Cataract Surgery & Lens Implants

In order to understand more about cataracts and lens implants, it is important to first begin by understanding some things about the way your eye functions. In the normal eye there are two structures that are mainly responsible for refracting, or bending light so that it focuses properly on the retina. The first structure is the outermost dome shaped structure called the cornea. The second is the crystalline lens, which is located behind the colored part of the eye, or the iris. The crystalline lens can be examined during your consultation by using various instruments to look through the pupil, or the dark center of the iris. Both the cornea and the crystalline lens must be perfectly clear if your vision is to be crisp and clear. While the cornea maintains its clarity throughout life if you are relatively healthy, the crystalline lens may undergo a number of changes as you age.

If you are over 40 years old it is likely that you have started to experience some of the changes in your vision that each and every one of us will encounter. Even if you have had “normal” eyesight all your life your vision begins to change in a several distinct ways. For most people who are between the ages of 40 and 60, the most obvious changes to our vision occur in the crystalline lens.

Presbyopia

One of the earliest changes in the crystalline lens that you will experience occurs when the lens loses its flexibility. Up until the age of approximately 40, the crystalline lens is both “crystal “ clear and quite soft and flexible. This flexibility permits the crystalline lens to change its shape and alter its curvature so that it can help focus your vision at various distances-from far, to near, to arms length, to far or near again. Having this flexibility allows the ability to see things at all distances. Around the time we enter our 40’s, the crystalline lens begins to stiffen, which makes it progressively more difficult to change focus and see clearly at all distances. Usually this lessens our ability to easily see objects at see arms length or close objects or reading material. When this loss of flexibility occurs, it is called Presbyopia or “old eyes’.

Presbyopia is a normal and expected consequence of growing older. As the crystalline lens loses its ability to flex and change shape, it is no longer able to effectively bend light rays resulting in a gradual and progressive loss of your ability to focus on near objects. Anyone who experiencing the start of Presbyopia will typically notice that their "arms are too short" to read and they have to hold close objects farther away in order to bring them into focus and see them clearly. Presbyopia usually becomes noticeable between the age of forty and fifty and continues to progress through age sixty-five. It is important to note that Presbyopia affects everyone including those who have cataracts. When Presbyopia begins people who have never worn eyeglasses find that they need reading glasses or bifocals in order to read and see up close. People who already wear glasses may need bifocals or trifocals in order to see comfortably up close. Today, there are many advances in lens surgery techniques and presbyopia correcting multifocal lens implants so that lens replacement surgery can help patients restore their normal range of vision without dependence on bifocals or trifocals.

Cataracts & Lens Implants

As the crystalline lens loses it flexibility, it is often followed by another type of change whereby it begins to lose its transparency. As you progress through your 50’s and 60’s, the normally crystal clear lens gradually becomes yellow and cloudy. As the crystalline lens loses its transparency and its optical clarity, it may begin to impair your ability to see well in dim illumination, such as for night driving. The cloudiness may also create glare, light sensitivity or an overall decrease in your vision. If parts of the crystalline lens become too cloudy they may cause a significant decrease in both your day and night vision. These symptoms are quite common and are what patients who have cataracts typically experience.

Cataract surgery today is safe, effective and quite common. In fact if you have been told that you have a cataract, there is no need to be overly concerned as you are not alone. Each year in the United States, more than 2.5 million people have cataract surgery. Thanks to advanced cataract surgical procedures and lens implant technology, cataract surgery is not only one of the most frequently performed surgical procedures in the United States, but it is also one of the safest and most successful surgical procedures that you can have. Cataract surgery is performed on an outpatient basis and usually only requires a few hours of your time from beginning to end.

Cataract Surgery Procedure

Cataract surgery today is quite comfortable. Dr. D’Ambrosio Jr. performs cataract surgery and lens replacement surgery at the Cataract and Laser Center in Gardner as well other facilities required by your insurance plans. Upon your arrival at the Cataract and Laser Center in Gardner, there will be a number of staff members present to assist you and make your experience comfortable. First, the procedure will begin with your eye being treated with an anesthetic so that you will feel little if anything during your surgery and minimal if any discomfort.

Next, Dr. D’Ambrosio Jr. will make a very small incision at the outermost edge of your cornea, just large enough to allow a microscopic instrument the size of a pen tip to pass through it. Once the microscopic instrument is actually passed through the tiny incision, ultrasound from the tip of the microscopic instrument will be used to gently break the cataract into pieces small enough to be washed away, drawn through the instrument and removed from the eye.

This cataract removal method is called “phacoemulsification” and is the preferred technique of cataract surgery available today.

After the cataract has been removed, Dr. D’Ambrosio Jr. will be able to insert a new permanent intraocular lens implant (IOL) into your eye. The replacement lens can actually be inserted and placed in the correct position through the same tiny incision at the outer edge of the cornea through which Dr. D’Ambrosio Jr. removed the cataract.

