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Aging today isn’t the same as it was during our grandparents’ time. Those of us approaching our senior years expect to remain as youthful as possible for as long as possible — and we look to modern medical advances to make that happen.
Some of the natural effects of aging are more easily dealt with than others, primary among them the fuzzy and foggy vision caused by cataracts. Records of surgery to remove cataracts can be found as far back as the 5th century B.C., with the “modern era” of cataract removal beginning in the 18th century, according to the Foundation of the American Academy of Ophthalmology. But the majority of advances have occurred in the last 50 years, with the most recent being a selection of “multifocal” replacement lenses that can restore a person’s vision to a nearly natural acuity.
The conventional “monofocal” artificial lens implant most commonly used to replace the natural lens corrects vision at only one distance — near or far — and glasses are still needed after surgery. “Premium” multifocal implants, however, may do away with the need for a person to wear glasses to see things close up or far away.
A cataract (from the Greek word katarhaktes, meaning waterfall) occurs when the crystalline lens of the eye becomes opaque, causing double or blurry vision and poor night vision. To a person with cataracts, lights may seem glaring and too bright, or appear to have a halo around them.
Most people 60 and older will develop a cataract in one or both eyes; by age 80, more than half of Americans will have a cataract or will have undergone cataract surgery, according to the National Eye Institute. People in their 40s or 50s can also develop a cataract, but they usually fall into specific risk categories: diabetics; those who use tobacco products or spend a lot of time in the sun; those who have used steroids for extended periods and/or suffered a traumatic eye injury — no matter the cause, no one is immune.
“Everyone will get a cataract, if they live long enough because the clear lens of the eye will get cloudy with time,” said Dr. Joseph Chacko, director of neuro-ophthalmology and assistant professor of ophthalmology and neurology at the Jones Eye Institute at the University of Arkansas for Medical Sciences.
Surgery is the only way to remove a cataract, Chacko said. “Cataract surgery is the most successful surgery of all time for all mankind. More than 90 percent of people are very happy with the results of their surgery.”
The surgical technique is called phacoemulsification. “We use a small instrument that uses ultrasonic energy to break up the lens, then it’s sucked out of the eye,” Chacko said. “This way, we can do surgery through small incisions. We don’t have to use stitches anymore. The wound self-seals.”
Dr. Mitchell Weikert, an eye surgeon and assistant professor of ophthalmology at the Baylor College of Medicine in Houston, said he describes the eye to his patients as being like a peanut M&M.
“It has a shell around it, a layer of chocolate and it has the peanut in the center. There’s a kind of cataract where the center part of the eye — the peanut — gets cloudy. That’s the most common age-related cataract. It’s called a nuclear cataract.”
After the cataract is removed, doctors insert an artificial lens made of plastic into the eye to restore clear vision. In most cases, this is the monofocal intraocular (IOL) lens, Weikert said. “Basically, what that means is the lens is designed to focus at one distance. We can choose the power of the lens we put in the eye to target being able to see far away or up close. Most people want to see as good as possible far away.”
The advancing field of medicine now offers patients more exceptional options when it comes to the quality of their vision. People with cataracts can choose from several types of the new multifocal or “premium” intraocular lens implants that improve vision at multiple distances.
“With multifocal lenses, there are a several rings on the lens,” Weikert explained. “Some of the rings focus far away and some focus up close. You can put that lens in a patient and get better vision close up and far away. There’s also a multifocal lens that we call ‘accommodating.’ This lens theoretically moves with the eye, flexes in the eye to focus at different distances.”
With either of these, it’s possible to improve eyesight so that the patient doesn’t need glasses or contacts, Weikert and Chacko both said. Another type of premium lens, the toric IOL, corrects astigmatism as well as restores acuity.
Medical insurance, Medicare and Medicaid cover conventional lens implants, but not the cost of premium lenses, which can run an additional $1,500 to $2,500 per eye, depending on the surgeon and the type of lens used, according to AllAboutVision.com. Patients who want these must pay out of pocket. Because of this, their use is still rare.
“At Jones Eye Institute, we might have six or eight surgeries in a day and only one using the premium IOLs,” Chacko said. “But the majority of people are happy with these lenses because they can see near and far with them.”
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