Rapid changes in surgical technology leave us with too many choices and insufficient information to make the right decision. Ophthalmic Partners is committed to working with each patient and individual. We will identify the significant issues, educate you about options, and help you choose the best. The physicians of Ophthalmic Partners perform an average of 3,000 cataract surgeries each year. In addition, Dr. Richard Tipperman focuses predominantly on cataract surgery, emphasizing higher-risk eyes and managing complications.

WHEN IS CATARACT SURGERY INDICATED?

The impact of a cataract can be subjectively assessed by how it affects your activities of daily living. In addition to progressive blurred vision and glare, cataracts can also cause impaired color vision and even double vision. A major concern is the loss of depth perception. Often cataract progression occurs so slowly (especially if both eyes are changing at the same rate) that patients adapt to their visual impairment and fail to notice. Testing can measure your compromised vision and the impact of glare, and in the early stages, changing your glasses may provide some improvement. Cataract surgery is most often indicated when your visual function no longer meets your needs, and your eye exam, combined with the results of diagnostic testing, suggests the likelihood of improved vision if the cataract is removed. In a small percentage of patients, surgery is indicated for the health of the eye or to facilitate the diagnosis and management of another ocular problem.

WHAT IS THE IMPACT OF CATARACT SURGERY?

The loss of visual function in the elderly is associated with a decline in physical and mental functioning, as well as independence in activities of daily living such as driving, reading, social and community activities, and household tasks. Visual function plays an important role in terms of mobility and is a significant factor in falls and hip fractures, which often lead to nursing home placement. Up to 90% of patients undergoing cataract surgery note improvement in functional status and satisfaction with vision after surgery in the first eye, with a significant reduction in the rate of falling and hip fracture. Similar improvement following surgery in the second eye has also been confirmed. Drivers with visually significant cataracts are also two to three times more likely to have an at-fault motor vehicle crash.

Numerous studies show that physical function, mental health, emotional well-being, safety, and overall quality of life can be enhanced when visual function is restored by cataract extraction. Most people who choose cataract surgery are extremely pleased with the results.

WHAT DOES CATARACT SURGERY DO?

Cataract surgery removes the cloudy focusing lens from the eye and replaces it with an implant. Virtually every operation is combined with the placement of a new focusing lens called an intraocular lens implant or IOL, which is designed to remain in the eye forever. Many traditional implants improve vision at one focal point, so patients often continue to need glasses. Advanced Technology Intraocular lenses can decrease the dependency on glasses after surgery and correct astigmatism and presbyopia.

Surgeons at Ophthalmic Partners choose from a wide variety of IOLs to address individual patient needs and desires. The strength or power of the IOL is calculated from measurements obtained at the time of your evaluation. If you are having cataract surgery, you have a number of intraocular lens focusing technology options:

• Monofocal IOLs are calculated to focus light at one distance. You and your surgeon can decide to aim for good distance vision, good intermediate vision, or good near vision without glasses. In addition to the patient’s desires, the most important issue is to choose an IOL so that both eyes work together without too much of an imbalance. Glasses are usually necessary after surgery to provide a full range of vision since the mono-focal corrects only one range.
• Blended vision/Monovision is a condition in which one eye is corrected for distance, and the other eye is corrected for intermediate or near vision. This requires the brain to shift into the clearer-focused eye while suppressing the blurred image in the fellow eye. Many patients tolerate this well and are able to function uncorrected for most activities.
• Toric IOLs are a type of mono-focal designed to maximize uncorrected vision quantity and quality by neutralizing pre-existing astigmatism, which is present in more than 30% of patients.
• Presbyopia-correcting IOLs are designed to correct presbyopia (loss of near vision with aging). They can reduce dependence on glasses by providing a greater range of vision uncorrected from distance to near or, at the very least, reduce the need for glasses, ideally providing independence from glasses for many activities.
• Multifocal IOLs divide the light that enters the eye, improving both uncorrected distance and near vision compared to mono-focals.
• Accommodative IOLs are designed to change position or shape in the eye to provide a greater focusing range.

WHAT IS “PREMIUM CATARACT SURGERY”?

Premium cataract surgery refers to astigmatism reduction and/or multifocal/accommodative IOL surgery to reduce dependence on glasses. Additional testing and surgical planning are required, and these options are associated with an additional cost not covered by insurance. These decisions can be finalized only after a detailed discussion with your surgeon at Ophthalmic Partners.

CAN MY CATARACT BE REMOVED USING A LASER?

There are many surgical options to remove a cataract. In the United States, most include the use of phacoemulsification, where ultrasound is used to break up the densest parts of the cataract so they can be removed through a small incision. The femtosecond laser is the newest advancement in cataract surgery and adds additional precision and control when utilized for astigmatism reduction.