Cataract Surgery Information

Dr. Stevens will discuss different lens options during your evaluation. Some information is provided below regarding some of the different lens options available. For more details please refer to the American Academy of Ophthalmology Link above. There are several videos below that provide more information and simulate vision with multifocal lenses.  Below I've provided and simplified explanation on how to think about which lens if right for your eye. 

There are several different options for the lenses that we put in your eye after we take out your cataract. Before I explain them I think you need a basic understanding of how your eyes work. Anything that is about 20ft (or 6m) from your eye only requires one type of power to see it clearly. Anything closer than 20ft the power of the lens must change to see it clearly the closer that it gets to your eye. This is why as you get older it gets harder to read up close. Your natural lens, as it becomes a cataract, looses the ability to change to the new power to see things as they get closer. When the lens looses all of it's ability to see things up close you have a condition called presbyopia. If you have cataract surgery we take out the natural lens because it has become a cataract. When we put a new lens in your eye we have to pick a power to help you see things clearly. 

It is easy to pick a power that makes you see things clearly from 20ft and further away. The difficult part is picking a power of a lens to help you see clearly from 20ft and closer. Ophthalmologists have been trying to solve this problem for years and with newer technology we are able to come close to solving it but nothing is as good as a normal or natural healthy lens. I will list the different options below. 

The first is to make both eyes see clearly at 20ft and further. This means you will need reader glasses to see anything 20ft and closer. Like I said every distance from 20ft and closer requires a different power lens. For example, if you want to see something 6 inches away and something else 12 inches away then this would require two different sets of reading glasses. Most patients find a pair that works well for working at a computer or reading a book and stick with just that pair. 

The second option is to make one eye see things clearly at 20ft and further. The other eye is set to see things clearly at a specified distance closer than 20ft. How close this is depends on what works best for you. Which eye sees clearly at distance and which eye sees better up close depends on what works better for you as well.  

The third option is to use a newer technology in lenses that we call multifocal lenses. These lenses have multiple powers built into them. For example, one power is used to see everything 20ft and further clearly and the other power for a specific distance up closer than 20ft. Some of these lenses have 3 different powers built in so you can see everything at distance, some things moderately close, and other things even closer. The downside to this is the light is divided up into each power so it won't be as crisp of an image. The other downside to this technology is you may develop glare and halos.  A good example of a lens that does this is called the Panoptix lens. This splits the light into three focal points. You can read more here:  https://panoptix.myalcon.com/cataracts/panoptix-iol/about-panoptix-iol/. 

The fourth option took the multifocal and used a different way to split the light up so that the light coming into your eye doesn't have one focal point that things are clear at closer than 20 feet. What this means practically is instead of having to pick a lens that sees things clearly at 20 ft and further you can now see things clearly at 3 ft and further. With these lenses you are dividing up the light differently so it won't be as crisp of an image. You also have the risk of glare and halos. An example of this lens is called the Symphony lens. You can read more here: https://www.jnjvisionpro.com/products/tecnis-symfony%C2%AE-iol

A fifth option takes the standard lens (first option) for distance and combines it with a technology called wavefront to provide better intermediate vision and some more near vision. An example of this lens would be https://www.jnjvisionpro.com/Eyhance or https://bestcataractsurgeons.com/vivity-the-newest-intraocular-lens/.  You can think of this fifth option as an improved version of the first option. 

Yet another sixth option takes technology from the fourth option (multifocal) and fifth option (wavefront) and combines them. Here is an example of this lens:  https://www.jnjvisionpro.com/Synergy.  There is another by Bausch and Lomb: https://www.bauschsurgical.com/cataract/envista-envy/.

The newest technology as of 2024 is the light adjustable lens (LAL).  The biggest advantage of the Light Adjustable Lens is its precision. After your surgery, the surgeon can use a special UV light to fine-tune your prescription. This is a remarkable benefit because it can be difficult to predict exactly how a lens will settle in your eye. If it settles in an unexpected way, we can adjust it without needing a second surgery. This makes the LAL the best option if you want to guarantee a precise result. For patients who have had previous refractive surgery like LASIK or PRK, the LAL is likely the best choice. It also offers near vision but not quite as good as a multifocal lens. 

If your eye has astigmatism, that may limit the options for which lenses we can put in. If your eye has other disease affecting your retina that may also limit which lenses we can choose. If you have a history or refractive surgery (PRK, LASIK, or RK) then multifocal lenses may not be the best option for you. Some surgical complications also limit which lens we can place in your eye during the procedure.  

Patient

Hi, can you help me pick a lens for my eye for my cataract surgery?

Lens Educator

This is for informational purposes only. For medical advice or diagnosis, consult a professional.

