You only have one set of eyes.
Thinking about surgery? Think differently.
What is a cataract?
A cataract is a clouding of the natural lens of the eye. When the lens matures, it changes power. Most people over age 50 will notice changes to their vision. Many times, this could just be a new prescription or reading glasses. However, others develop changes to their vision that are not correctable in glasses or contacts. Surgery can help these people. The surgery is an outpatient procedure, done one eye at a time with a week or two between eyes. The surgery is generally painless for most people and is performed under topical anesthesia. You don’t have to be put to sleep. The procedure takes about 5-10 minutes and there are no patches. You’ll use the eye immediately. Following surgery there are minor activity restrictions and drops to help your eye recover. Are you ready to talk to a specialist about your vision problems? We’d like to hear from you!
What is Astigmatism?
Astigmatism is merely a different shape to your eye. Astigmatism can occur in the Lens or the Cornea. Most people know they have astigmatism and wear glasses or contacts to correct for it. However, there are lens options called toric lenses to eliminate or reduce your need for glasses with surgery should you desire. These upgrade lenses are not covered by insurance plans, but are available to improve your lifestyle. Your exam and evaluation will discuss your options for surgery for any lens choice that fits your lifestyle and budget.
I want it all again!
Many people hate glasses. We get it. Fortunately, technology continues to advance and the opportunity to have clear distance, intermediate and near vision is possible for many people. Selecting the right candidate for this technology is important. Not everyone has the eye health necessary for a good outcome, so a full evaluation is performed to determine if you are a good candidate. Like everything in life there are some compromises, but new “stretched” monofocal and trifocal intraocular lenses, both in toric and non-toric options, can help many people achieve their hope of a spectacle-free outcome (or mostly). Even if you don’t have cataracts and have been told that laser vision correction is not a good idea for you at your age, you can be a candidate for a lens based procedure to achieve your goals. However, like LASIK the procedure is not insurance covered. Interested in hearing more? Give us a call and let Dr. Karo examine your eyes.
Lens Options:
If you are thinking about surgery, you should think about what you desire your vision to be AFTER surgery. The surgery will correct the cataract problem, but there’s a potential bonus: better vision with a reduction or elimination of your need for glasses or contact lenses after surgery. It sounds a little weird, but until you think before your consultation about what you’d like to wear for correction after surgery — or not wear — you’re stuck making a decision you maybe feel a little uncomfortable about. If you’re confused about lens options for cataract surgery, read on.
Monofocal Lenses.
This is the most common lens implanted world wide. It is insurance covered and gets the job done for most people. With this lens option, you have a lens with ONE focal point. Most commonly, this is set for distance vision in both eyes. This means people with this lens style use correction for near items. That could be just reading glasses or a small correction for distance and near depending on their eye’s healing. However, there are options with this lens. Some artists and musicians use their intermediate and near vision more than distance and choose to set their vision for a closer focal point. This means this type of patient would PUT ON distance glasses when driving or watching TV from a distance but take them off when reading. It’s simply a lifestyle choice.
A third option is also available. Typically, people who have worn contact lenses into middle age ranges are familiar with the concept of Monovision. This is a situation where the dominant eye is set for distance while the non-dominate eye is set for near. This reduces the need for distance or near glasses, however, there are trade offs. It’s not perfect. Some people cannot deal with the prescription difference between the two eyes. Neuroadaptation, a process whereby your brain makes the switch between the two eyes depending on what you’re looking at, occurs over time. Generally speaking if you haven’t worn contacts with this, it is discouraged to permanently implant lenses for risk of intolerance and the need for a costly, higher risk second surgery. There are other issues: Depth perception may be reduced for some fine activities. But, on the plus side, most people who have experienced this in the past successfully in contacts can be permanently implanted and do most activities without the need for glasses.
Toric Lenses.
Toric monofocal lenses involve a correction for astigmatism and are considered a cosmetic, premium lens upgrade. If you have astigmatism, it just means your eye is shaped more like a football than a basketball. As a result, you usually need correction if the magnitude or power level of the astigmatism is high enough to cause disturbances to your quality of vision. With cataract surgery, you have the unique opportunity to neutralize most, if not all of your astigmatism reducing or eliminating this aberration from the eye. It is fair to say most people will not require correction for their astigmatism with a toric lens, however, some eyes are so extreme, or have such a magnitude of astigmatism, it cannot be fully corrected even with a new toric lens implanted. It will, however, be reduced significantly, often affording acceptable uncorrected vision.
