Cataracts

What is a cataract?

A cataract is the gradual clouding of the natural lens inside the eye. It is not a growth or a "skim" on the eye. Cataracts are very common especially in people over the age of 55. There is no known medicine or treatment to reverse the growth of cataracts. Once a cataract develops it will continue to cause progressively blurred vision until it is surgically removed.

How does a cataract cause blurred vision?

Light rays enter the eye through the cornea, pass through the lens and land on the back of the eye (retina). The brain interprets the image from the retina. As a cataract develops, thelight rays entering the eye have more difficulty passing through the cloudy lens (cataract) to reach the retina. This causes blurred vision. People with cataracts may complain that their vision appears blurry, hazy, smoky, or waxy. They may also notice more difficulty with reading, recognizing faces or walking especially in low light. Driving at night may become difficult and even dangerous due to glare and halos around lights.

When does a cataract need to be removed?

Advances in cataract surgery have made this one of the safest and most frequently performed surgeries today. Cataract surgery is generally considered when your vision impacts your activities of daily living, making it more difficult to perform everyday tasks. You may want to consider having cataract surgery if you are having more difficulty driving at night, reading, cooking, shopping, working, watching TV or using the computer due to your vision. We will review a questionnaire with you during your examination to properly evaluate how much your vision is impacting your daily life.

How will cataract surgery affect my vision?

The goal of cataract surgery is to correct blurred vision caused by the cataract. Dr. Patterson performs cataract surgery through a 2.8 mm incision in the cornea. There is usually no discomfort or bleeding. The cataract is broken up with ultrasound and removed from the eye. After the cataract has been removed, Dr. Patterson will insert a new artificial lens implant called an intraocular lens (IOL), which will remain in your eye permanently. The corenal wound is self sealing and routinely no sutures are used. Cataract surgery will not correct other causes of blurred or decreased vision, such as glaucoma, diabetes, or age-related macular degeneration.

Will I have to wear glasses after surgery?

Your vision after surgery depends on the choices you make before surgery. Even if you have never worn glasses before it is possible that you may need to wear them after your cataract surgery. In addition to standard implants, optional premium implants designed to reduce or eliminate your need for glasses are available to provide custom vision depending on your personal needs. These options are not covered by your insurance. Dr. Patterson will discuss these options with you during your eye examination.

The difference between standard and refractive cataract surgery

Standard cataract surgery includes removing the cataract and replacing it with an intraocular lens implant (IOL). This is considered to be medically necessary and is generally covered by most medical insurances. After standard cataract surgery you may need to wear glasses most, if not all of the time, especially reading (even if you do not currently wear glasses).

Refractive cataract surgery includes removing the cataract, but with additional treatment to reduce or eliminate your need for glasses. This may include simply treating nearsightedness, farsightedness or astigmatism to provide good distance vision or implanting a multifocal or accomodating lens implant to provide a wide range of vision without depending on glasses. Additional pre-operative testing is required. RCS also includes treating any astigmatism you might have as well as the additional follo-up care that may be required. These options are completely elective and are not covered by medical insurances.

RCS options

With RCS, instead of inserting a standar implant into the eye, a special accomodating, multi-focal implant is used. Dr. Patterson has been successfully implanting premium implants since 1997. These implants provide good vision at a range of distances. Patients with premium "full range vision" implants have good functional vision and enjoy life without glasses for most tasks. Your vision should be clear enough to legally pass the vision portion of the driver's license test, use a computer and read normal sized print without glasses. Glasses may be needed on occasion for smaller print, reading for long periods of time or driving in poor conditions. Over 90% of our patients with premium implants report that they seldom if ever wear glasses.

At Eye Centers of Tennessee, we also offer a "Legal to Drive" option. This option will correct nearsightedness, farsightedness and minimal astigmatism. Vision will be in focus at a distance for tasks such as driving, watching TV or recognizing faces from across the room. We anticipate that you will be able to legally pass the vision portion of the driver's license test without glasses. Glasses will be required for most if not all reading and computer work.

There is also a third option for patients who are either nearsighted or farsighted and have astigmatism. Astigmatism is caused by an irregularly shaped cornea, which can make your vision blurry. Generally with RCS mild to moderate astigmatism is treated at the time of surgery with a limbal relaxing incision (LRI), which is simply a small, painless incision on the outer edge of the cornea. For patients with higher amounts of astigmatism a toric astigmatism correcting implant may be used.

When would I notice improved vision with premium implants?

Most people see well soon after surgery. However, it may take a few weeks for your brain to adjust to your new vision, especially the premium lens implants. Your vision may continue to improve for several months following the procedure. Minimal glare or halos around lights especially at night is normal for the first few months.

Vision fluctuation and enhancements with RCS

While the methods used to calculate your IOL power are very accurate, the final result may be different than what you and your surgeon planned. Everyone heals slightly differently. The IOL may move slightly forward or backward as your eye heals. The amount of movement is not the same in everyone. It is also possible that you may have residual astigmatism which needs to be corrected after surgery. If this is significant enough to interfere with your functional vision an enhancement or "touch-up procedure" may be performed to tweak the results and refine your vision further. Enhancements are included up to 1 year after surgery. Generally, the need for enhancement will be obvious within the first 2-3 months. Our enhancement rate is around 10%.

Am I a candidate for RCS?

Most people are very good candidates for Refractive Cataract Surgery, but there are exceptions. RCS is generally recommended for people with reasonably healthy eyes. If you have conditions such as macular degeneration or diabetic retinopathy, Dr. Patterson will discuss your options with you.

Will my insurance cover RCS?

Your medical insurance will be billed for the standarad cataract surgery which is considered medically necessary. RCS is an extra elective portion and will not be billed to your insurance. You will be responsible for the additional fees for RCS. Affordable, no interest payment plans are available. A discount will be given for paying in full the day of surgery.