August is cataract awareness month. We asked Stephen Reck, M.D. to talk with us about some of the newest advances in cataract surgery.

This is a very exciting time to be a cataract surgeon. Advances in surgical technique and lens implant technology are allowing people to recover more quickly and see better after surgery than they did in past years. As an ophthalmologist, I see a lot of patients who are having trouble with their vision. But I am happy when I can tell someone that their only problem is a cataract. This is because we can usually restore their vision with cataract surgery. Cataract surgery can be a life-changing experience for some people who may regain their ability to read and drive. I really enjoy seeing my patients after surgery because they are usually so happy with their vision.

Can you explain some of the different types of lens implants?

After the cataract is removed, an artificial lens implant is placed inside the eye. In past years, before lens implants were available, people needed very strong glasses to see. Today’s artificial lenses allow most people to see well without glasses following surgery.

There are three main types of lens implants: monofocal lenses, toric lenses, and presbyopia-correcting lenses. The cataract surgery page on our web site has more information and a few videos that provide more information.

Monofocal lenses focus the image at one distance. We can choose to set the focal distance for long-distance, mid-range, or up-close. These lenses do not correct astigmatism and they do not adjust their focus for different distances. Many people with these lenses are able to do some activities without glasses, but they do not eliminate a person’s need for glasses. They usually give excellent vision with glasses and are the only type of lens that is covered by medical insurance.

Toric lenses: In order to see clearly, any significant astigmatism needs to be corrected. This has traditionally been done with glasses or corneal surgery. In recent years, astigmatism correcting lens implants have become available. These are called toric lenses. For people who have astigmatism and have been dependent on glasses or contacts for years, cataract surgery now offers a chance to see clearly without glasses.

Presbyopia-correcting lens options: The natural lens inside the eye is able to adjust its focus so that we can see clearly at different distances. As we get older, we begin to lose this ability. This condition is called presbyopia. This is why we eventually need to wear bifocal glasses or separate glasses for reading and driving. Artificial lens implants also do not adjust their focus for different distances. This is why people usually need to wear bifocals or reading glasses after cataract surgery. Many people want to be less dependent on glasses after cataract surgery. There are different ways of helping people accomplish this.

One method is called monovision, where one eye is set for distance vision and the other is set for near vision. This means that one sees well in the distance and the other eye sees well up close. Most people adjust to this well, allowing them to go without their glasses most of the time.

Multifocal lenses are another way of giving good distance and near vision without glasses. Multifocal lenses have several concentric rings of alternating powers. This allows the lens to focus on objects both in the distance and up close. With multifocal lenses, most people are able to see without glasses most of the time, but there is a little reduction in the image quality. This is because the lens splits the light into different focal points, which causes a little blur and glare. Despite this limitation, most patients are very happy with the visual freedom these lenses offer.

Accommodative lens implants are another technology. All of the surgeons at Clarus have stopped offering accommodative lenses as an option. We believe that multifocal lenses are safer and more effective than accommodative lenses.

With so many choices, how do you help people decide which lens is best for them?

All of the ophthalmologists at Clarus take the time to talk with our patients face-to-face about their goals and expectations for surgery. It is important to have this conversation with your surgeon before surgery.

The main consideration is whether or not a patient wants to be able to see clearly without glasses or contacts. Monofocal lenses are usually the best choice for patients who plan to wear glasses full-time after surgery. One big advantage of monofocal lenses is that they are covered by medical insurance, so the cost for patients is lower. Monovision is a great option for patients who have liked monovision in the past. However, for people who have not tried it before, I generally don’t recommend it. Monovision may be covered by insurance if no astigmatism treatment is needed. Toric lenses are a great choice for patients with corneal astigmatism who desire to see clearly without glasses. Toric lenses can be used for distance, mid-range, near vision, or monovision. Unfortunately, they are not yet available in a multifocal lens. Multifocal lenses are an option for patients who want to see clearly both in the distance and up close without glasses. Multifocal lenses are an option for people who do not have any other problems that might limit their vision. To be a good candidate for a multifocal lens, a person needs to be motivated to succeed. The quality of vision may not be quite as good as with a monofocal lens and there is a slower recovery as the brain adapts to the new lens. In exchange, most people gain good vision without glasses both in the distance and up close.

There are a wide variety of treatment options for people with cataracts today. The ophthalmologists at Clarus all take the time to talk with their patients before surgery about their unique visual goals and needs. This dialogue between the patient and surgeon is the best way to help patients choose the option that best suits their needs. Please call or schedule an appointment on-line if you would like to meet with one of us.