The best cataract patient is an informed cataract patient.We encourage our patients to review the information provided about cataract diagnosis, treatment, and intraocular lens implant options. Your PVI SURGEON is ultimately responsible for deciding which surgical procedure is right for you. It's the one that will provide you with the very best vision outcome possible for your unique vision needs.
To learn more about cataract surgery, please review our answers to questions most commonly asked by our patients. We look forward to answering any additional questions you may have at your cataract evaluation visit or during your pre-operative exam.
"Thanks to Dr. Pepose, I am seeing signs of spring everywhere. And I'm able to see my golf balls land!" -- Jo Arnold
1. What is a cataract? A cataract is a clouding of the normally clear, transparent lens of the eye. A cataract is not a tumor or growth of new tissue over or in the eye. It is a fogging and loss of clarity of the lens itself. The lens is located in the eye just behind the iris and the pupil. The function of the lens is to focus light entering the eye onto the retina. When a cataract forms, the lens is no longer able to focus the light clearly and your vision becomes cloudy. An early cataract may cause few problems with vision. If the cataract gets worse, sight may be partially or completely lost until the cataract is removed.
Although cataracts result from many conditions, the most frequent cause is the natural aging process. Other causes may include eye trauma, chronic eye disease, and other medical conditions such as diabetes.
Cataracts can take from a few months to several years to develop. Certain medications can accelerate the development of cataracts. Sometimes, the cataract stops developing in its early stages and vision is only slightly decreased. But if it continues to develop, vision is impaired, and surgical treatment is required.
Back to Top2. My vision isn't as sharp as it once was. How do I know if I have a cataract? The only way to determine if your vision problem results from a cataract is to visit an eye care professional for a complete examination. At Pepose Vision Institute, we use the same state-of-the-art diagnostics to evaluate your eyes as we use for our laser vision correction patients. Our wavefront diagnostic technology generates thousands of data points about your eyes in a matter of minutes. We are the only cataract surgeons in the bistate area to provide this level of thoroughness during your exam. We ensure that your treatment plan addresses the primary reason for your diminished vision. PVI is highly experienced in the diagnosis and treatment of other eye conditions, such as glaucoma, and is able to provide the continuity of care you deserve, irrespective of the ultimate diagnosis.
The key to living with cataracts is knowing when it's time not to live with them any more! Usually, this happens when your normal lifestyle reading the morning paper, driving to the grocery store or seeing the expression on the face of a child or grandchild is jeopardized by impaired vision. Cataract surgery is just that - surgery and your surgeons at Pepose Vision Institute believe that the right time to have such surgery is an individual, personal choice that depends on one's individual lifestyle requirements.
Back to Top3. Can cataracts be cured? The only effective treatment for a cataract is surgery to remove the diseased lens. Neither diet nor medications has been shown to stop cataract formation. In a cataract operation, the eye's natural lens is removed. Vision can then be obtained by implanting a permanent intraocular lens (IOL), which replaces the natural lens. This artificial lens is made of plastic and is usually inserted at the same time the cataract is removed. Depending on the individual case, the lens is placed directly behind or, less frequently, in front of the iris, the "colored" part of the eye.
Back to Top4. Is there just one IOL that is used for everyone? Cataract surgery must be customized for each patient. Once it's determined that your natural lens should be replaced, an extensive pre-operative evaluation is required to ensure that the optimal synthetic lens is implanted. Like contact lenses and prescription eyewear, intraocular lenses differ in terms of refractive power. The length of your eye must be carefully measured and the curvature of the cornea evaluated. Calculation of the implant power is based on this information. Because your cornea plays a central role in determining the appropriate IOL, we strongly recommend that you consult a cornea subspecialist for your cataract surgery. At Pepose Vision Institute, our cornea subspecialty trained surgeons have the skill and experience required to ensure the very best vision result possible. This is particularly important if you have had previous cornea surgery, such as laser vision correction. In such a situation, calculating the appropriate IOL requires special expertise in order to incorporate the corneal changes resulting from this earlier procedure.
