Cataract Guide

Complete Guide to Cataract Treatment and Surgery

Cataracts form when the natural human lens in the eye becomes cloudy, usually due to the natural aging process. When cataracts have progressed to the point that they significantly impair vision, cataract surgery may be needed to restore vision. This guide will help patients navigate their vision correction journey via cataract surgery.

Cataract surgery is one of the safest and most commonly performed procedures today. The great news is that over the past several years, there have been many significant advancements in the technologies used to treat cataracts. More than ever, patients have many more options available to them!

To make the most of this exciting, once-in-a-lifetime opportunity, patients are encouraged to read this guide thoroughly and make a list of questions to ask the Doctor at the Cataract Evaluation appointment.

SIGNS & SYMPTOMS OF CATARACTS

Cataract surgery may be considered when the natural human lens in the eye becomes clouded and impedes clear vision. Other signs/symptoms of cataracts include:

• Cloudy, hazy, blurry vision
  Yellow, white, or smoky tint
• Difficulty seeing at nighttime or in bright light circumstances
• Seeing glares, halos, and/or starbursts when looking at oncoming lights
• Needing more light to see clearly
• Colors look faded or diminished
• Glasses don’t seem to work any longer
• Prescription fluctuates

CONSIDERING CATARACT SURGERY

Perhaps you were told a few years ago that you have cataracts, but they weren’t ready for surgery yet. Or, maybe you’ve started to notice changes in your vision. No matter what’s brought you here to seek answers, we’re here to shed light on the solution, and partner with you through the process.

A UNIQUE, PATIENT-FOCUSED
TEAM APPROACH

We pride ourselves on caring for our patients with a dynamic, care team approach. This
means patients can expect to partner with a few different team members during the cataract surgery journey. This includes:

An Optometrist evaluates your eyes before,
as well as after surgery. Your surgeon and the Optometrist will work together to coordinate your post-surgical care and ensure all of your needs are met.

Technicians who will perform diagnostic testing and measurements, before and after surgery.

The Surgeon will meet with you at Pre-Op and discuss your individual needs, partner with you for a final surgery plan, and perform your procedure.

The Surgery Counselor will provide education about cataract surgery options, schedule your appointments, and be your liaison through the process.

A Physician’s Assistant (PA) will perform a History & Physical screening to ensure the patient is medically suitable to proceed with surgery.

CATARACT EVALUATION

Patients should plan on being at the cataract evaluation appointment for approximately 2 hours. This appointment includes a comprehensive dilated examination, as well as numerous diagnostic tests to identify the degree of impairment that is caused by the cataract. It is recommended to take a list of the problems you’re experiencing so that you may discuss these with the Provider. Patients will also learn about their preliminary candidacy for advanced cataract surgery options, and schedule an appointment to meet with a surgery counselor for the next steps.

PRE-OP EDUCATION

Now that you’ve been recommended for cataract surgery, you’ll meet with a surgery counselor who will review the exciting options available to you, schedule your appointments, and continue to work with you at future appointments to ensure a smooth process.

PRE-SURGERY TESTING: HISTORY & PHYSICAL AND A-SCAN

The first appointment after meeting with the surgery counselor is the official start of the road to better vision!

At the History & Physical (H&P) component of the appointment, our PA will meet with you and perform an assessment of your overall health to ensure you are medically stable to proceed with your surgery. After the H&P, you will be taken for measurements, called A-Scan.

The A-Scan measurements are what will help to determine the prescriptive power of the new implant lens that will be placed in your eye once the cloudy human lens (cataract) has been removed. We use the most technologically advanced measurement equipment. If needed/requested, additional pre-surgery testing will be performed at this time. Finally, you’ll meet with the surgery counselor at the end of the appointments.

CATARACT SURGERY: REVOLUTIONARY OPTIONS FOR LENSES AND SURGICAL TECHNIQUES FOR OUTSTANDING OUTCOMES

Today’s cataract surgery is more technologically advanced than ever. We are proud to offer the best surgical equipment and techniques, performed by our world-class surgeons. Now more than ever before, implant lens options are able to provide a significant decrease in the dependence on glasses after surgery.

The traditional method of cataract surgery is known as Phacoemulsification. This is a manual process, where the surgeon performs all steps of the procedure. Your skilled surgeon will effectively and efficiently remove the cataract through very small, self-healing incisions that usually do not require any sutures. Microsurgical instruments are used to gently break up and extract the cloudy natural human lens. Once this step is complete, a small foldable artificial lens (Intraocular Lens or IOL) is inserted where the cataract was removed, and put into position.