After your cataract and lens implant surgery. A staff member will take you to rest and relax in a comfortable area in the Cataract and Laser Center. After a short time you will be allowed to be driven home by a family member or friend. Usually we will arrange a visit at D’Ambrosio Eye Care to examine your eye within 24 hours after your cataract surgery. We will prescribe some eye drops for you to use and ask you to wear a protective shield, mainly at night to help you remember not to rub your eye. Although each patient heals a slight bit differently, most patients see well enough to return to their routine activities within a day or so after their cataract surgery.

Presbyopia Correcting Multifocal Lens Implants

In the past, the choice of which type of lens implant to have was really made by the cataract surgeon. That's because there really weren't any options for patients. All lens implants were of a type called a monofocal lens implant. A monofocal lens implant provides excellent vision after cataract surgery-but only at one set distance-usually for seeing things at a distance and thus does not correct Presbyopia or enable you to see close objects or even read without reading glasses or bifocals. This means for seeing distant signs when driving, going to a movie or going to a ballgame, a monofocal lens implant will provide the vision you need to see clearly. But with a monofocal lens implant you will most likely need to wear eyeglasses for any type of near vision activity-for example reading, knitting, sewing, playing cards or keeping your golf score will require you to wear glasses.

Today, we are able to offer you the choice of a presbyopia correcting multifocal lens implant. A presbyopia correcting multifocal lens implant provides excellent vision after cataract surgery at a variety of distances. Depending on your specific vision requirement, there are several types of presbyopia correcting multifocal lens implants Dr. D’Ambrosio Jr. might suggest including the ReSTOR® Lens Implant, the ReZoom™ Lens Implant and the Crystalens™ Lens Implant. Each of these lens implants or intraocular lenses (IOL) works in a different way to help you achieve your vision correction goals of being able to see at a variety of distances after cataract surgery, without being dependent on eyeglasses. Presbyopia correcting multifocal lens implants correct both your distance vision and your presbyopia after cataract surgery. For the vast majority of patients, having a multifocal lens implant means that you will be able to see at distance and up close without being dependent on eyeglasses. So, patients choosing to have a presbyopia correcting multifocal lens implant will likely find that they can drive, watch television, read or do crafts-without the need for glasses.

In general, patients who choose to have monofocal lens implants will be dependent on glasses either some or most of the time in about 70% of cases. Patients who choose to have multifocal lens implants will only be dependent on glasses either some or most of the time in about 15% of cases.

So, patients choosing multifocal lens implants typically experience a greater overall freedom from glasses allowing them to participate in most everyday activities without dependence on, or the hassle of glasses.

As with any surgical procedure, there are always risks as well as benefits. During your cataract consultation at D’Ambrosio Eye Care we will perform a cataract examination and then arrange your cataract surgery scheduling. In addition, we will the spend the time necessary to review what typical daily routine activities are most important to you-and whether being independent of glasses for those activities is something that you would like to achieve. As you prepare for your visit to D’Ambrosio Eye Care, it will be helpful to the eye doctors and staff if you begin thinking about what those activities are so that you can discuss them and explore them with the staff.

If you decide to have a presbyopia correcting multifocal lens implant, our staff will make sure to review your questions and fully explain any additional fees related to the multifocal lens implant that you might be responsible for. Medicare and most insurances cover the cost of the cataract surgery, the surgical facility fee for cataract surgery, the cataract surgeon's fee for cataract surgery-but not the cost of the presbyopia correcting multifocal lens and its implantation. In most cases, the additional cost of the multifocal lens is the responsibility of the patient. Our staff will be able to review the cost as well as the payment options, should you decide that the multifocal lens is the best choice.

Common Questions About Cataracts & Cataract Surgery

• How Do I Know If I Have A Cataract?

If you think you have a cataract you may experience one or more of the following common symptoms:

Cloudy or Blurry Vision

Lights may seem too bright with uncomfortable.

Glare may be troubling.

Car headlights may be too bright.

Haloes around lights at night.

Colors may be less intense or yellowed.

Night vision may be difficult.
You may experience shadowy images, double images or even multiple images.

You may seem to require frequent changes in your eyeglasses or contact lenses.

Your near vision may seem to temporarily improve.

• How Are Cataracts Treated?

Patients with beginning cataracts, may notice that their vision is sometimes improved by using different eyeglasses, magnifying lenses, or even stronger lighting. These options do not really treat the problem of the crystalline lens becoming clouded. Cataract Surgery is the only proven and effective treatment for restoring clear vision. As described above, cataract surgery requires removing the cloudy lens and replacing it with a new clear implantable lens, called an Intraocular Lens (IOL) or Lens Implant. Your cataract needs to be removed when it interferes with your everyday activities, such as driving, reading, or watching TV. It is important that you your eye doctor make that decision together. In most cases, waiting until you are ready to have cataract surgery will not harm your eye. If you have cataracts in both eyes, Dr. D’Ambrosio Jr. will remove them one at a time in order to achieve the best possible results. Sometimes, it is necessary to remove a cataract even if it doesn’t seem to cause problems with your vision. This is the case if it prevents a thorough examination of the retina or optic nerve, or treatment of another eye problem, such as age-related macular degeneration or diabetic retinopathy.