Modern cataract surgery is extremely safe and effective and complications are rare. However, serious complications can occur even with properly performed cataract surgery, and in rare cases these complications can permanently and seriously reduce your vision.

There are risks associated with anesthesia and sedation, which include injury to the eye, heart and breathing problems, and in very rare cases, death. During or after surgery, intraocular infection, intraocular bleeding, intraocular inflammation, or retinal detachment can occur, and these complications can rarely cause permanent blindness. It may not be possible to implant the specific intraocular lens you have chosen or any intraocular lens at all. The intraocular lens can become decentered or dislocated, and in some instances require a second surgical procedure to reposition or replace the lens.

While the methods used to calculate the necessary intraocular lens power are very accurate in most patients, the final result may be different from what you and your surgeon planned. The proper intraocular lens power is especially difficult to predict in patients who have had LASIK, radial keratotomy, other refractive surgical procedures, and some diseases of the cornea. Having your refractive surgery records will assist in calculating the IOL power, so please try to obtain them prior to your cataract surgery.

It is impossible to list all of the possible risks and complications associated with this proposed surgery or any other treatment. Risks and complications that are considered to be unforeseeable, remote, or commonly known are not discussed. In addition, even though cataract surgery has been performed for many years, there still may be long-term effects that are not yet known or anticipated.

The goal of cataract surgery is to correct the decreased vision that is caused by the cataract. Cataract surgery will not correct other causes of decreased vision, such as glaucoma, diabetes, or age-related macular degeneration. Vision may not be completely normal after cataract surgery because these or other abnormalities may not have been diagnosed before cataract surgery was performed.

The purpose of cataract surgery is to improve the quality of vision that can be obtained with the best possible glasses or contact lens prescription you can be given. Although an attempt is made to provide good vision without glasses or contact lenses, this is not always possible. Because the calculation of the intraocular lens (IOL) power is not perfect, IOLs may not completely correct astigmatism, and the actual location the IOL occupies within the eye (which affects its power) is not completely predictable. Thus, correction with glasses or contact lenses is frequently necessary after cataract surgery.

Astigmatism and alternatives for distance vision after surgery: Some patients have significant astigmatism, which is an irregularly shaped cornea that causes objects to appear somewhat distorted at all distances.

Options for Correcting Astigmatism after Cataract Surgery

• You can have a standard monofocal intraocular lens for near or distance vision and continue to wear glasses or contact lenses to correct the astigmatism.
• You can have a special lens, toric IOL, implanted that can correct astigmatism. Since most insurance companies will not cover the cost of a toric IOL, there is an additional out-of-pocket charge for this type of lens and professional services associated with its use.
• You can have refractive surgery such as LASIK or photorefractive keratectomy (PRK) several months after cataract surgery to correct not only astigmatism, but also any residual nearsightedness or farsightedness. There is an additional charge for LASIK or PRK that is not covered by insurance.

Presbyopia (Near Vision) and alternatives for near vision after surgery: At about age 45, people with good distance vision begin to have difficulty with near vision. If they require corrective lenses to see at distance, the same lenses do not produce good vision at near because the optical system of the eye must change its power to change its point of focus. This is normally accomplished by changing the power of the lens inside the eye. As we age, the lens becomes stiff, so it cannot change the focal point of the eye from distance to near. Bifocal glasses contain lenses have different powers in the top and bottom of the lens. The top of the lens focuses distant objects, and the bottom focuses near objects. If no correction is needed for clear distance vision, non-prescription reading glasses correct near vision.

Options for Correcting Presbyopia after Cataract Surgery

• Spectacles or contact lenses: You can choose to have a monofocal (single focus) IOL implanted for distance vision in both eyes and wear bifocals or reading glasses after surgery. Some patients choose to have the IOL implanted for near vision and wear glasses to see well at distance.
• Blended vision: You can choose to have a monofocal lens implanted in both eyes, with the goal of focusing one eye at distance and the other at near. This combination of a distance eye and a reading eye is called monovision or blended vision. It should allow you to perform most tasks without glasses. Because both eyes are not focused together at the same distance, depth perception could be impaired to some extent, and some patients do not tolerate this as well as others. If you choose this option, it is important to decide which eye you will use for distance vision and which you will use for near vision.
  
  Most patients who are successful with blended vision still use glasses for visually intensive tasks such as night driving and reading. If you have been wearing contacts lenses for blended vision, you will most likely be happy with this option after cataract surgery. Your doctor can try to simulate blended vision with glasses or contact lenses, but because your vision is decreased by the cataract it is not possible to show you exactly what your postoperative vision will be like.
  
  Although many patients will adjust well to blended vision, some may find it uncomfortable. For those patients, blended vision can usually be reversed by elective laser vision correction, but this surgery will not be covered by your medical insurance.
• Multifocal IOL: A multifocal IOL is a newer type of lens that offers reduced dependence on glasses following cataract surgery by providing simultaneous distance, near and intermediate vision in each eye. There is no guarantee that all the distance, near and intermediate vision will be restored. It could take six to eight weeks for your brain to adapt to see distant and near objects simultaneously.
  
