Cataracts: Frequently Asked Questions
What is a Cataract?
A cataract occurs when the clear lens inside of our eye (suspended behind your pupil) becomes cloudy and hard to see through. The most common risk factor is age, but any number of things like trauma, radiation, cigarette smoking, etc can cause cataracts to form at younger ages. Cataracts are the leading cause of preventable blindness worldwide and cataract surgery is the most common surgery performed in the USA.
Normally the lens inside our eye is suspended in the eye behind the colored part of our eye called the iris. Modern day cataract surgery removes the cloudy cataract and replaces the lens with a new acrylic lens which goes in the same anatomic location as the old lens.
Is Cataract Surgery Painful?
The vast majority of patients report NO PAIN after cataract surgery. The standard method utilizes IV or oral sedation similar to minor medical procedures like colonoscopies to ensure that the patient is properly sedated. Many patients take a short nap during their cataract surgery and remember next to nothing about what transpired the next day. As long as the patient avoids infection the standard post-operative recovery period is not painful either. It is common to feel a scratchy sensation or foreign body sensation for a few days after the surgery.
Is Cataract Surgery Covered by Insurance?
The short answer is YES! Any and all medical insurances including medicare, medicaid, blue cross, tricare, etc. cover cataract surgery. Depending on the specifics of your insurance plan you may be responsible for a copayment or deductible. The insurance helps cover the "nuts and bolts" of surgery like anesthesia, the procedure fee and facility fee. Insurance also pays for concurrent glaucoma procedures, should those be recommended by your surgeon. There are premium lens options available which are not covered by insurance. The purpose of these premium lens options usually are to get rid of astigmatism in order to get you out of glasses for distance tasks, or give you the ability to see near and far. Your surgeon will discuss these in detail at your pre-operative appointment and will make you aware of the out-of-pocket costs.
How Long Does Cataract Surgery Take?
With few exceptions, cataract surgery usually is a quick surgery, taking between 10 and 15 minutes under the microscope. Patients are usually shocked at how quick and painless it is.
What Are The Risks Of Cataract Surgery?
The biggest and scariest risk of cataract surgery is an infection in the eye. Unfortunately, patients have lost eye sight and have even lost their eyes due to bad post-operative infections. In order to avoid infection, it will be crucially important for you, the patient, to avoid rubbing or touching your eye after surgery. It is also important that you take your post-operative antibiotic drops as instructed (usually it is recommended to take one drop three times a day for the first week, and then twice a day for the two subsequent weeks, but your surgeon may encourage you to take more drops per day or for a longer duration depending on your specific circumstance). We also recommend that you don't use eye make-up for ten days after your surgery and that you avoid pools, jacuzzis and saunas for one month after your surgery. The national average for post-operative infection after cataract surgery is roughly one infection per four hundred cases. Using the most modern antiseptic techniques, Dr Grange is proud of the fact that he is well-below the national average for post-operative infections. Just to reiterate, as long as you, the patient, avoid rubbing your eyes and take your drops it is very unlikely that you will develop an infection.
Another risk of cataract surgery relates to the lens support within the eye. The lens is typically suspended in the middle of the eye. In the setting of trauma, old age, and other risk factors, occasionally the patient has inadequate lens support. This interferes with the standard goals of surgery in which the entirety of the old cataract lens is removed and replaced with a new clear lens in its place. Roughly one out of two hundred patients require a secondary procedure to either extract old lens fragments from the eye or to sew in a new lens in place of the old lens. If this should be required, your surgeon will gladly discuss why a secondary procedure will be required and the expected prognosis, which in most cases is quite good.
Many patients experience a small amount of bleeding and swelling of the front of the eye after cataract surgery. These things are more common in elderly patients with dense cataracts, in cataracts due to trauma, and after concurrent glaucoma procedures. This causes post-operative blurry vision for one to two weeks, but ultimately clears up on its own. Your post-operative drops will help you recover and help the vision clear faster.
Briefly Discuss Premium IOLs?
The number one reason people wear eyeglasses to see distance targets is ASTIGMATISM. The number one reason people wear eyeglasses for reading is PRESBYOPIA. Both of these conditions are treatable nowadays at the time of cataract surgery. Of the two, PRESBYOPIA may be the easiest to understand.
