A Brief History of “Premium” Lens Implants for Cataract Surgery in the U.S.

Scott Grealish M.D.
EyeHealth Northwest Cataract Surgery Specialist
Portland, Oregon

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A New Surgical Paradigm

Since 2004 there has been a fundamental change in the way cataract surgery is performed in the US. Prior to then, patients simply had surgery when their cataracts had gotten bad enough to interfere with their activities (many still think the cataract gets “ripe”, a false concept; the lens simply turns yellow and cloudy). Their surgeon removed the cataract lens completely and replaced it with an artificial plastic “lens implant”. Since the choice of the lens implant “brand” or “type” had no noticeable effect to the patient, surgeons chose the lens implant based on their experience.

New Technology to Solve an Old Problem

Technology and the government changed that model forever when the first “Premium” or “Deluxe” lens implant hit the US market in 2004. The first FDA approved lens offering patients a chance to see clearly without glasses both near and far after surgery was the Crystalens. The very concept of adding this tremendous benefit onto the already successful, universally applauded modern cataract procedure was a game changer. Surgeons and patients alike were naturally attracted to the idea of creating not just clearer vision by removing the cataract, but better vision by surgically improving the focusing ability of the eye at all distances.

New Regulation to Solve an Old Problem

There was, however, one big problem with this new concept of better vision. The companies who were developing the technology had spent many years and millions of dollars bringing the new lens implants to market. Naturally they needed to charge more than their “standard” lens implants. Medicare (and consequently private insurance) regulations at the time, however, prohibited surgeons or hospitals from passing this cost to their patients. In fact, if a patient did pay the extra charge, they would lose their normally covered benefits for the surgery! If surgeons paid for the lens, they would in effect be doing the surgery for free! In the end, the government stepped in with a pivotal ruling allowing patients to get fully covered for their “normal” cataract surgery, but with an option to “electively” pay extra out of pocket to receive a “Deluxe” lens implant. Likewise, surgeons and clinics were allowed to perform the extra “elective services” needed to implant the “Deluxe” lenses and bill patients directly. This new model of payment has allowed a competitive market amongst companies and surgeons. The results to date have been rapid advances in lens implant technology and the surgical skills needed to provide patients with their best vision.

A Qualified Success, For Those Who Qualify

While a big success in most ways, patients are in fact the ones who, for better or worse, are paying out of pocket to receive the latest “Deluxe” lens implants. Since these can add thousands of dollars to their surgery, not all can afford this option. For those who can afford it, however, the “free market” that has developed around “Deluxe” cataract lens implants means they have a chance of seeing better after surgery than ever before. For nearly all patients who have elected that option, the price has been well worth it considering the value we all place on our vision.

Success Leads to More Success

There are almost 3 million cataract surgeries performed annually in the U.S. and that number is forecast to grow with the aging population. On average, only a small fraction of those surgeries currently utilize a “Deluxe” lens implant. That fraction is growing rapidly however, because the word is getting out amongst patients that new options are available. Amongst surgeons like myself, who specialize in vision correction surgery, the use of “Deluxe” lens implants is commonplace. In my practice between about 1 in 3 patients elect a “Premium” lens upgrade over the “standard” lens when they have cataract surgery. The explanation is simple. Based on successful experience, both patients and surgeons recommend these new implants to others considering cataract surgery. Those surgeons who do more “Deluxe” cataract surgery initially end up doing even more over time. The companies that manufacture and distribute these lenses are hoping this phenomenon eventually spreads to all surgeons in the U.S.

The Future is Becoming More Clear

I believe surgeons and patients share that hope because their goals are similar: Better vision = Happy patients = Happy surgeons. If future technology can improve the chances of eliminating glasses after surgery from the current levels of about 80-90%, to over 98% (similar to current LASIK results), I believe the pendulum will swing decisively in favor of the “Premium” model. In fact, I believe we will reach a point in the not too distant future where “consumers” will “elect” to purchase these implants to improve their vision even in their 40’s and 50’s before cataracts have even developed. Considering how far we’ve come since 2004, I think it’s just a matter of time until the paradigm shift is complete and the “old” concept of waiting until the cataract is “ripe”, then fixing the cataract with surgery, is replaced by the “new” concept of fixing the vision, (regardless of the cataract and regardless of insurance or government payers) as a purely elective cash procedure.

Back to the Present

For those suffering with cataract and poor vision now, these speculations about the future might be interesting, but not particularly useful for solving their problem. Patients undergoing cataract surgery in the near future may wish to read my articles on “Realistic Expectations for your Vision after Cataract Surgery” as well as “Results with the Restor Multifocal Lens Implant” and “Results with the Crystalens Lens Implant”.