Cataracts and Lens Implants

What is a Cataract?

A cataract is a clouding or darkening of a natural part of the eye called the lens. The lens is a living tissue which sits in the center of the eye and actively changes shape in order to keep vision in focus. At first, this lens is clear and flexible, but over time it becomes stiffer and does not focus as well. This happens in most people at around age 40, which is why most people at this age start needing reading glasses. The lens then becomes cloudy and more difficult to see through, and at this point we start calling it a cataract. Risks for cataract development include advancing age, family history, smoking, sun exposure, diabetes, steroid use, and other conditions. Poor vision from cataracts can affect lifestyle (such as driving and reading), but can also create health problems ranging from depression to injuries from falls and auto accidents. Cataracts can also lead to higher eye pressure, especially in patients with farsightedness.

Symptoms. Early cataracts just cause a change in the glasses prescription, typically making patients more nearsighted or farsighted. More advanced cataracts blur vision in a way that cannot be cleared up, even with new glasses. The vision gradually dims, colors are less distinct, and glare or haloes occur with bright lights.

Prevention and Treatment. Ensuring adequate nutrition, and wearing UV-blocking sunglasses to lower the eye’s UV exposure, can help to slow cataract development. Using an antireflective coating on driving glasses can help with nighttime headlights; eventually, avoiding nighttime driving may be necessary. Using brighter lights while reading, using sunglasses for daytime glare, and avoiding night driving can also help. To date, no drops of any kind have ever passed the requirements of the FDA to prove safety and effectiveness in slowing cataract formation in human beings. Once all other options have been exhausted, and when the quality of life is significantly affected, cataract surgery may be the best option.

Cataract Microsurgery

Cataract microsurgery using ultrasound energy is a painless and quick outpatient procedure. My cases usually last around 15 to 20 minutes. Once the cataract is removed, a clear lens implant is placed in the eye in order to focus light on the retina, allowing the eye to see.

The lens implant is permanent and stays safely inside the eye, so the patient never feels it, and it never needs changing. As with any surgical procedure, there are some risks associated with cataract surgery, including eye infection. Precautions must be followed in all cases, including eye drops before and after surgery.

What about Laser Cataract Surgery? Laser cataract surgery is known as FLACS. I have not yet found FLACS necessary to maintain my track record of visual results and patient safety, which has helped to maintain robust word-of-mouth referrals to my practice.

To see the results for yourself, you can compare the photo below (of one of my postop cases) with online photographs of laser-cut capsulorhexes. (Please email us if you see a clinically significant difference!)

Advanced-Technology Lens Implants

Standard lens implants (“monofocal” lens implants) focus vision at a single distance, making it necessary for most patients to use glasses postoperatively in order to improve their range of vision.  To decrease patients’ dependence on glasses postoperatively, additional options include astigmatism-correcting (Toric) lenses (which in nearly all patients eliminates the need for distance glasses), to lenses that offer both distance and intermediate vision, such as the current models of the Symfony and Panoptix Trifocal lenses, as well as models that have been popular in previous years such as the Restor, Crystalens, and Tecnis Multifocal. Other implants are also available.

Not everyone is a candidate for advanced-technology implants. While some patients ask to have “the best lens available,” I instead recommend the best lens for that particular patient’s visual needs, in coordination with his/her lifestyle and goals.

Results

After cataract surgery, the eye usually heals very quickly, with minimal discomfort. Most patients return to their normal routines on the day of surgery, and the vision clears over hours to days, depending on the patient. To ensure safety, the postop regimen of eye drops must be followed closely, even after full visual recovery. Most patients note improvements in all aspects of vision, including color intensity, clarity of vision, and brightness of light. While cataracts never grow back, over time, a film may grow over back of the lens implant (this is called “posterior capsule opacification”). A medical laser, called a YAG laser, may be used to clear away this film and improve vision.

Surgery Locations

Dr. Biser performs work as a cataract surgeon in Westchester NY. Virtually all of his Westchester cataract surgery is performed at the Eye Surgery Center of Westchester (in Chester Heights, which is between Bronxville and Pelham). Dr. Biser performs all cataract surgery himself, and personally examines each patient both before surgery and after surgery. He has taught and lectured on cataract surgery to other eye surgeons at N.Y.U. and Manhattan Eye, Ear and Throat Hospital (where he won the Attending Surgeon of the Year award for his surgical teaching skills.)

Insurance Coverage/Payment

All major health insurance plans, including Medicare, will cover the basic costs of cataract surgery, including the cost of a standard lens implant. Many HMOs and PPOs require that patients make a coinsurance payment to the facility; this amount varies with the plan. The cost of an upgrade to an advanced-technology implant is optional, and is left up to the patient.

Scheduling Your Visit

We are happy to schedule a consultation at your convenience. However, please understand that it may take some time between your first visit and your actual surgery. Careful preoperative planning, based on your individual needs, is necessary to achieve optimal outcomes.