Treatment Guide: Cataracts

The latest ways to improve your view

People often describe cataracts as a kind of fog over their eyes, as if they were looking through a frosted window. In fact, a cataract is just that, a clouding of the lens due to chemical changes related to aging, injury or disease. They are typically discovered through an eye examination rather than by some sudden great loss of sight, and their mere presence isn’t enough of a reason to rush to surgery.

[sidebar]Because there are risks, albeit small, of infection, glaucoma or detached retina, Dr. Stephen Orlin, an ophthalmic surgeon at Penn’s Scheie Eye Institute, says, “Doctors tend to let patients be their guides. When they complain their vision is foggy, that’s when it’s time to operate.”

The primary advance in cataract surgery has been the advent of the implantable multi-focal lens that’s promoted as offering freedom from glasses. While pretty darn remarkable, don’t expect the holy grail. “Patients read about these new lenses and they have unrealistic expectations,” says Wills Eye ophthalmologist Dr. Stephen Lichtenstein. “They expect to have the perfect vision they had in high school, and it doesn’t work like that.”

At the moment a cataract patient has these choices:

Traditional lenses:
Proven and completely covered by insurance, they correct for either near or far vision.

Premiums lenses:
Doctors typically charge several hundred to several thousand dollars beyond the insurance allotment because these lenses are very expensive and the surgery is more complicated. But here’s the rub: No premium lens covers all bases. One deals with vision and the other with astigmatism, but neither corrects both.

One option is the multifocal lens that provides something close to the glasses-free vision you had in your youth — near, far and in between. However, if you also suffer from an astigmatism (a vision problem based on the imperfect shape of the cornea), you will need an additional surgical procedure to correct it. Patients who go this route sometimes complain about seeing halos and glare in bright light and they aren’t fully satisfied with the astigmatism surgery either. Or you can go opt for an implantable lens that deals with just the astigmatism. In that case you will still need glasses to read or see signs a block away.

Here’s the good news: By 2010 a new lens will be available that fixes both vision and astigmatism. But it will be costly. You should pick your eye surgeon very carefully since the more complicated the lens, the higher degree of the skill to match it to your eyesight. At the very least, you’ll want a doctor who uses the basic Zeiss IOL Master, an expensive instrument that measures the length of the eye: “This data,” says Dr. Lichtenstein, “is critical to reaching the most successful outcome.” His office was a test site for the upgraded version of this technology, and he’s one of the few in the city to have it.