Back to Top5. I've heard about multifocal (trifocal) and monofocal IOLs. What is the difference? Until recently, a monofocal intraocular lens, which cannot change shape, has been the standard implant for cataract surgery. Its power is usually calculated to maximize a patient's distance vision so that the patient can see well enough to do most things without glasses. Reading glasses must still be worn to see up close up. In most cases, patients notice rapid and significant improvements in vision as a result of the IOL.
In 2005, the FDA approved the first major innovation in IOL technology in decades the multifocal IOL. This deluxe implant, which replaces the natural lens in the same fashion as the monofocal lens, gives good "walk around" distance and near vision, thereby lessening dependence on glasses. The FDA has approved three types of multifocal lens, each of which has been optimized for a slightly different vision zone. Pepose Vision Institute is the only cataract surgery practice in the region that has been certified to offer all three of these IOLs Crystalens, Restor and Rezoom. This gives us a unique opportunity to "mix and match" the IOLs used in each of your eyes and to personalize your vision outcome for your unique lifestyle.
Back to Top6. What are IOLs made of? Have any problems been reported with using a man-made lens to replace the natural lens? There are three materials presently used for intraocular lenses: polymethylmethacrylate (PMMA), silicone, and acrylic, with other materials currently under development. Each has advantages and disadvantages. PMMA must be implanted through a larger incision than the other materials. Silicone and acrylic can each be placed through a smaller incision than PMMA. Silicone lenses are usually avoided in diabetic patients and patients with severe retinal problems. Acrylic affords a very controlled unfolding of the lens. Today's intraocular lenses are very safe and effective. We use the most advanced lens material available and we tailor the choice of lens material to the needs of each individual patient.
Back to Top7. Are stitches (sutures) required for cataract surgery? One of the newest advances in cataract surgery is the ability to remove the cataract and implant an intraocular lens through a small incision. New techniques for making incisions have, in most instances, eliminated the need for sutures following cataract surgery. For some individuals, other types of incisions, ones that require sutures, will provide a better visual result. We select the surgical procedure that is best suited for each patient's situation.
Back to Top8. What results can I expect? Over 90% of people achieve a vision better than 20/30 after cataract surgery, as long as no other eye diseases are present (for example, a retinal condition). Reading glasses are required after cataract surgery (in many cases they were also required before surgery) when a monofocal IOL is used. Multifocal IOLs substantially reduce a patient's dependence upon reading glasses for near vision tasks.
Back to Top9. I have heard a lot about topical or "no-needle, no-patch" anesthesia for cataract surgery. What does this really mean? Originally, cataract surgery was performed under general anesthesia, requiring patients to stay in the hospital. Later advances used a local anesthesia injected behind the eyeball. Although this procedure allows patients to return home the same day and is safer than general anesthesia, it is not entirely free of risk.
Pepose Vision Institute has adopted the latest, safest approach to anesthesia, using topical anesthetics when medically permitted. The eye is anesthetized using eye drops rather than through an injection of anesthetic under the eyeball with a needle. Avoiding the needle reduces the risk of bleeding, bruising and inadvertent damage from the needle itself. Visual recovery begins immediately since the eye muscles are not paralyzed as with local block anesthesia. Even when topical anesthetics are used, patients may be given an IV sedative to help them relax and keep them comfortable during the procedure.
Back to Top10. Will my medical insurance cover my cataract surgery? Standard cataract surgery, using a monofocal IOL, is typically covered by most medical insurance plans as a "functional" eye surgery. Medicare covers this procedure, subject to the usual deductibles and co-payment requirements.
Because cataract surgery is the most common procedure surgery covered by Medicare, and accounts for a large percentage of Medicare expenditures, the Federal government has decided that it will not cover the additional costs associated with deluxe multifocal lens implants. Not only do these lenses cost more (8 to 10 times the cost of a monofocal lens), but the pre-operative and post-operative care required is substantially more resource intensive. Medicare has, however, agreed to cover the cost of cataract extraction and monofocal lens implantation, leaving the patient responsible only for the incremental fees associated with the deluxe multifocal lens. These fees are tax-deductible as a necessary medical expense, and are eligible for reimbursement through a medical flex spending account, should you or your spouse participate in one.
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