  Some patients with multifocal IOLs experience visual disturbances, like glare and shadow images, especially at night and in low-light conditions. No one, including your eye care physician, can predict with certainty if you will experience these disturbances, nor can they predict the frequency or the severity of the disturbances. For many people these effects diminish over time. If you drive a lot at night or perform detailed, “up-close” work requiring perfect vision, a monofocal lens in conjunction with eyeglasses may be a better choice.
  
  Although multifocal lenses may represent one of your best options for reducing dependence on glasses, it is not possible to guarantee that glasses will never again be worn. There will be a charge for the multifocal lens, as well as professional services associated with its use that is not covered by insurance carriers. You may not be a candidate for some of the IOL options that are listed. Discuss with your surgeon the best options for you.

No matter which type of intraocular lens (IOL) is chosen for your surgery, there are factors that could affect your visual outcome after surgery:

• Cataract surgery can not correct decreased vision caused by conditions or diseases of the cornea, iris, optic nerve or retina such as: keratoconus, glaucoma, diabetes, or age-related macular degeneration.
• The proper selection of the IOL, while based upon sophisticated equipment and computer formulas, is not an exact science, so glasses or contact lenses may be required to obtain vision that is acceptable to you after surgery.
• Individual healing factors cannot be predicted with 100% accuracy, so the final prescription of the eye after surgery in not completely predictable.
• If a monofocal IOL is implanted in both eyes in an effort to achieve the best distance vision possible, either bifocal or reading glasses or contacts will be needed after cataract surgery to obtain adequate near vision.
• Multifocal IOLs may reduce dependency on glasses but might also result in reduced quality of vision, which may become worse in dim light or fog. They may also cause some visual side effects such as rings or circles around lights at night. It may be difficult to distinguish an object from a dark background, which will be more noticeable in areas with less light. Driving at night may be affected.
• Any residual refractive error after surgery may need to be corrected with eyeglasses, contact lenses, refractive surgery or replacement of the IOL.

Monofocal IOL: Monfocal, or single vision lenses, are the standard lenses that have been implanted at the time of routine cataract surgery for many years. These lenses take the place of your cataract and can help you see distant objects. However, these lenses will not correct astigmatism and will not correct near vision, so it is likely that you will need to wear glasses at least part-time for distance activities and full time for near work.

Toric IOL: In addition to correcting nearsightedness or farsightedness, toric lenses have the ability to correct astigmatism. If you have significant astigmatism before surgery, then this lens option will provide you with a better opportunity to have clear distance vision without glasses. Toric lenses still correct primarily distance vision and will not correct near vision.

Multifocal IOL: Multifocal lenses are appropriate for some patients who have a strong desire to see distant and near objects without glasses and who are willing to potentially somewhat compromise the quality of their vision to obtain freedom from glasses. The two available multifocal IOLs are the ReZoom lens (AMO) and the ReSTOR lens (Alcon). In appropriate candidates, multifocal lenses can improve distance, intermediate (computer distance), and near vision and can reduce your dependency on spectacles at all of these distances; however, neither lens restores the natural vision at all distances you had as a youth, and you may experience some problems with these lenses. These include, but are not limited to: poor night vision, including glare and halos, less sharpness of vision than may be obtained with a monofocal IOL and spectacles, and inadequate near and intermediate vision that still may require the use of glasses. Multifocal lenses may require some time for adaptation, and in very rare cases, the vision obtained with multifocal lenses may be so poor that replacement of the lens with a monofocal lens may be necessary. This is a separate procedure for which there will be a charge, and it carries additional surgical risks.

Pseudo-accommodative IOL: The crystalens® is a pseudo-accommodative IOL that is designed to provide good distance acuity and a moderate amount of intermediate and near correction. Most patients find that they still require reading glasses for most near tasks. The crystalens® is not offered as an intraocular lens option at Emory.

Your insurance company will generally cover the cost of cataract surgery with implantation of a standard monofocal intraocular lens (IOL). Each insurance plan is different, so you should check with your individual carrier to confirm fees that are applicable to you. In addition to these fees, there are out-of-pocket expenses for the different IOL and LASIK options mentioned. These additional fees cover the cost of the lens or LASIK technology and the added physician and technician time required to make the appropriate calculations necessary for your eyes.

Monofocal IOL: There is no additional out-of-pocket expense for this lens option. If you desire LASIK after this procedure to correct any residual refractive error so that glasses or contact lenses are not required to obtain the best vision possible, the cost will be $2,400 per eye.

Toric IOL: There is an additional out-of-pocket expense of $750 for toric IOL implantation that your insurance company will not cover. If you desire LASIK after this procedure to correct any residual refractive error so that glasses or contact lenses are not required to obtain the best vision possible, the cost will be $900 per eye.

Multifocal IOL: There is an additional out-of-pocket expense of $1550 for multifocal IOL implantation that your insurance company will not cover. If you desire LASIK after this procedure to correct any residual refractive error so that glasses or contact lenses are not required to obtain the best vision possible, the cost will be $900 per eye.