Are you considering a Toric, Restor, Crystalens, or other Accommodating or Multifocal lens implant? If so, take the time to learn more about:
Realistic expectations for your vision after Cataract Surgery with a Deluxe lens implant.

Scott Grealish MD
EyeHealth Northwest Deluxe Lens/ Cataract Specialist
Portland, Oregon

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Cataract surgery is a marvel of medical technology that improves vision for millions each year. The overall safety, ease of both surgery and recovery, and quality of vision after surgery make it one of the most valued medical experiences for most patients.For those who elect to pay extra out of pocket expenses to receive a “Deluxe” lens implant, the potential for satisfaction is even higher. These implants have the ability to reduce dependence on glasses after surgery compared to “Standard” lens implants. However, they are not currently able to eliminate glasses or provide “perfect” vision in 100% of patients (no matter which brand lens is used).I think it’s critical that all patients undergoing Deluxe Lens implantation have a good understanding of the Pro’s and Con’s of their choice and “Realistic Expectations” about what they can expect. To illustrate, I’ll describe one of the rare occasions where patients can actually be unhappy with their choice of Lens Implant, putting themselves and their surgeon into something like the following dilemma:

Imagine “John”, a 70 year old with cataracts who has worn glasses his entire life. “John” learns from his doctor that his declining vision can be improved by having his cataracts removed and he is motivated to proceed. He discovers that when the cloudy, yellow cataract lens is removed his surgeon will replace it with an “Intra-ocular Lens Implant”, or IOL for short. He watches a video about these implants given by his doctor (and often sponsored by the company making the lens implants) that shows patients who chose a “Deluxe” lens implant for their surgery and now have the ability to see clearly at all distances from near to far without glasses. “John” is understandably excited by the prospect of throwing away his glasses and decides to spend the extra money (which might be thousands per eye) on his surgery, hoping he’ll save money in the long run by not buying glasses. His surgeon accepts “John’s” choice, counsels him accordingly, has him sign all sorts of paperwork and does the surgery.

Now imagine all goes well with the surgery, it’s two weeks later and “John’s” surgeon examines him and declares everything a success. “John” is confused and disappointed because although he can tell colors are brighter and more light is getting to his eye without the cataract, his focus is not what he expected. In fact, although he can see pretty well far away, he can’t read well at all without reading glasses. His surgeon reassure him that it may take months for his vision to fully heal and reminds him that he was counseled before surgery that even after months he might still need glasses for some activities.

“John” leaves the office angry and upset. He knows he was given a lot of legal papers to sign before surgery and he remembers talking to the doctor about the surgery, but there was so much information to keep track of he isn’t sure he recalls being told he would need glasses or have any of the focusing problems he seems to have. All he knows is that he paid a lot of money out of pocket to get rid of his glasses, and now his surgeon is telling him he might need reading glasses forever!

What went wrong here? First, you should realize that out of the literally hundreds of thousands of “Deluxe” lens implant surgeries, the chances of being truly unhappy are remote. In fact, most studies show that somewhere between 80-90% of patients choosing a “Deluxe” lens implant are either totally or mostly free of their glasses and even more are “very satisfied” with their vision after surgery (even though it is obviously not “perfect” in all cases). In my experience, only about 1% of patients have a “John” type scenario. In these cases, the problem almost never involves a complication with the surgery, the lens implant, or the patient’s healing (though each is possible). In fact, what goes wrong is almost always a failure to communicate realistic expectations to the patient. After all, the surgeon and his staff presumably deal with the specifics of cataract surgery and lens implants every day. But for “John”, the information he received before surgery is typically so foreign and overwhelming that he ends up simply taking the doctor’s advice and hoping for the best.

Now we come to the real “moral” of the story.Communication is a two way street. The surgeon has a responsibility to educate patients on their options for their eyes.People learn differently, so in my practice, for example, we use video’s, written questionnaires, brochures, posters, websites, and personal counseling by our technicians, schedulers, and myself as the surgeon. Despite these measures, I have witnessed the “John” scenario where the patient somehow got through the entire process with “unrealistic” expectations for their vision. How could that happen? Usually it results from “wishful” thinking rather than real understanding on the part of the patient. Hoping for the best outcome is natural, but it’s important for patients not to “selectively hear” only the upside pre-operatively and only “selectively remember” that same good news post-operatively, forgetting the “limitations” of the technology, surgery, and healing that are a reality in any surgery.

So the “moral” of “John’s” story is that patients also have a responsibility in the communication process. Listen, read, ask and learn before you spend your money on a “Deluxe” lens implant. If you do, I’m confident you’ll become a “success” story no matter what your visual outcome. Remember that in the end, your surgeon’s goal is to give you the best technology and surgery for your eyes so you have a chance to achieve your best vision. Become an educated partner in the process and you can be confident you’ll boost your chances for spending your money well and achieving a happy outcome.