CATARACTS Evaluation and Treatment


CATARACTS Evaluation and Treatment
Evaluation and Treatment
Most people develop cataracts as they age. Cataracts may also develop in patients with
certain general disease conditions or following trauma to the eye. At Tauber Eye Center,
we specialize in surgery to improve vision in patients with cataract. We are happy to
provide this brochure to educate you about cataracts and your treatment options.
What is a cataract?
Cataracts are a clouding of the lens that impairs the focusing ability of the eye, leading
to blurred vision. It can be compared to a window that is frosted or yellowed. The amount
and pattern of cloudiness can vary, and if the center of the lens is not affected, you may
be unaware that a cataract is present.
A cataract is not a film over the eye or caused by overuse.
Common symptoms of cataract are:
Painless blurring of vision
Glare or light sensitivity
Poor night vision
Double vision in one eye
Needing brighter light to read
Fading or yellowing of colors
How are cataracts diagnosed?
Cataracts are diagnosed during a routine eye examination. It is important to be sure that
other diseases are not responsible for reduced vision. Most age-related cataracts develop
slowly over years, but some types progress much more rapidly, over weeks or months.
Tauber Eye Center 4400 Broadway Suite 202, Kansas City MO 64111 (816) 531-9100
How are cataracts treated?
Changes in eyeglasses may improve vision in the early stages of cataract development. Diet,
supplements and exercise have no effect on preventing cataracts. Until your ability to perform
daily activities is affected, it is not necessary to have surgery. Cataracts are progressive and
eventually surgery will be needed. Surgical removal of the clouded lens is the only way to
reverse the effects of cataract on vision. Cataract surgery can be performed when your vision
needs require it. Though most cataract surgeries are very successful, you should discuss
your personal vision needs with your doctor before deciding when to have surgery.
How is a cataract removed?
Cataract surgery is microscopic surgery done to
remove the clouded natural lens and replace it with
an artificial lens, called an IOL. Prior to your
surgery, measurements will be performed to
determine the appropriate IOL power for your eye.
You will be informed of risks, benefits and
alternatives to surgery, and you will have an
opportunity to decide which type of IOL to receive. You will need to use eye drop
medications for a few weeks after surgery, to control inflammation and promote proper
healing. You will return for evaluation on the day following surgery as well as 7-10 days
later and additionally as needed. Each type of IOL provides different ranges of vision
correction (far distance, midrange and near). Because every patient has unique needs
and goals, it is important to understand the range of vision each type of IOL can provide.
Understanding Your Options in Choosing an IOL
The artificial replacement lens used in cataract surgery is called
an intraocular lens, or IOL for short. IOLs are very small and
precise medical devices, which are designed to mimic the natural,
crystalline lens. Different types of IOLs are designed to meet
individual eye health and lifestyle needs. The type of IOL
implanted will affect how you see when not wearing eyeglasses. Glasses may still be
needed by some people for some activities. You may be a candidate for each IOL option,
so be sure to talk to your doctor about which IOL is right for you.
Monofocal (“standard”) IOLs provide excellent vision for those
who do not mind wearing glasses for near vision tasks
This type of IOL, which has been used for decades, will provide good vision for seeing
objects in the distance, such as when you are driving. For near or intermediate vision,
(reading or computer) you will typically need to wear glasses. For those who do not mind
wearing reading glasses, monofocal IOLs are an excellent option. Most insurance carriers
cover the entire cost of these IOLs. There are many designs, and we use an advanced
aspheric design monofocal IOL that gives excellent, crisp distance vision.
Monovision – an option to reduce dependence on reading glasses
When both eyes are focused for the same distance, we call this “Balanced vision.”
Another way to achieve independence from eyeglasses for both distance and near vision
involves choosing a different goal for each eye. “Monovision” or “Blended vision” means
that one eye will be focused for distance sharpness and the other focused for near vision
sharpness. The brain adapts and synthesizes the information from both eyes to provide
vision at intermediate distances. People who regularly use computers, PDAs or other
digital devices may find this especially useful. Individuals considering monovision may be
able to try this technique with contact lenses first to see how well they can adapt to “one
far and one near” arrangement of blended vision. Patients who require crisp, detailed vision
may decide monovision is not for them. To be sure, when both eyes are focused for the
same distance, the quality of vision is better than the “one far and one near” arrangement
of blended vision. Still, many patients with appropriate vision prescriptions find that getting
balanced IOLs for monovision allows them see well at most distances with little or no need
for eyeglasses, and the cost of the monofocal IOLs is fully covered by most insurance
carriers. Blended vision can deliver independence from eyewear in most situations, but is
not ideal for every patient.
