Cataracts can be genetic, causing people to develop them earlier in life and even during childhood. However, most cataracts form due to the cumulative effects of environmental factors like UV exposure and because of the natural aging process. Surgery is the only way to treat cataracts, and it’s a highly safe and effective procedure, but the overall outcome relies largely on the type of lens you choose to have implanted during the process.
Understanding Cataract Surgery and Lens Options
Cataract surgery is an outpatient procedure, which means you do not need to be admitted into care and you can go home almost immediately after the surgery is complete. Prior to the procedure, you’ll need to spend some time evaluating your lens options, as it’s an important and permanent decision.
The Cataract Surgery Process
When you arrive for your surgery, you can expect the following procedure:
- Prep: Your doctor will numb the surface of your eye using a topical anesthetic. The anesthetic is typically administered via eye drops, and additional medicine may be given to help you relax. You will be awake during the procedure, but you won’t see anything except a rainbow of light.
- Incision: After your eye is numb, your surgeon will use a blade or laser to make a very small incision in your cornea. This incision is so small that it will generally heal closed on its own without the need for stitches.
- Cataract removal: There are a few ways for a doctor to remove a cataract, but phacoemulsification is the most common method, which utilizes ultrasonic waves to break up the damaged lens into small pieces. Suction will then be used to remove the pieces through the incision.
- Lens insertion: After the cataract is removed, the surgeon will insert a new artificial lens through the same incision. Most intraocular lenses (IOLs) fold easily and then unfold within the eye within the space where your cloudy lens used to be.
- After-care: Following the procedure, your surgeon will place a shield over the eye, which resembles an eye patch. This will be taped in place to protect your eye during the healing process.
The entire surgical procedure for cataract removal takes about 10 to 15 minutes, but preparation and in-office recovery can take a few hours. You’ll need someone to drive you home after the procedure.
Importance of Choosing the Right Lens
During cataract surgery, the natural lens of your eye is removed and is replaced with a clear, artificial lens. There are multiple types of intraocular lenses (IOLs) available, and your ophthalmologist will help you select the best one for your needs.
Lenses have different focusing powers to correct nearsightedness and farsightedness. Additionally, specialty IOLs are available to correct issues like astigmatism and presbyopia. Since the lens you choose is a permanent decision, be sure to ask questions about all of your options.
Available Lens Types
- Monofocal lenses can only correct distance or near vision, not both, so you’ll need to decide which is more important to you. For instance, you can correct distance vision so you don’t have to wear glasses while driving, but you will need to wear glasses for reading.
- Toric lenses are used to reduce astigmatism to improve overall vision quality. If you have astigmatism, your surgeon may recommend a toric lens, but insurance may not cover the additional cost.
- Multifocal lenses, also known as presbyopia-correcting lenses or extended-depth-of-focus lenses, correct both near and far vision. This means you won’t have to depend as much on glasses after cataract surgery.
Evaluating Your Needs and Lifestyle
Cataract surgery is effective no matter how advanced your cataract is, and there is no benefit to delaying surgery. However, many people wait until they have changes to their vision. If you are considering surgery, documenting changes in your vision is important for insurance coverage, and this is something your eye doctor will assist with.
Visual Acuity Requirements
Contrary to popular belief, there is no national coverage determination (NCD) that specifies a person must have a certain visual acuity (VA) like 20/40 or worse in order to receive coverage for cataract surgery. However, individual payers may have their own requirements.
If your insurance company has requirements in place, you may have to wait to receive cataract surgery until your vision has worsened to the degree to which your insurance company agrees surgery is necessary. In the meantime, prescription glasses may help slightly in maintaining your vision quality.
Night Driving Considerations
Cataract development can impact distant vision and cause glares and halos when looking at bright lights. Cataract surgery can correct these issues, but you may notice after surgery that car lights and street lights appear brighter. There will be a period of adjustment during recovery, so it’s important to time your surgery appropriately.
Astigmatism Management
Astigmatism is an eye condition characterized by the surface of the cornea or lens being irregularly shaped. If you have astigmatism, your surgeon may utilize some special techniques during your procedure to correct it without the need for special lenses.
During cataract surgery, a special laser called a femtosecond laser can be used to fix astigmatism by flattening the steep curve of the cornea, giving the eye a more spherical shape to give you the best vision.
In-Depth Look at Lens Types
Monofocal Lenses
Monofocal lenses have a single point of focus, which typically improves distance vision but will not correct near vision. Many people get monofocal lenses anyway as the cost of these lenses is covered by insurance as part of a cataract surgery. Since monofocal lenses have been around for over 50 years, they are well-manufactured and very reliable.
