the day but might feel more comfortable just going home and relaxing. The use of eye drops needed after surgery will be explained to you along with your restrictions which include not lifting anything over 30 pounds, pushing on the eye or swimming for two weeks after surgery.

We see you in the office the day after surgery.

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A cataract is a clouding of your natural lens, located behind your pupil. The lens contains protein that degenerates with age. When you are about 45 years-old, this change in the lens protein makes the natural lens firmer and that's why reading glasses are needed at that time. Later, the lens protein begins to change color which makes the lens cloudy. The result is a cataract and blurred vision.

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Dr. Jay or Dr. Cueto make a tiny incision in the eye towards your ear that is less than 3 mm in size. They then break up your natural lens with a tiny sound wave probe and gently vacuum out the cataract. All the instruments are very small and are viewed through a microscope. Once the lens has been removed, it is replaced with a tiny implant. If we did not use an implant, you would need thick glasses or contact lenses to see as was done 20 years ago.

As noted above, we now have the choice of placing an implant to maximize your distance vision only or one to allow both near and distance vision (Bifocal-like implants) without glasses after surgery. We also have Toric implants to compensate for your astigmatism.

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Cataract surgery is very safe and one of the most common operations in America. But it is surgery and problems could occur. Very severe complications such as bleeding, infection or blindness are fortunately rare - on the order of one in 200,000.

A more common, but still rare, potential complication is for the thin membrane behind the lens to break or for the small muscles that hold the natural lens in place to weaken. This could result in part of the lens going into the back of the eye. This is a fixable problem that occurs less than 1% of the time. On occasion, it may require a second surgery.

The bottom line is that 95% of patients are thrilled with cataract surgery and their recovery.

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Once we determine that you do have a cataract, our surgical coordinator will find a date for surgery and a time for you to return to be measured for the lens implant. Your post-operative appointments will also be arranged. You will be asked to call your primary care doctor to schedule a pre-operative history and physical.

When you return for the lens measurements, which takes about an hour, we will give you’re a kit containing eye drops and explain how they are to be used. On the day of surgery, you will be asked to change into a hospital gown. You may leave your undergarments on. An IV will be started and you will be placed on a gurney.

Once in the operating room, you should feel no pain and just concentrate on looking at the light. You will be in the operating room about 30 minutes and the procedure will take about 10 to 15 minutes.

Afterwards, you will return to you family or waiting friends for a light snack. You will be able to go home in 30 to 45 minutes after the surgery.

We will see you the next day in the office to be sure your healing is going well.

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Unfortunately no.

Dr. Jay and Dr. Cueto take pride in providing their patients with the latest innovations in cataract surgery and eye care. They have consistently have offered their patients the newest and best techniques available. That's why they generally do the small incision cataract surgery. The result is a no-stitch, no-patch and no-shot procedure. This makes the surgery quicker, safer and recovery more rapid.

The offering of Bifocal-like and Toric implants are further examples of our doctors being at the forefront of the field of ophthalmology.

Are there other questions we have not addressed?  Give us a call or click on "Contact Us.

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