A toric lens is not covered by insurance, but insurance companies and Medicare allow you to pay out of pocket if you desire to have access to this technology. We’ll review all of your options and you can make the best choice for you.
Toric lenses come in two versions: monofocal and multifocal. A toric monofocal is just like the monofocal lens described above — set for one focal point, or with monovision in appropriate candidates. Even with a toric monofocal upgrade, you likely will still need glasses for either distance or near vision post-op unless you are a candidate for monovision style correction.
A toric multifocal lens has multiple focal points for a better range of vision — distance, intermediate and near — while also correcting for astigmatism. Keep reading below for more discussion on multifocal style lenses.
“Stretched” Monofocals.
A style of lens, called Vivity™, uses a non-diffractive technology called X-Wave™. This is a proprietary non-diffractive technology which uses all the available light to create a continuous, extended range of vision. We call this a “stretched” monofocal IOL.
The key difference is that in diffractive multifocal lenses, the light is split into multiple separate focal points. Patients with other brand multifocal lenses or older generations often complain about visual disturbances such as halos, starbursts, and glare. Some patients therefore opt for monofocal lenses because they have a much lower rate of these post-cataract side effects. The Panoptix™ Trifocal — a type of multifocal implant — has greatly reduced, but not eliminated these problems as technology advances. This is where a stretched monofocal lens comes in.
Patients with the stretched Monofocal lens report lower visual disturbances offering comfort to those concerns. To be sure, even a standard Monofocal IOL some patients will complain in some degree of glare and haloes. You just can’t predict it. However, the Vivity™ results are more like those seen with monofocal lenses with lower rates of those disturbances. This is a distinct advantage for patients looking to drive at night, such a truck drivers that make their living where these conditions are most noticeable.
Many patients with stretched monofocal lenses are able to check a message on their smartphone or read a label at the store without glasses. However, it is important to note that they likely will need their glasses to read a newspaper or a prescription label.
Further, this lens can be used for patients with other ocular problems that preclude them from being good multifocal candidates which require normal ocular anatomy. With a “stretched” monofocal style lens, you get the benefits of a monofocal IOL with additional benefits of improved near and intermediate vision over standard monofocal IOLs — even if you’re not a candidate for multifocal technology. However, the near performance is just not that of a true “multifocal” IOL. So, expect to have to wear some readers for some tasks.
Multifocal lenses.
A multifocal lens is the most advanced surgical vision correction implant available for cataract surgery patients. Coming in both toric and non-toric options, if you have a healthy eye, you could benefit from this technology to allow for a lifestyle that’s as spectacle free as possible. This lens gives a range of vision across all distances. However, it is not like vision when you were twenty. That technology, unfortunately, doesn’t exist. But, the latest generation of trifocal or extended depth of field lenses can offer a great reduction in the need for spectacles at any distance. Notice we didn’t say it’s a guarantee you’ll be without glasses. Sadly, that can’t be guaranteed.
Why? Because the human body is dynamic. We use complex mathematical formulas to determine what power of lens to place in the eye. Along with the latest surgical pre-operative equipment and a skilled, experienced physician who has honed his formulas to provide the most accurate results, the risk of error is minimized. But, it is not eliminated. The goal for any operation is to get into driving vision without glasses. Which, for most states like ours, is 20/40 or better. Our goal is to bring that as close to 20/20 both distance and near as possible. Sometimes better. But, the human body being dynamic, you cannot guarantee where the lens will heal inside the eye.
Other important notes: this lens is probably not for your engineer or other type A individual that wants to see a speck of dust on the counter from across the room or crumb on the counter like it was filmed in 8K high definition. The ability to read the finest print in your book or on a prescription bottle is probably asking too much as well for some people. However, if you want to visit your grocery store and, by and large, not have to put on a pair of glasses to see to read labels or the aisle markers, this can be a great option.
Last, we’re living longer, better lives. More Americans of age live active lifestyles playing tennis, golf and regularly pursue other athletic activities, especially here in our beautiful WNC environment. A multifocal lens can maximize your goals of a largely spectacle independent life. Like a toric lens, a multifocal lens is not insurance covered, but for the investment, this technology — which is permanent — can make life more enjoyable for the active or the person who values being as spectacle free as possible. Sometimes you do get what you pay for.
