In my last post I explained what cataracts are and the risk factors for developing them. In this post I will discuss treatment options for cataracts.

In the early stages, cataracts may cause difficulty with night vision and glare from oncoming headlights, or decreased contrast sensitivity in bright lights. Often, antireflective coating on glasses, or amber tinted glasses, can reduce glare and make nighttime driving easier. Lightly tinted sunglasses may help reduce glare from bright ambient light during the day.

As cataracts develop, they often result in a change in one’s glasses prescription. Updating one’s glasses to achieve the best visual potential is often the only treatment required in early stages of cataract development. Eventually, however, the vision deteriorates to the point where new glasses do not sufficiently improve vision.

This point is usually where cataract surgery is recommended. Surgery is the only way to effectively treat cataracts. Surgery involves removing the cloudy natural lens, which is inside the eye behind the pupil, and replacing it with an intraocular lens, or IOL. The cataract is broken up into smaller pieces using a small ultrasound probe, then aspirated. Cataract surgery typically takes about 15 minutes and is done in an operating room. It can be done without sedation and using topical numbing drops only, but often is done with mild intravenous sedation with the patient monitored by an anesthetist. The recovery usually takes only a few days with few restrictions, and most patients are back to normal activities within a week.

IOLs are small, flexible, and made of acrylic or silicone. They are inserted through a tiny incision that usually does not require sutures. The IOL is permanent and does not need to be replaced over time. Without an IOL, the eye cannot focus. Removal of the cataract and insertion of the IOL are done at the same time. The power of the IOL is determined by measuring the length of the eye and curvature of the cornea.

There are several types of IOLs. Monofocal IOLs are lens implants with a single focus point, usually at distance. Glasses are needed to see intermediate and near distances, such as computer use and reading. Some people enjoy doing close work or reading in bed without glasses, and may choose a monofocal IOL set for near work. A second type of IOL is a multifocal, trifocal, or extended depth of focus IOL. These IOLs allow one to see clearly at distance and also reduce dependence on reading glasses for most tasks. Some people have astigmatism, which describes a cornea that is not spherical like a baseball but is more football shaped. If one has astigmatism, it is most likely present in one’s current glasses, and a toric IOL may be inserted during surgery to reduce astigmatism and give clearer postoperative vision. Monofocal and multifocal IOLs are available with astigmatism correction.

In the last few years, using a femtosecond laser to perform the first part of the cataract surgery has become a popular option. Femtosecond lasers are more precise, accurate, with reproducible results, allowing some of the more challenging steps in cataract surgery to be completed safely in under twenty seconds.

The type of IOL one chooses ultimately depends on a number of factors: the preoperative refractive error, amount of astigmatism, desire to see near, far, or both without glasses, the general health of the eye, lifestyle, hobbies and activities, and financial concerns. A monofocal IOL is included in cataract surgery and is covered by insurance. Some advanced technology IOLs and laser cataract surgery may not be fully covered by insurance and may result in an out of pocket expense. These IOL choices are considered “lifestyle” choices, since they enhance the quality of life by reducing dependence on glasses, but are not considered “medically necessary” like the cataract surgery itself.

Your ophthalmologist and surgical counselor will make a recommendation regarding what type of surgery and IOL is recommended for your particular situation.