It is Time for Cataract Surgery, How do I Make the Right Lens Choice?

By: Dr. Perry Lee

Cataract surgery is the most performed outpatient surgical procedure in the United States. The actual surgical time is less than 15 minutes and gives patients cataract free vision for life. During cataract surgery, the cloudy lens is removed, and an intraocular lens is placed into the eye. There are a variety of lens choices that can be used during cataract surgery to customize the patient’s final visual outcome. A standard lens is typically covered by your medical insurance, while specialty lenses have extra out of pocket charges that are not covered by your medical insurance. Specialty lenses include toric lenses for astigmatism reduction, Vivity Extended Depth of Focus lenses, PanOptix Multifocal lenses, and Light Adjustable lenses. With many lens choices, how does one know which option is best? That answer is dependent on some important factors.

The most common lens in cataract surgery is a standard lens. There are two scenarios that can be chosen for standard lenses with cataract surgery: both eyes for distance or monovision, which is one eye for distance and one eye for near. If a patient does not have a significant amount of astigmatism, then the standard lens can result in a reduced need for distance glasses following cataract surgery. If both eyes are focused for distance, then the patient will need glasses or contacts for intermediate (arm’s length) and near vision. Again, if a patient does not have a significant amount of astigmatism, then monovision with the standard lens can result in a reduced need for distance and near glasses or contacts following cataract surgery. Up to 20% of patients do not like monovision, so it is only recommended if patients have previously tried it with contacts and liked the results.

If a patient has a significant amount of astigmatism and wants to be less dependent on glasses, then a toric specialty lens can be chosen. The toric implant can reduce farsightedness, nearsightedness, and astigmatism, which results in less dependency on glasses following cataract surgery. Again, if both eyes are focused for distance, reading glasses would be needed for intermediate (arm’s length), or near vision. Monovision, one eye for distance and one eye for near, can also be chosen with a toric lens during cataract surgery reducing the need for distance and near correction with glasses or contacts.

Cataract surgery patients that have not worn monovision contacts successfully in the past and want improved distance vision and reduced dependence on reading glasses can choose the Vivity Extended Depth of Focus specialty lens. The Vivity lens gives almost as crisp of distance vision as a standard lens and good intermediate vision. Intermediate vision is the distance of your car speedometer, a typical desktop computer screen, or arm’s length tasks like cooking or shopping. This lens can reduce farsightedness, nearsightedness, and astigmatism as well as reduce the need for reading glasses following cataract surgery. Instead of having to use glasses to view digital device screens and for reading, you might only have to use reading glasses part of the time instead of all of the time with a standard lens.

Cataract surgery patients that have not worn monovision contacts successfully in the past and that want better near vision than the Vivity Extended Depth of Focus lens can choose the PanOptix multifocal specialty lenses. As you improve the near performance of a contact lens or a multifocal implant with cataract surgery, the sharpness of the distance vision gets lessened. Most patients can still see well at distance, but they do notice it is not as sharp, especially when driving at night. However, instead of just getting intermediate (arm’s length) vision with the Vivity Extended Depth of Focus lenses, the PanOptix can reduce the need for reading glasses more than the Vivity Extended Depth of Focus specialty lens.
The latest specialty lens choice for cataract surgery is the Light Adjustable Lens. Cataract surgeons make every effort during the lens calculations before cataract surgery to select a lens that gives the best distance vision. However, sometimes there is a small-scale prescription for glasses or contacts that will be required to get the vision perfect. The Light Adjustable Lenses were developed to fine tune the final prescription even further. Three to four weeks following cataract surgery, the surgeon uses a special light over several sessions to finalize the prescription of the intraocular lens. For example, if you had a small farsighted, nearsighted, or astigmatism correction following cataract surgery, the doctor could adjust the prescription in the intraocular lens to further reduce the need for glasses for distance. The light adjustable lenses work well for monovision and with or without astigmatism.

Cataract surgery has improved tremendously over the past. Today’s state of the art implants can give you options for good distance vision, good near vision, or both! Our team at Lake Oconee Eye Care can help you make the best choices for great vision for life. We look forward to discussing your options with you if you’re faced with cataract surgery.