If you have never required eyeglasses to see distance, but at or around forty years of age you started to require reading glasses to see up close, then you have PRESBYOPIA. From a medical perspective, PRESBYOPIA refers to the stiffening of the lens within your eye. As the lens becomes less malleable and stiffer, it does not ACCOMMODATE as well. ACCOMMODATION refers to the shift in lens shape and position which allows us to see up close and at distance, and we lose this ability as we age because the proteins in our lens becomes stiffer. The PRESBYOPIA correction favored currently by Dr Grange at the time of cataract surgery is the PANOPTIX TRIFOCAL lens. Dr Grange had the distinction of being one of the first in Idaho to implant this lens. It has been used for decades in Europe and is the market leader because it provides reliable near, intermediate and distance vision. TRIFOCAL refers to the three focal points provided by this lens, which gives the patient good vision at distance, near, and intermediate ranges. One caveat is that the near focal point is 14 inches from the patient's nose. This means that you should be able to read menus at restaurants (with good background illumination), and to read your cell phone or kindle, but for intense near work like tying flies, or pulling slivers out of fingers you will still require magnification for such tasks. The intermediate focal point allows the user to have good computer vision after surgery. This lens requires neuro-adaptation, which means that it will take weeks to months for your body and mind to get used to the new lens system in the eye and to learn where your focal points are the clearest. Dr Grange will discuss with you at your pre-operative appointment if you are a good candidate for such lenses, and will discuss their out-of-pocket costs with you. People who typically are NOT good candidates for these lenses are those with advanced glaucoma, retinal pathology (like macular degeneration, macular holes, etc), and people who have double vision without their prism glasses. The vast majority of other people are considered good candidates for these lenses.
ASTIGMATISM refers to the shape of your eye. If the front curvature of your eye is more oblong in one dimension and looks more like a football than a basketball, then you have astigmatism. ASTIGMATISM is exceedingly common, and it is highly unusual to find perfectly round eyes without any astigmatism. Small degrees of astigmatism can be well-tolerated, but higher degrees of astigmatism necessitate eyeglasses to see well at distance. Pre-operative measurements will tell Dr Grange about how much ASTIGMATISM you have and will suggest optimal treatments thereof. TORIC lenses are lenses with curvatures which offset the shape of your eye in order to correct for astigmatism. TORIC contact lenses are in popular use, and at the time of cataract surgery, Dr Grange can implant a TORIC lens into your eye to correct for astigmatism in order to give you the best distance vision you are capable of. People who are not good candidates for these lenses have IRREGULAR ASTIGMATISM (either from trauma, growths on the front of the eye, keratoconus, etc). The vast majority of other patients are good candidates for these lenses. Dr Grange will be happy to discuss whether or not you are a candidate for such lenses at the time of your pre-op visit and will discuss the out-of-pocket costs associated with them.
STANDARD or TRADITIONAL cataract surgery covered by the vast majority of medical insurances DOES NOT PAY for the cost of ASTIGMATISM CORRECTION or PRESBYOPIA CORRECTION. The rationale, ostensibly, is that both of these conditions can be corrected by eyeglasses. Assuming that you are a candidate for such lenses (i.e. you don't have any of the above listed contraindications for their use), Dr Grange will counsel you about what he recommends for you and why. He is fond of saying that the options can be thought of as GOOD, BETTER, and BEST. GOOD is what insurance covers - traditional cataract surgery has a huge impact on peoples lives, and if you don't mind wearing eyeglasses to see distance and near than this will almost certainly be the most economical approach. If you have an active lifestyle and don't want to wear eyeglasses for distance vision like driving, playing golf, cycling, etc. than a TORIC lens to correct ASTIGMATISM is likely a BETTER OPTION for you, because afterwards all you should require is reading glasses to see near. And finally, if you desire to be spectacle-independent for most tasks, then the TRIFOCAL lens to give you distance, intermediate and near vision is maybe your BEST OPTION.
There is plenty of nuance to this discussion, so please be prepared to spend some time with us before your surgery as we counsel you about all the myriad options available. Dr Grange is fond of pointing out that you only need cataract surgery once in a lifetime and that it is best to change your mind about lens options before surgery as opposed to after surgery. All of our staff are extensively trained on these lens platforms and would love to help you make an informed decision that you will be happy with. At the end of the day, our only concern is your happiness. We are not used car salespersons, and will never cajole you into choosing one lens over the other. We will invest as much time and energy as is required to make sure you are satisfied with the lens you chose and the outcomes thereof.
What is it going to cost?
We believe that we have the lowest cash-pay rate in all of Idaho. This is advantageous to those who either don't have insurance, or have really high deductible plans, etc. These are our cash pay rates as of February 2023:
Standard/Traditional Cataract Surgery: $1500/eye
TORIC (Astigmatism-correction to give you the best distance vision possible): $2500/eye
TRIFOCAL (Gives each eye distance, intermediate, and near vision): $3500/eye