By Scott Grealish MD
EyeHealth Northwest Lasik Specialist
Portland, Oregon

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One of the most amazing aspects of modern Cataract surgery is the surgeon’s ability to customize the lens implants we use to best match each individual’s needs. Often the surgeon identifies conditions like astigmatism or farsightedness for example, that can be best corrected with a specific lens implant during Cataract surgery. In some cases medical conditions such as diabetes, glaucoma, or macular degeneration guide the surgeon’s choice of lens implant. Since 2005 however, many surgeons have adopted a new approach to customizing lens implants by involving patients themselves in the decision making process.

I was an early adopter of this process in my practice back in 2005 when the FDA approved a new lens technology called the “Restor Multifocal” lens implant (click here to learn more about my results with this lens implant). The Restor Multifocal was the first lens implant widely used in the U.S. to correct vision after Cataract surgery, allowing patients to see without glasses at all distances from near to far. In fact, about 80% of patients in the FDA trial stated they never wore glasses after surgery. Not surprisingly, the company that developed the Restor elected to charge a premium price for the lens, and because surgeons must also perform additional specialized testing before and after surgery, they too routinely charge an additional fee to patients electing the Restor (and several other lens implants such as the Crystalens and Toric lens implants). As a result of this new technology , which combined significant visual benefits along with extra cost to patients above their normal insurance coverage, we now routinely ask our patients to play an active role in choosing their lens implants for their Cataract surgery.

Now let me clarify that “playing an active role” does not mean patients should start analyzing the FDA data for the various lens implants! Please realize that the customization process is really very straightforward for most patients and doesn’t involve any highly technical decision making for patients. Rather, the best methods of customization typically involve the following steps:

1. During your Cataract evaluation you would answer a series of questions about your vision to help your surgeon decide if your Cataracts qualify for surgery at this time (click here to view Dr Grealish’s version of this test).
2. Next, you would answer a series of questions designed to help your surgeon learn about your individual visual goals after surgery. For example, some patients prioritize reading vision without glasses, others distance vision , etc.. (click here to view Dr. Grealish’s version of this test)
3. Finally, your surgeon would review the results of a variety of computerized exams, perform a detailed microscopic exam of your eyes, and consider the information you provided in the questionnaires. After discussing the options with you, experienced surgeons are typically going to recommend the “best” lens implant for your situation. I like to meet with patients and their families at least once more prior to Cataract surgery just to review the options and make sure everyone is comfortable with their choices and the entire Cataract surgery process.

The majority of Cataract surgery patients meet their goals with just these three pre-operative steps. For some, however, the customization of lens implants for Cataract surgery actually continues after surgery. We know that every patient heals differently, and in some cases that means that several months after surgery their vision is still not meeting their needs. If this is a result of being slightly out of focus (a little nearsightedness or astigmatism for instance), surgeons know that the “Deluxe” lens implants will perform best if we give our patients optimal focus by using another advanced surgical technology called LASIK. Indeed, the combination of performing a LASIK type surgery and using a “Deluxe” implant has been shown in recent studies to give the best results for many patients, especially those with astigmatism. As recently as 10 years ago, few surgeons would have guessed that we would now routinely be combining Cataract surgery with Deluxe customized implants and LASIK laser surgery to create great vision without glasses in so many Cataract aged patients.

In summary, it’s truly amazing to look back to the early 90’s when I began performing Cataract surgery to see how far we’ve come with new technology. Today we can routinely eliminate Cataract permanently with a 10 minute painless procedure, customize the vision of our patient’s with a variety of “Deluxe” lens implants, and even compensate for minute differences in healing by performing laser surgery to optimize the vision without glasses. It’s a great time to be an eye surgeon, and while nobody really wants eye surgery, technology has made it a great time to have Cataract surgery if you need to see better.