Intraocular lenses (IOLs) have been revolutionized over the past few decades, and the options only keep getting better! Taking the time to learn about all options and understand the impact cataract surgery can have on your life is well worth the time!

Monofocal Lenses provide a single range of vision that can be set for either distance or near, but not both. These IOLs are also known as a “standard” or “basic lens.” The monofocal lens does not treat astigmatism. This is the lens that medical insurance pays for in cataract surgery, with the understanding that patients will require the use of glasses after surgery for their best-corrected vision.

Advanced technology lenses have progressed significantly over the past several years. Multifocal IOLs are not all designed the same way, and there’s not a “one size fits all” approach to determining patient candidacy. Your surgeon will take the time to learn about your lifestyle and visual needs so that they can make the best recommendation for the IOL that will meet all your needs. Some technologies available include:
Trifocal IOLs provide excellent near, intermediate, and distance vision with minimum use of glasses following the surgery

Extended Depth of Focus (EDOF) IOLs utilize a unique approach to bending incoming light in a way that stretches and shifts the light so that it can be fully used. The IOL is able to provide functional near vision, as well as ample intermediate and distance vision with minimal use of glasses dependence following surgery.

Toric IOLs are available for patients requiring a higher level of astigmatism management so they may enjoy excellent distance vision with reduced dependence on glasses following surgery. Toric IOLs incorporate unique optics to compensate for the irregularities of the cornea and/or natural human lens.

Multifocal / Trifocal / Extended Depth of Focus IOLs is also available in Toric models, too! Utilizing one of these options allows the surgeon to remove the patient’s cloudy cataract and replace it with an IOL that provides astigmatism correction and all ranges of vision!

LASER CATARACT SURGERY

Traditional cataract surgery is widely recognized as one of the most accurate, safe, and successful procedures performed worldwide. Our practice offers laser cataract surgery using the most state-of-the-art Femtosecond laser. This laser is computer-guided and is meant to supplement your skilled surgeon during the procedure. The laser is designed to improve precision and reproducibility during the most delicate phases of the surgery, including the creation of the primary incisions, providing surface treatment of corneal astigmatism, and IOL placement. Studies have shown that the femtosecond laser is the best option for managing corneal astigmatism (irregular shape of the cornea) during surgery. Though not every eye requires or qualifies for this treatment, your surgeon will partner with you to establish candidacy and answer all questions you may have.

ORA

Optiwave Refractive Analysis (ORA) is one of the most significant advances in cataract surgery over the past years and gives data not possible to obtain with conventional measurements and instruments. ORA provides a live-time analysis of the eye during surgery, which results in unparalleled accuracy. Here’s how it works: At the time of surgery, once the cataract has been removed, ORA will perform a series of 40 automated refractions in a matter of a few moments in order to identify the most precise prescriptive power for the new IOL implant. This data is then coupled with your pre-operative testing results, and ORA will provide
a live result to your surgeon, so they
are able to make the most accurate IOL power selection for the lens that will be implanted into your eye. Regardless of the IOL used, ORA can be used to optimize any cataract surgery.

GENERAL CATARACT SURGERY INFORMATION

Cataract surgery is a very safe, minimally invasive procedure that typically takes place at an Ambulatory Surgery Center (ASC). Though surgery is relatively brief, patients may expect to spend 2-3 hours at the ASC on the day of surgery. A nurse anesthetist, or CRNA, will administer a local anesthetic (also known as “twilight”) and provide monitored anesthesia care to the patient in order to keep them calm and comfortable during the procedure. Once the surgery is complete, the patient will be taken to recovery, and then discharged and sent home to rest. The ASC nursing team will provide comprehensive instructions to guide patients through their recovery. Patients will return to the clinic the day after for their first post-op visit so their vision and pressure can be assessed, and further care instructions will be provided. A final glasses prescription, if needed, will be prescribed 3-6 weeks following surgery.

INSURANCE COVERAGE & COSTS

Standard cataract surgery is considered a medical procedure and is billable to Medicare and medical insurance. Certain criteria must be met in order for cataract surgery to be billable, such as functional complaints and decreased visual acuity. Surgery is subject to the insurance’s deductible, as well as co-insurance or co-pay. The cost of advanced technology with cataract surgery is not a covered benefit by any medical insurance. It is considered refractive, which means that it is an excluded service. Therefore, there is an out-of-pocket expense associated with the advanced options that are offered. The cost of the upgraded services is in addition to the insurance amounts due.