In some patients after cataract surgery, the membrane that holds the intraocular lens in place can become wrinkled or cloudy with scar tissue. This is called Posterior Capsular Opacification (PCO), or an “after cataract,” and is commonly seen after cataract surgery. If posterior capsular opacification develops, the patient typically notices the onset of blurred vision. PCO is easily treated with the YAG laser. The YAG laser is a “cold” laser which disrupts the scar tissue behind the implant, thus opening up the visual pathway for more light to enter the eye. Because there are no nerve endings in the scar tissue, there is no pain associated with the procedure. Side effects after the treatment include the presence of floaters which typically resolve after several days. YAG laser treatments are covered as a medical necessity under all insurance plans, including Medicare and Medicaid.
If further LASIK or PRK is necessary for any of our Custom Cataract Surgery patients, Dr. Schulze will waive his professional fees. Thus, if you should require PRK or LASIK after Custom Cataract Surgery to fine tune your vision, you will only be responsible for the facility fee to the surgery center that covers the operating expenses for the excimer laser, which amounts to a 50% discount of our standard combined fees for LASIK and PRK. For those patients who choose to have Basic Cataract Surgery, understand that additional refractive procedures are NOT covered and are your financial responsibility.
Remember that all of the options presented above represent efforts to reduce your dependence upon glasses and contact lenses. None of these options can guarantee you to throw your glasses away. Talk with us about which of these options might be best for you.
Although the techniques we use to measure the eye and calculate IOL powers are state of the art, they are not perfect. We make every effort to ensure that our patients’ refractive results are as intended. Because of some inherent limitations of these technologies, a small percentage of patients may have an unpredictable outcome after surgery, especially in patients who have had prior refractive surgery such as RK, LASIK, or PRK. A way to think of this is to imagine that some patients may under- or over-respond to surgery, despite our computer calculations and measurements prior to surgery. Although these are not common, under or over responses to surgery are a statistical inevitability and the possibility that you may be one of these over or under responders must be taken into account as you consider surgery.
Regardless of the option you choose for rehabilitating your vision after cataract surgery or refractive lens exchange, understand that further surgery such as PRK, LASIK, and/or intraocular lens exchange may be required to fine tune your vision afterwards.
Refractive Lens Exchange is a procedure that utilizes all of the available technologies we have for cataract and refractive surgery to improve vision and lessen dependence upon glasses and contact lenses in people who do not have cataracts. All of the options discussed above, including traditional monofocal lenses for binocular distance vision, monovision, toric intraocular lenses for correction of astigmatism, limbal relaxing incisions, and multifocal intraocular lenses, can be used to achieve decreased dependence upon glasses and contact lenses.
Multifocal intraocular lenses offer excellent potential for reducing your dependence on glasses and contact. Our practice has extensive experience with multifocal lenses dating back to 1997. Multifocal lenses work by providing simultaneous near and distance vision in each eye, thus allowing both eyes to work together for both distance and near.
The Tecnis Multifocal lens: the Tecnis Multifocal provides excellent distance and near vision. It is now available in three different models, depending upon your specific needs for near vision.
Weaknesses inherent in all multifocal IOL designs include aberrations that can cause glare and halos, especially at night. About 1 in 20 patients describe the glare and halos with multifocal lenses as “severe.” Multifocal lenses work best with binocular vision (both eyes working together), therefore, you will not get the full effect of multifocal vision until you have had surgery on your second eye.
Although multifocal lenses may represent your best option for reducing your dependence upon glasses and contact lenses, it is impossible to guarantee that you will be able to throw away your glasses. Reading glasses, for instance, will always magnify near objects, thus making them easier to see, even with a multifocal lens in place. Because Medicare and private insurance companies consider multifocal lenses to represent a luxury technology that is not absolutely necessary for good vision, these lenses are not covered by Medicare and insurance.
