What is a Cataract?
A cataract is a loss of clarity or clouding of the lens in the eye. Cataracts are very common among older adults. Most everyone, if they live long enough, will eventually develop cataracts. As we age, the lens undergoes changes with gradual hardening and loss of transparency. This results in a progressive decline in the quality and crispness of vision. Common symptoms include:
Greater problems with night vision
Glare from oncoming headlights
Needing more light to read
Changes in glasses prescription, particularly greater nearsightedness.
How are cataracts diagnosed?
An eye exam with pupil dilation by an Ophthalmologist can diagnose cataracts. At Schefkind Eye Care, we will do a thorough evaluation to determine if cataracts are present, and if so, their severity. We will also counsel you on the timing of cataract surgery. If cataracts are mild, they can be monitored. However, if significant, it may be necessary to proceed with surgery to restore vision to a satisfactory level.
What are my surgery options?
There are now two different options for performing cataract surgery–basic surgery (traditional method) and laser assisted surgery (advanced technology procedure).
Removing the Cataract
OPTION ONE: Basic Cataract Removal
Traditional Cataract Surgery involves creating a small incision with a surgical steel or diamond blade. The cataract is then removed using an ultrasonic device (phacoemulsification) that breaks the cloudy lens into small pieces. These pieces are then gently removed from the eye using suction leaving the capsule of the lens in place. Traditional cataract surgery is usually covered by insurance less any co-pays, coinsurance or deductible.
OPTION TWO: LASER CATARACT REMOVAL
(ADVANCED TECHNOLOGY PROCEDURE)
The Catalys® Laser Cataract System is specifically designed for cataract surgery. It uses a high resolution imaging device to give your surgeon a fully automated analysis of the cornea and lens surfaces, and couples that with an advanced femtosecond laser. These systems work together to deliver laser pulse placement, resulting in incredibly precise surgical incisions. This leads to less trauma to the eye and more predictable visual results. There is an additional cost for laser cataract surgery that is typically not covered by insurance. However, with this option, you have a higher chance of achieving excellent vision without spectacle correction.
Implanting the Artificial Lens
OPTION ONE: Basic IOL (Monofocal)
This corrects vision at only 1 distance and does not correct for astigmatism. With this option you will need glasses for reading and possibly for distance. Standard IOLs are typically covered by insurance less any copay or deductible.
OPTION TWO: Toric IOL (Astigmatism-correcting lens)
Astigmatism is typically caused by the cornea (the clear window of the eye) being shaped more like a football than a basketball. This causes images to focus at different points on the retina, resulting in blurred vision.
Astigmatism can usually be corrected with glasses or contact lenses but can also be treated at the time of your cataract surgery to reduce your need for glasses postoperatively. For low amounts of astigmatism, we use the Catalys® femtosecond laser to make incisions in the outer margins of the cornea to reduce the curvature of the steeper axis allowing images to focus on one point of the retina instead of several. For higher amounts of astigmatism, a toric IOL is necessary to achieve the same goal. Our surgeons will discuss the best method of correcting your astigmatism prior to your surgical procedure. Toric IOLs are not typically covered by insurance.
OPTION THREE: Multifocal IOL (Restor lens)
Presbyopia is a condition most people over the age of 40 experience resulting in difficulty seeing up close without the aid of bifocals, trifocals, or reading glasses. Many people realize they have developed presbyopia when they find themselves having to push reading materials further and further away to focus.
Patients who undergo cataract surgery with a basic monofocal IOL will experience the same visual effects as presbyopia because standard monofocal IOLs can only focus at one distance. Therefore, they will need reading glasses or bifocals to read following their procedure.
However, by choosing a multifocal (ReSTOR) IOL, patients will achieve a decrease in dependence on glasses, contacts, or bifocals at all distances for most of their daily activities. Multifocal IOLs are not typically covered by insurance.
Which Option is Right For Me?
We take precise ocular measurements as part of the preoperative process. With these measurements, combined with your lifestyle needs and budget, we can discuss the best lens option for your surgery.
What does Cataract Surgery entail?
Our advanced cataract surgery is performed at the INOVA HealthPlex, located at 6355 Walker Lane, Alexandria, VA 22310. It is an ambulatory center with knowledgeable, warm staff focused on exceptional care.
Most surgeries are performed with IV sedation- medication administered by an anesthetist that puts you into a very relaxed state but without the risks of general anesthesia. Other anesthesia options are available and can be discussed with your surgeon ahead of time.
The eye itself is anesthetized with eye drops before and during the procedure. No shots are required.
A microincision of less than 1/10th of an inch is created. The cataract is removed with an ultrasonic or laser device that breaks up the cataract and vacuums it away. The IOL is then folded and placed into the eye with an injector. The incision seals without sutures and no patch is applied. The entire procedure typically takes less than 15 minutes and you should be comfortable throughout with minimal to no discomfort.
What Happens after Surgery?
It is recommended that you return home after your surgery and avoid any strenuous activity for the remainder of the day. You can watch TV, do some light reading, and eat whatever you feel up to. You should avoid any lifting and exposure to dirty or dusty environments. Do not drive for the remainder of the day.
It is quite common for vision to be blurred on the day of surgery and to experience some mild scratchiness or irritation. Significant pain is unusual and warrants a call to our office.
Most patients can start to return to a normal routine within 1 to 2 days.
A 1 day postop appointment is always scheduled to check on your eye after surgery. Our staff can further advise you on resuming activities at this appointment.
How Can I Pay for Cataract Surgery?
Medical insurance typically covers the basic cataract removal and the basic IOL. However, additional costs may apply for laser cataract removal and Toric or Multifocal IOL implants. Most traditional insurances do not typically cover these costs.
In addition to the option of paying out of pocket, there may be an option to use the benefits of your Health Savings Account (HSA) - ask our surgical coordinator if this applies to you. There is also a financing or payment plan option offered through CareCredit, which is a card you can apply for. It has reasonable terms that may make cataract surgery more affordable for you. If you are interested, please follow the directions on the link below.
Cataract Surgery at a Glance
A comprehensive evaluation is done to determine the overall health of the eyes and the extent to which cataracts are affecting vision. This will include a discussion with your doctor regarding each person’s individual situation and surgical options. In many cases, the recommendation is to defer surgery until the cataracts are more significant.
If the decision is to proceed with cataract surgery, you will meet with the Cataract Surgery Coordinator who will help with all the pre and post op arrangements for your surgery.
An appointment is scheduled for measurements to be taken by a certified Ophthalmic Technician using advanced technology — this test is termed an “A Scan” and is performed with the newest instrument of its kind called the “IOL Master”. This is followed by another discussion with your doctor on the different implant options available (in part based on the measurements) and to answer any additional questions.
The surgery is performed on an outpatient basis at the INOVA HealthPlex surgicenter in Springfield. The procedure itself takes approximately 15 minutes and is performed under light sedation — you should be comfortable throughout the procedure. You must have transportation home from the surgicenter with someone responsible for you. Plan on relaxing at home for the rest of the day.
You will be scheduled for post op appointments in our office — typically the day after surgery and then approximately 2 weeks later.