Cataract Surgery and Lens Implants

Presbyopia is one of the first changes that results from the crystalline lens losing its flexibility. Presbyopia begins at around age 40 and progresses until about age 65. Before approximately the age of 40, the crystalline lens is both “crystal “ clear and quite soft and flexible. This flexibility permits the crystalline lens to change its shape and alter its curvature so that it can help focus your vision at various distances-from far, to near, to arms length, to far or near again. This flexibility gives you the ability to see things at all distances.

Around the time we enter our 40’s, the crystalline lens begins to stiffen. The stiffening of the crystalline lens makes it progressively more difficult to change focus and thus to see clearly at all distances. Usually this reduces our ability to see objects clearly at arms length or close objects, or reading material. When this loss of flexibility occurs, it is called Presbyopia or “old eyes’. Presbyopia is a normal and expected consequence of growing older and it affects everyone. As the crystalline lens loses its ability to flex and change shape, it is no longer able to bend light rays. This results in a gradual and progressive loss of your ability to focus on near objects.

Patients who experience the start of Presbyopia will most often observe, that their "arms are too short" requiring them to see up close by moving near objects and reading material farther away in order to bring them into focus and see them clearly.

It is important to note that Presbyopia affects everyone including those who have cataracts. When Presbyopia begins, people who have never worn eyeglasses find that they need reading glasses or bifocals in order to read and see up close. People who already wear glasses may need bifocals, trifocals, or progressive bifocals in order to see comfortably up close.

There have been many advances in cataract surgery and lens implant surgery techniques. Today, patients can elect to have presbyopia correcting multifocal lens implants so that lens replacement surgery can help patients achieve clear distance vision as well restore their normal range of vision without being dependent on bifocals or trifocals.

In addition to the crystalline lens losing its flexibility, it often begins to lose its transparency and optical clarity. As you progress through your 50’s and 60’s, the normally crystal clear lens may gradually become yellow and cloudy. Initially you may experience a mild blurring of your vision and feel that you need a change of eyeglasses. As the crystalline lens loses its transparency and its optical clarity, it may begin to impair your ability to see well in dim illumination, such as for night driving. The cloudiness may also create glare, light sensitivity and a continuing decrease in your vision. If parts of the crystalline lens become too cloudy they may cause a significant decrease in both your day and night vision. These are the visual symptoms that are common for those patients whose crystalline lens has clouded and formed a cataract. If you are in your 50’s or 60’s and experiencing vision changes like these, it is important to schedule a comprehensive eye examination and cataract consultation.

Cataract surgery today is safe, effective and quite common. If you suspect that you have a cataract or have been told that you have a cataract, there is no need to be overly concerned as you are not alone. Each year in the United States, more than 2.5 million people have cataract surgery. Thanks to advanced cataract surgery procedures and lens implant technology, cataract surgery is not only one of the most frequently performed surgical procedures in the United States, but it is also one of the safest and most successful surgical procedures that you can have. Cataract surgery is performed on an outpatient basis and usually only requires a few hours of your time from beginning to end.

Dr. Brass performs cataract surgery on an outpatient basis at the Albany Regional Surgery Center, as well as other facilities approved by your insurance plans. The entire process usually only requires a few hours of your time from beginning to end.

Cataract surgery today is quite comfortable. When you arrive at the surgery center there will be a number of staff members present to assist you and make your experience pleasant.

The procedure will begin with your eye first being treated with an anesthetic so that you will feel little if anything during your surgery and minimal if any discomfort. For most, this entails having a few sets of eye drops placed in your eyes.

Dr. Brass will then place a very tiny incision at the outermost edge of your cornea. This incision will be just big enough to allow a microscopic instrument the size of a pen tip to pass through it. This microscopic instrument is a sophisticated tool to help Dr. Brass remove your cataract.

Next, Dr. Brass will gently pass the microscopic instrument through the tiny incision and ultrasound produced at the tip of the instrument will be used to gently break the cataract into pieces small enough to be washed away, drawn through the instrument and removed from the eye. This cataract removal method is called “phacoemulsification” and is the preferred technique of cataract surgery for most patients.

