Cataract surgery has long been one of the quickest and safest procedures around.  In just 10 minutes, without generally needing shots or stitches, your cataract is a thing of the past.  But we never stop striving to improve this already great procedure.  The latest innovation is the use of “bifocal-like” implants.  At the time of cataract surgery, we replace your natural lens with a tiny clear plastic implant.  In the past, we could only choose an implant that would improve your distance vision.  Now we have bifocal-like implants that let you see close up, intermediate distance, and far away – all without glasses.  This means that you may be able to read the newspaper, work on your computer and drive without glasses after cataract surgery. 

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They work in a couple of ways.  The ReSTOR and ReZoom lenses have multiple zones oriented in a circular or concentric fashion.  That means that you don’t have to look down to read, unlike the situation with bifocal glasses.  The Crystalens moves slightly in the eye to change the focusing point.  When you are seen for a cataract evaluation, we determine which implant would be best suited for your visual needs.  We will want to know about what you do on the job, what your hobbies are and how far away you like to hold reading material.

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That would be too good to be true!  What the lens does is allow you to be relatively free of glasses.  You still might need glasses to see things very close or small such as maps, phone books or the backs of medicine bottles.  For those rare activities, you would probably need weak over-the-counter reading glasses.  In contrast, if you had a conventional lens implant you would need glasses 100% of the time in order to see anything closer than about 3 feet away.

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Certainly not.  You could elect to have your implants set for monovision.  This means that we correct one eye for distance vision and the other for near vision.  Again, you would be relatively free of glasses but would loose 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, monovision has the disadvantage of only giving you two focal points (you only have two eyes!).  The bifocal-like implants allow you to use both eyes for 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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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.   And not everyone is a candidate for a bifocal lens implant.  You may have too much astigmatism or an abnormal retina.  We will let you know what your options are at the time of your cataract consultation.

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Astigmatism is when the front part of your eye, called the cornea, is curved like a football instead of round like a baseball.  This makes your vision blurry without glasses.  We have two ways of dealing with this common problem during surgery.  One is with the use of limbal relaxing incisions.  This means that we relax the cornea during surgery in the steep direction to round it out.  We routinely do this to optimize our patient’s vision after surgery but it has its limitations. 

A second option is with the use of toric lens implants.  These specially designed implants compensate for your astigmatism and work well for those with a more extreme astigmatism problem. Like the bifocal-like implants, toric implants are an upgrade from what your insurance covers but do give you the opportunity to maximally improve you vision.  The added fee is about $1000 per eye.   

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You can't really tell if you have a cataract without a complete examination by an ophthalmologist.  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 out-patient procedure that usually takes 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 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. 

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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 makes a tiny incision in the eye towards your ear that is less than 3 mm in size.  She then breaks up your natural lens with sound waves and gently vacuums it out.  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 (Crystalens Premium lens implants) without glasses after surgery.

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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 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 Cueto take pride in providing their patients with the latest innovations in cataract surgery and eye care.  Through continued education, they 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 more examples of Drs. Jay and Cueto 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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