Toric IOLs are excellent choices if you have astigmatism
Although a standard (monofocal) IOL can improve your vision by replacing your eye’s cloudy
natural lens, if you have astigmatism, you may still need glasses or contacts to see crisp
distance vision as well as for reading at near. Uncorrected astigmatism will blur vision.
Some patients who want to reduce (or possibly eliminate) the need for eyeglasses may opt for
an additional treatment called LRI (or limbal relaxing incisions), which may be done at the same
time as cataract surgery or separately. These small incisions allow the cornea's shape to be
rounder or more symmetrical, correcting mild to moderate astigmatism.
Premium Toric IOL
Depending upon your priorities and lifestyle, your doctor may suggest a
Premium Toric IOL. This advanced design IOL corrects your
astigmatism (even higher amounts than can be corrected with an LRI)
and typically provides crisper, clearer vision with less reliance on
glasses for distance vision. If you have significant astigmatism, you
should give strong consideration to choosing a Premium Toric IOL. More fully correcting your
astigmatism will generally result in sharper vision than if there is uncorrected astigmatism after
your cataract surgery. Premium Toric IOLs are an excellent choice and work well for either
balanced vision or monovision. These IOLs involve a modest additional out-of-pocket expense,
because most insurance carriers will not pay for the higher costs of these advanced-design
IOLs. Premium Toric IOLs are monofocal IOLs that also correct astigmatism. Like monofocal
IOLs, these do not correct for near vision and most patients will need eyeglasses for near
reading with these IOLs (unless choosing monovision or blended vision).
Multifocal IOLs typically result in the greatest freedom from
wearing glasses
Multifocal IOLs are designed to provide
patients the ability to see objects clearly at
most distances without glasses—near, far,
and everywhere in between. For people who
inconvenient, the multifocal IOL can be the
optimal choice.
The design of multifocal IOLs is quite advanced, incorporating a
series of focal zones or rings into the IOL. Incoming light focuses
through all the zones, and is distributed to allow you to see both
near and distant objects clearly.
The ability to read or perform other closeup tasks without glasses
varies from person to person but is generally best when multifocal
or accommodative IOLs are placed in both eyes. It may take up to
6 to 12 weeks after surgery on the second eye for the brain to
adapt and vision improvement to be complete with these IOLs.
Presurgical Planning
Whichever IOL is chosen, cataract surgery itself is performed
in the same manner, but before a Premium Toric or Multifocal
IOL is selected, special imaging studies will be done to
ensure the best possible outcome. We have been delighted
with our patient's response to these new lenses, and find that
most achieve independence from needing eyewear for the
majority of daily activities.
Simulated vision with a standard monofocal lens
Good distance vision, but vision may be blurry for intermediate and near tasks.
Simulated vision with the Tecnis Multifocal lens
Excellent vision at all distances, under most lighting conditions—day and night.
Because the multifocal IOLs distribute light to different distances, some patients may notice
rings or halos around light, often when driving at night right after surgery. Over time, the visual
impression of these rings typically lessens or goes away, as your eye and brain adapt to the
Early after surgery, some patients may notice rings around lights when driving
As the eye adjusts over time, the visual impression of rings lessens or goes away.
Multifocal IOLs are not perfect. Some additional considerations with multifocal or
accommodative IOLs:
For some patients, multifocal IOLs reduce but do not completely eliminate the need for
glasses or contact lenses. For example, a person may read without glasses, but the
words appear less clear than with glasses. For tiny print, such as on medicine labels,
glasses may still be necessary.
Each person's success with multifocal IOLs may depend on the size of his/her pupils
and other eye health factors, especially astigmatism.
Glare or halos around lights, or decreased sharpness of vision (contrast sensitivity) may
occur, especially at night or in dim light. Most people adapt to and are not bothered by
these effects, but those who frequently drive at night or need to focus on close-up work
may be more satisfied with monofocal IOLs, and use eyeglasses for near or computer.
Many patients choose multifocal IOLs in hopes of reducing as much as possible their need
for glasses. This kind of IOL may not be appropriate for every patient, including patients
with macular degeneration. Your doctor will need to tell you if you are a candidate for a
multifocal IOL.
All of these options may seem complicated, but you need to consider your personal goals
to make the best choice for yourself. Discuss your visual goals in detail with your doctor.
This brochure is intended to provide helpful information, but is not a substitute for
discussing the best recommendations for your particular needs with your doctor.
Thank you for choosing
Tauber Eye Center for your
vision care.
We appreciate your trust!
Tauber Eye Center 4400 Broadway Suite 202, Kansas City MO 64111 (816) 531-9100