After the cataract has been removed, Dr. Brass will be able to insert a new permanent Intraocular Lens implant (IOL) into your eye. The replacement lens will actually be inserted and placed in the correct position through the same tiny incision at the outer edge of the cornea through which Dr. Brass removed the cataract.

Upon completion of your cataract and lens implant surgery, Dr. Brass will instruct a surgery center staff member to take you to rest and relax in a comfortable area inside the Albany Regional Eye Surgery Center facility. After a short rest, you will be allowed to be driven home by a family member or friend, or someone from the surgery center.  Dr. Brass will arrange to see you at Brass Eye Center within 24 hours of your cataract and lens implant surgery so he can examine your eye and confirm that you are healing and seeing as planned. Dr. Brass will prescribe some eye drops for you to use and ask you to wear a protective shield, mainly at night to help you remember not to rub your eye. Although each patient heals a little bit differently, most of Dr. Brass’s patients see well enough to return to their routine activities within a day or so after their cataract surgery.

Until recently choosing a lens implant was entirely Dr. Brass’s responsibility. That's because there really weren't any options for patients.

All lens implants were of a type called a monofocal lens implant. A monofocal lens implant provides excellent vision after cataract surgery-but only at one set distance-usually for seeing things at a distance. A monofocal lens implant does not correct Presbyopia or enable you to see close objects or even read without reading glasses or bifocals. This means for seeing distant signs when driving, going to a movie or going to a ballgame, a monofocal lens implant will provide the vision you need to see clearly. But with a monofocal lens implant you will most likely need to wear eyeglasses for any type of near vision activity-for example reading, knitting, sewing, playing cards or keeping your golf score will require you to wear glasses.

Today, Dr. Brass is able to offer you the choice of a presbyopia correcting multifocal lens implant. A presbyopia correcting multifocal lens implant provides excellent vision after cataract surgery at a variety of distances. Depending on your specific vision requirement, there are several types of presbyopia correcting multifocal lens implants Dr. Brass might suggest, including the ReSTOR® Lens Implant or the ReZoom™ Lens Implant. Each of these lens implants or Intraocular Lenses (IOL) works in a different way to help you achieve your vision correction goals of being able to see at a variety of distances after cataract surgery, without being dependent on eyeglasses. Presbyopia correcting multifocal lens implants correct both your distance vision and your presbyopia after cataract surgery. For the vast majority of patients, having a multifocal lens implant means that you will be able to see at distance and up close without being dependent on eyeglasses. So, patients choosing to have a presbyopia correcting multifocal lens implant will likely find that they can drive, watch television, read or do crafts-without the need for glasses.

In general, patients who choose to have monofocal lens implants will be dependent on glasses either some or most of the time in about 70% of cases. Patients who choose to have multifocal lens implants will only be dependent on glasses either some or most of the time in about 15% of cases.

So, patients choosing multifocal lens implants typically experience a greater overall freedom from glasses allowing them to participate in most everyday activities without dependence on, or the hassle of glasses.

As with any surgical procedure, there are always risks as well as benefits. During your eye examination and cataract consultation with Dr. Brass, we will perform a cataract examination and then arrange your cataract surgery scheduling. In addition, we will spend the time necessary to review the everyday activities that are most important to you-and whether being independent of glasses for those activities is something that you would like to achieve.

As you prepare for your visit to Brass Eye Center, it will be helpful to Dr. Brass if you begin thinking about what those activities are so that you can discuss them and explore them with the staff.

If you decide to have a presbyopia correcting multifocal lens implant, our staff will make sure to review your questions and fully explain any additional fees related to the multifocal lens implant that you might be responsible for. Medicare and most insurance covers the cost of the cataract surgery, the surgical facility fee for cataract surgery, Dr. Brass’s fee for cataract surgery-but not the cost of the presbyopia correcting multifocal lens and its implantation. In most cases, Medicare or the insurance provider asks Brass Eye Center to bill you for the additional cost of the necessary testing, the multifocal lens and its implantation. Our staff will be pleased to review any costs as well arrange easy affordable monthly payments to fit your budget, should you decide that the multifocal lens is the best choice.

If you, a family member or friend suspect that you have a cataract it would be our pleasure to arrange an eye examination or cataract surgery evaluation at Brass Eye Center for you. Please call us at 518.782.7827 or e-mail us to schedule an appointment.