Pros:
- Covered by medical insurance
- Compatible with everyone
Cons:
- Single point of focus
- Near vision may still require glasses
Premium Lens Options
Premium lenses, also known as multifocal lenses, give multiple points of focus, helping a person depend less on eyeglasses after cataract surgery. These lenses are more advanced in design than monofocal lenses and can correct vision at a distance, up close, and in between.
The biggest downside of multifocal lenses is that insurance often does not cover the difference in cost, increasing your out-of-pocket expenses. Additionally, you may not be a candidate for multifocal lenses, so it’s important to discuss your options during your consultation.
Pros:
- Wide range of focus
- Correct multiple vision problems
- Reduced dependency on glasses
- Maintains proper depth perception
Cons:
- Insurance may not cover the cost difference
- Not everyone is a candidate
- You may notice glare and halos around lights
Emerging Lens Technologies
The lenses you choose during cataract surgery will determine your vision for the rest of your life, which means those who choose monofocal lenses may grow frustrated with how reliant they are on glasses or contacts. Meanwhile, while multifocal lenses are far better, emerging technologies look to move the industry another step forward.
One of the leading lens technologies today is the light adjustable lens, which allows for customized vision enhancements after surgery. This lens can be adjusted even after it is implanted and fully healed, allowing a person to adjust their sight to fit their lifestyle requirements.
Light adjustable lenses are controlled using a specialized light treatment, which reshapes the artificial lens while inside of your eye. They can be adjusted multiple times, allowing them to be fine-tuned to suit your preferences.
Financial Considerations and Insurance Coverage
Insurance may cover cataract surgery, but it’s important to remember that you’ll need to meet your deductible first. Whether or not you have insurance, you can speak with your doctor to discuss out-of-pocket costs, payment plans, and ways to bring costs down.
Standard vs. Premium Lens Costs
Multifocal lenses typically cost $4000-5000 while toric IOLs cost about $2000-3000. Standard monofocal IOLs cost significantly less and are often covered by insurance. If you opt for a premium lens, you may only be responsible for paying the difference in cost between a monofocal lens and your choice of lens, but you may have to spend much less over time since you may not need to purchase glasses and contact lenses.
Insurance Coverage for Intraocular Lenses (IOLs)
Both Medicare and private insurance will cover cataract surgery and the cost of the lens implantation if there is a medical need, which means you meet the payer’s criteria. Requirements vary, but they typically involve being symptomatic with a cataract that actively inhibits your daily life.
Out-of-Pocket Expenses and Payment Plans
The average cost of cataract surgery for someone without vision insurance ranges from $3,500 to $7,000 per eye. However, insurance may cover 80% of these costs or more, reducing out-of-pocket expenses to as low as $0. If you have any out-of-pocket expenses, consider discussing a payment plan with your clinic.
Making an Informed Decision
Consultation with Your Surgeon
During your surgical consultation, it’s important to ask questions so you can better understand the procedure, side effects, and outcomes. Here are some questions to consider:
- How will cataract surgery change my vision?
- How long after surgery will I notice improvements?
- Will I still need glasses after surgery? What for?
- How can I prepare for my surgery?
- Do I need to stop taking or change any of my medications?
- What type of anesthesia will I have during surgery?
- What types of lenses am I a candidate for?
- How do I care for my eye after surgery?
Weighing The Pros and Cons
Cataract surgery has a high success rate with over 95% of people who have it reporting improved vision. The surgery is generally quick and easy, but you may experience some general itching in the days following the procedure.
As with any surgery, there are some risks associated with cataract removal, such as bleeding, swelling, retinal detachment, infection, glaucoma, vision loss, dislocation of the artificial lens, and secondary cataracts. You should discuss the risks with your surgeon prior to the procedure.
Next Steps
Would you like more information about cataract removal and your options for vision restoration? Schedule a consultation with SuraVision by calling 713-730-2020 or contacting us.
Frequently Asked Questions
Are there different grades of lenses for cataract surgery?
There are two primary types of lenses used in cataract surgery: Monofocal (standard) and multifocal (premium). There are also specialty lenses, which may be offered to correct conditions such as astigmatism. Lens technologies also exist, like light-adjustable lenses, which can be adjusted after the procedure.
Which is better, monofocal or multifocal?
Monofocal lenses only correct at one distance, while multifocal lenses allow for vision correction at a range of distances. Multifocal lenses reduce the need for glasses or contacts, but they may not be covered by insurance.