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Ask Dr. Hynes: Cataract surgery can decrease need for glasses

Dear Dr. Hynes:

I am a 70-year old male with lifelong myopia and probably someday will be a candidate for cataract surgery. I've seen pictures in brochures in doctors' offices showing contraptions they put inside your eyeballs to replace the old lenses, and I am a bit trepidatious about them. I don't know how well they hold up, and I would not want to undergo the surgery again. Besides which, I greatly value my native close vision, and do not mind wearing eyeglasses for distance.

So my question is: is there a simpler way of replacing a lens, maybe with a simple (uncorrected) clear plastic lens which sits right where the old lens was? If there is, I would assume it would give me clear vision, free of astigmatism but otherwise neutral (uncorrected) vision such as I have now, but with my current superb close vision still intact. Am I correct?

Dear Mr. A:

When we do cataract surgery, the surgeon removes a cloudy lens and replaces it with an artificial lens implant (IOL- intraocular lens implant). If you don't have the surgery, your doctor would have to give you very thick magnifying glasses. This is what we used to do about 40 years ago. I am sure the older generations can remember seeing older people wearing "Coke bottle" glasses. Those glasses caused peripheral distortion. That's why the standard of care for the last 30-plus years is to implant an artificial lens and not to prescribe those glasses.

Over the last few decades, the lenses have improved tremendously. The material and design of them have become much better, they are more compatible with the eye and almost never cause any problems if they are implanted correctly.

There are very few exceptions when we may not recommend inserting these lenses. The most common would be for a young child who develops a cataract as the result of ongoing chronic inflammation due to rheumatoid arthritis.

All modern implants are approved by the Food and Drug Administration and should last you for the rest of your life.

The big advantage available to us through modern technology is that we can calculate the power of that artificial lens accurately, which allows us to decrease the need for glasses after surgery.

So, if you are nearsighted, we can do the implant, which will allow you to be able to see without glasses at a distance, but you may need to have reading glasses. This is what a lot of people choose. Some prefer to stay nearsighted and do not use the glasses for reading and keep their glasses for driving, which is also possible, but you will need to discuss this with your surgeon prior to your surgery. Your doctor should explain what type of artificial lenses are available, which ones are covered by your insurance what are your options.

An important thing to know about these implants is that they can't change shape as your natural lens used to do before you reached your mid- to late-40s. Usually around this age most start using bifocal glasses.

If you want to decrease the need for reading glasses after the surgery, you have two options. One is to let your surgeon put in a restore (bifocal) implant. These types of implants are expensive and a lot of people on a fixed income can't afford them. They are relatively new.

Your second option, which surgeons started using before bifocal implants were available to us, is to fix your dominant eye (main eye) for distance as close as possible to 20/20 without glasses (of course, if your eye is capable of seeing it) and make your non-dominant eye slightly nearsighted. The second eye would be your reading eye. This technique is called monovision and we use it not only with cataract surgery but also with people who use contact lenses and don't want to use reading glasses. By selecting that approach, it will decrease the need for reading glasses significantly, but will not eliminate it completely. You will need reading glasses for extremely small print.

If you have astigmatism - when your cornea (front part of the eye) is shaped like a football, rather than like a soccer ball - the regular implant may not be able to get you sharp vision without glasses, even for distance. The outcome with the standard implant will depend on the degree (severity) of your astigmatism. In the case of a severe astigmatism, your surgeon may offer you a special implant to correct for it, which also is not covered by medical insurance, but it's not as expensive as the bifocal implants.

Dr. Alla Hynes of Eye Care Physicians & Surgeons of Woodstock and Winchester, is a board certified opthalmologist specializing in the treatment of a wide variety of eye diseases. Email her at info@nvdaily.com if you would like her to answer your questions in her column next month. Read her bio: http://www.nvdaily.com/lifestyle/dr-alla-y-hynes.php.


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