There are a few things in life that are inevitable. As a colleague of mine likes to phrase it, "If you live long enough, you will get a cataract." But developing cataracts is not a diagnosis of doom and gloom. Today's cataract surgery is as much a refractive procedure to bring you back to clear vision (maybe even without glasses!) as it is a medical one. Some of my patients are actively hoping for that cataract diagnosis from year to year so we can correct their high nearsightedness or reduce their dependence on reading glasses. And cataract surgery itself has changed so much, even in the last decade. Now there are ways to reduce healing time, and achieve more precise vision refinement. There are implants that can correct even high amounts of astigmatism, and that can help you read again free from those OTC readers. If you are about to undergo cataract surgery, here are the two questions you need to ask yourself to prepare for the best procedure for your needs:
1) Should I Get Laser Assisted Cataract Surgery?
Laser assisted surgery can have many benefits, but it is not covered by medical insurances. It's an extra expense and you need to decide if it's worth the cost for you. The laser does not do the actual removal of your cataract; you will still have to undergo surgery in the operating room to remove the cloudy lens inside your eye. Using the laser has these advantages:
- Makes a more precise incision (capsulorhexis) so that the optical implant (IOL) placed inside your eye to correct vision is more likely to center perfectly and stabilize there for best vision. Without a laser cutting the capsulorhexis, your doctor will use a traditional manual cut, which even with a skilled surgeon will not be perfectly symmetric. That imperfection increases the risk of shifting and decentering of your IOL, reducing the possibility that you will get perfectly corrected vision from your implant.
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| This is an excellent maunual capsulorhexis, but you can see even with a great technique there is imperfection being created. via |
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| Notice the more precise circular incision of the laser assisted capsularhexis. A more precise incision will hold the IOL (seen here with a bluish outline) perfectly centered in the visual axis.via |
- Breaks up the cataract prior to being physically removed in the operating room. Using the laser to break down the cataract first reduces the time of your operation, which in turn makes for less exposure to high energy phacoemulsification techniques that can increase internal inflammation and increase the risk of operative side effects like cystoid macular edema, iritis, and corneal edema (swelling).
- Places more precise limbal relaxing incisions to reduce low amounts of astigmatism. If you have astigmatism left over after your cataract is removed you may still be reliant on glasses for clear vision. The laser assisted surgery can help reduce your astigmatism by placing more precise laser markings in the cornea that counteract the astigmatism present in that tissue post-operatively.
- Want to learn more? Check out this great podcasts from cataract surgeon Dr. Isaac Porter:
Who is not a candidate? Dr. Porter states that most patients are great candidates for laser assisted surgery, but he would likely be unable to use the laser procedure for patients with dense corneal scars. If it is hard to visualize the eye through the scars it would be hard to align the laser properly which reduces it's usefulness.
2) Should I Get a Specialty IOL?
Medical insurances like Medicare pay for "standard monofocal IOLs", which means that only 1 aspect of your vision will be corrected. Most people will chose to correct their distance vision, which means they will need reading glasses full time after the surgery. If you have high amounts of astigmatism (typically greater than 1.00D of astigmatism), then a standard IOL will not correct for this either, and you will need full time glasses to see clearly after the surgery. Depending on your refractive needs, you can choose to upgrade to one of two types of premium IOLs:
- Toric IOL: For patients with more than 1.00D of astigmatism it is unlikely that simply removing the cataract and placing limbal relaxing incisions will fully correct this. A better option is to correct your astigmatism within the implant itself. Many surgeons will recommend that you have laser assisted surgery if you chose to upgrade to a toric IOL because they can better increase accuracy for the way the IOL positions (and thus the vision you will achieve) by creating a more perfect capsulorhexis.
- Multifocal IOL: Another inevitability about eyes? Around 45 you are going to lose your ability to read and do up close activities (called presbyopia). Standard implants cannot correct both your distance and your reading vision; you have to pick one. If you want to be able to see clearly again to read without reading glasses, you would need to upgrade to a multifocal IOL. These implants have rings of distance and near vision within the implant so that your brain receives both images on the retina for processing. Most people that get multifocal IOL implants may still need reading glasses under certain conditions (dim lighting, really small print, reading for long periods of time), but the need will be significantly reduced. There is also the risk for glare off of the implant because the rings in the implant will create more reflections. Your doctor will discuss the pros and cons with you, but if you want to avoid having to use full time reading glasses after surgery, this is an upgrade worth considering. You can learn more from Dr. Porter here.
A multifocal IOL via