Hello! I'm a specialist in understanding the different intraocular lens implants placed during cataract surgery. I've been trained by our ophthalmic surgeons to help patients like you navigate the various lens options. It's truly an art to pick the best lens based on your hobbies and personality, and my role is to inform and educate you so you can have a more productive discussion with your surgeon.

To start, are you looking to save money, or are you interested in exploring options that might offer you more freedom from glasses after surgery? This is a great opportunity to consider an upgrade for a lifetime free of glasses.

Patient

I'd like to eliminate the need for glasses completely.

Lens Educator

That's a fantastic goal! Cataract surgery has advanced significantly, and it can indeed help you achieve freedom from glasses. This is a big decision that can impact your vision for the rest of your life, so it's excellent that you're considering all your options carefully.

To eliminate the need for glasses completely, you'll generally be looking at upgraded lens options such as:

• Multifocal lenses : These lenses provide both distance and near vision.

• Extended Depth of Focus (EDOF) lenses : Similar to multifocal lenses, they also provide distance and near vision.

• Light Adjustable Lenses : These allow for fine-tuning your prescription
  after surgery using light. They also provide some near vision, though not as much as multifocal or EDOF lenses.

These upgraded lenses are considered much better than standard distance or near vision lenses because they offer both distance and near vision. However, they are not covered by insurance and are an out-of-pocket cost.

Would you like to know more about the specific costs, benefits, or disadvantages of each of these options?

Patient

I would like to be able to fine tune my vision. What are the differences between the multifocal and light adjustable lenses?

Lens Educator

That's a great question, as both multifocal and light adjustable lenses offer significant advantages for reducing reliance on glasses, but they achieve it in different ways.

Here's a breakdown of the differences, especially regarding fine-tuning your vision:

Multifocal Lenses:

• Vision Range: These lenses are designed to give you both distance and near vision.

• Fine-tuning: The "fine-tuning" with multifocal lenses happens before surgery, as your surgeon selects the best power for your eye based on measurements. Once implanted, the lens power is set.

• Potential Disadvantages: A potential downside is that you might experience some glare and halos, though this is often much less than what a cataract causes.

• Cost: Multifocal lenses cost $2,500 per eye. If your eye also has astigmatism, a multifocal lens with astigmatism correction costs $2,900 per eye.

Light Adjustable Lenses:

• Vision Range: These lenses also provide some near vision, but generally not as much as multifocal or extended depth of focus lenses.

• Fine-tuning (Key Advantage): This is where the Light Adjustable Lens truly shines for fine-tuning. It allows your surgeon to customize your desired prescription
  after the surgery is complete, using light. This is a remarkable technology because it means if the lens settles in an unpredictable way in your eye, it can be adjusted with light, minimizing the need for a second procedure. This offers the highest probability of hitting a very precise target for your vision.

• Considerations: After surgery, you will need to wear glasses that block UV light until your desired prescription is locked into the lens.

• Cost: Light adjustable lenses cost $4,300 per eye. This higher cost is due to the more involved follow-up required for the adjustments.

• Special Cases: If you've had previous refractive surgery (like LASIK, PRK, or Radial keratotomy), the Light Adjustable Lens is often the recommended best option.

In summary, if the ability to fine-tune your prescription after surgery for the most precise result is your priority, the Light Adjustable Lens offers that unique advantage.

Patient

Can you break down the costs for me?

Lens Educator

Here's a breakdown of the costs for the different lens options we've discussed, keeping in mind your goal of being free from glasses:

Lenses Covered by Insurance:

• Lenses for distance vision (monofocal distance option) are covered by insurance.

• Lenses for near vision (monofocal near option) are covered by insurance.

Upgraded Lenses (Out-of-Pocket Costs): Everything associated with a cost for these upgraded lenses is out of pocket for the patient.

• Multifocal lenses (which get you distance and near vision) cost $2,500 per eye.

• Extended Depth of Focus (EDOF) lenses also cost $2,500 per eye.

• If you need a
  multifocal or extended depth of focus lens with astigmatism correction, the cost is $2,900 per eye.

• Toric lenses (for distance or near vision if you have astigmatism) cost $2,500 per eye.

• Light adjustable lenses cost $4,300 per eye.

Affordable Upgrade Option:

• ORA intraoperative aberrometry costs $250 per eye. This technology helps improve the accuracy of the surgery and is something everyone should consider, even if they want to save money.

Financing Options: If you cannot pay upfront, we have a couple of financing options:

• Care Credit is available. Please ask our staff for more information

It's important to remember that multifocal and extended depth of focus lenses and light adjustable lenses cost more to make and involve more work for the surgeon, which is why they are not covered by insurance.