Artificial Lens Implants FAQ
Does cataract surgery mean that I won’t need glasses anymore?
Not exactly. While we are young, our internal eye muscles change the shape of the natural human lens to move our focus smoothly from far to near and back. This natural focusing ability present in young eyes is called accommodation. Because of a loss of lens flexibility with age, we all lose this ability to change focus (“presbyopia”), and it is usually noticeable by the time we reach our mid-forties. This re-focusing function must be replaced with reading glasses, progressive lenses, bifocals, or trifocals.
Conventional artificial lens implants are single-focus or “monofocal” lenses. Like the older human lens, they cannot change focus from far distance to near. Following cataract surgery, although many activities may be fine without glasses, patients are able to choose from the same options available to everyone else over the age of 50 – contact lenses, bifocals, or separate driving or reading spectacles – to optimize their focus at different distances.
Your best option for correcting presbyopia will depend on many factors, including your overall eye health, visual preferences, occupational and lifestyle needs, other medical conditions, personality, age, and tolerance for glasses and contact lenses.
There are newer artificial lens implants that can reduce – but not eliminate – your dependence on eyeglasses. Multifocal lens implants are designed to produce a dual focus, as part of the lens is set for distance focus and part of the lens is set for near. Therefore, compared to a monofocal lens implant set for distance focus, a multifocal should improve your ability to see up close without glasses. Some types of multifocal lenses may compromise the crispness of vision, and many patients will at least temporarily notice glare or halos around lights with these lenses. The advantages of multifocal lenses may be lost if there is too much astigmatism or if there are other eye problems.
Can the lens implant be removed and replaced?
Yes, but the need to remove the lens implant is very unusual.
Can Astigmatism be reduced with cataract surgery?
Like nearsightedness or farsightedness, astigmatism describes a common type of blur in healthy eyes that is corrected by wearing eyeglasses. It results from an imperfect optical shape of the cornea, the clear front window of the eye. If the shape of your cornea is more oblong (like the back of a spoon) instead of spherical, then it will cause details to become blurry when corrective eyeglasses are not worn.
Astigmatism can be reduced at the same time that cataract surgery is done. The astigmatic keratotomy technique places tiny superficial incisions that do not enter the eye but reduce the undesirable oblong shape of the cornea. Another popular option is a modification to the artificial lens implant that is permanently implanted in every cataract operation. This toric lens implant incorporates the astigmatism correction that otherwise would have to be worn in prescription eyeglasses.
Both of these astigmatism-reducing techniques allow appropriate patients to see better when they are not wearing eyeglasses, and any eyeglasses worn will be less strong as a result. They are perfectly safe and do not require the cataract surgery to be performed any differently; however, they do involve additional costs.
A third option, the light adjustable lens, allows reduction of astigmatism by refining the lens power postoperatively. You can read more about the adjustable lens here.
Does the artificial lens replace the need for sunglasses?
Sunglasses provide two benefits. Dark tinting reduces brightness, and a transparent UV coating blocks out the invisible, but harmful, ultraviolet rays of the sun. Because all modern artificial lens implants contain this UV coating, they provide ultraviolet protection at all times. However, implants are not tinted, so patients may still choose to wear sunglasses for comfort, just as they did before their cataract surgery.
If I previously had LASIK, PRK, RK, or other refractive surgery, can I still have a lens implant?
Yes. However, prior refractive surgery significantly impairs the accuracy of corneal measurements, making it very difficult to estimate the optimum implant power. A new technology called wavefront aberrometry may improve the results by utilizing measurements taken in the operating room after the cataract is removed, although insurance does not cover the extra charge for use of this machine.
The light adjustable lens is another way to deal with the difficulty of selecting the lens power after refractive surgery. Instead of relying solely on pre- and intraoperative measurements, the eye is allowed to heal, the remaining lens prescription is measured, and the lens power is then adjusted. This page contains more information about the light adjustable lens.
What about the cost?
Health insurance, such as Medicare, covers the costs of cataract surgery with a conventional monofocal lens implant. Not surprisingly, the multifocal or toric lens implant procedure is more expensive, and the additional costs must be paid out-of-pocket by the patient. Remember that the benefits of these more advanced lens implants are to reduce the inconvenience of having to wear eyeglasses as frequently. They are not considered “medically necessary” because they have nothing to do with improving your eye health.
Reducing the need to wear glasses is not a priority for everyone and may therefore not be worth the added expense. All artificial lenses should provide equally good vision with glasses following cataract surgery. The difference is in what you can see when you aren’t wearing glasses.
You may also need eyeglasses to correct or optimize your far distance vision following cataract surgery. The artificial lens comes in more than 60 different powers. Because there is no opportunity for trial and error in selecting the lens implant for your eye, “perfect” distance focus is not usually achieved with surgery. Astigmatism is another reason that distance glasses may be needed at times. Fortunately, eyeglasses can be used to optimize distance focus just as for anyone whose eyes are not in perfect focus naturally.