A look at better vision

Lens replacement surgery can fix cataracts and eliminate the need for glasses.

Published: July, 2019

There is a good chance you wear some kind of glasses. And there is an even greater chance you one day will need cataract surgery. Now you can take care of both problems at once.

As you age, the lenses inside your eyes lose their flexibility. This process, called presbyopia, leads to the need for reading glasses or bifocal/progressive spectacles as you reach middle age and beyond. Over the years, your lenses also become progressively cloudy, a condition known as cataracts, which causes blurry vision that glasses alone cannot fix.

Unfortunately, both conditions are inevitable. "Your eyesight will naturally decline, and getting cataracts is as common as getting gray hair," says Dr. Z. Katie Luo, an ophthalmologist who specializes in cataract, cornea, and refractive surgeries at Harvard-affiliated Massachusetts Eye and Ear.

Life without glasses

LASIK has long been the go-to procedure to eliminate the need for glasses, but for most older adults, lens replacement surgery (LRS) is a better option. With LRS, the natural lens is surgically removed and replaced with a synthetic substitute called an intraocular lens (IOL). In an eye where the natural lens has already developed a cataract, LRS is called by a more familiar name: cataract surgery.

"LRS corrects vision by changing the focus at the level of the lens, so you can see clearly without glasses at the target distance," says Dr. Luo. "For older adults, many of whom already have some degree of cataract, it is particularly beneficial because it eliminates the cataract and corrects the focus at the same time," says Dr. Luo.

Artificial lens technology has evolved a lot over the past decade. Before, you could only choose a lens that corrected eyesight for one distance — near or far — so you had to choose whether you wanted help to read or to drive.

"But now there are many more choices available," says Dr. Luo. "The various designs of IOLs can correct astigmatism — an imperfect shape of the cornea that causes blurred vision — and provide a depth of focus to help you see at various distances. This way you can read both your text messages and a street sign without glasses."

The FYI on intraocular lenses

Three types are available to replace your natural lens, depending on your vision:

Monofocal intraocular lenses (IOLs). In healthy eyes without much astigmatism (an imperfect corneal shape), these lenses provide clear vision at a single distance. One can choose the clear distance to be far, intermediate, or near, but not all.

Presbyopia-correcting IOLs. These include multifocal IOLs, extended depth-of-focus IOLs, and accommodative IOLs. They can provide clear vision at multiple distances.

Toric IOLs. These correct astigmatism and come in both monofocal and presbyopia-correcting versions.

An eye on the procedure

LRS is a short outpatient procedure typically done one eye at a time. It is a broad term, but is essentially a cataract surgery regardless of whether the lens is clear or cloudy.

Here's how it works: After numbing the eye, the surgeon makes two tiny incisions into the cornea. Next, he or she makes a circular opening in the capsule containing the lens. Then the surgeon inserts an ultrasonic device to break the lens into very fine pieces for easier removal. The same device uses suction to remove the lens material. Finally, the new replacement lens is folded into a tiny roll and placed in the capsule, where it unfolds into a functional lens. The surgeon then adjusts the position for a perfect alignment.

"There is no pain during or after the procedure," says Dr. Luo. "People see out shortly after the surgery, and the eye feels essentially normal the day after."

Are you a candidate?

Lens replacement is most suitable for people with cataracts and those without cataracts who are quite farsighted or nearsighted and wish to be less dependent on glasses.

People with mild refractive errors (meaning their glasses prescription numbers are not too big) who can have good vision with regular glasses or contact lenses may not be the best candidates. "When considering LRS, the most important question to ask is whether it will give you the visual functions you care most about," says Dr. Luo.

Another issue to consider is cost. The price can range from $1,500 to more than $5,000 per eye, depending on the situation and which technologies are used. Check with your insurance.

Image: © avdeev007/Getty Images

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