As we age, the lens inside our eye causes a series of progressive visual deteriorations. What begins as the loss of near vision (presbyopia), will ultimately progress to a cataract, resulting in loss of clarity, focus, and visual function. To address these issues, your doctor may recommend cataract surgery, where the cataract is replaced with an artificial lens. While cataract surgery is one of the safest and most common procedures performed worldwide, not all cataract surgery is equivalent. Understanding the differences between a basic or traditional cataract surgery and a refractive cataract surgery will help you choose the best option for your visual goals and lifestyle.
In short, whereas basic cataract surgery replaces the clouding lens with a clear lens set for distance focus only, refractive cataract surgery replaces the clouding lens with a clear lens capable of correcting refractive error such as myopia (nearsightedness), hyperopia (farsightedness) and astigmatism, while also providing technology capable of eliminating the need for reading glasses and/or bifocals. If your goal is superb vision quality with independence from correction for the highest possible percentage of tasks, read on to learn more about what the surgeons at Durrie Vision can offer you.
What causes cataracts and how do they affect vision?
Cataracts form gradually and are a result of normal aging. While refractive errors (myopia, hyperopia, astigmatism) stem from the shape of the cornea, lens and length of the eye, cataracts are a product of thickening and compression of the crystalline lens inside the eye changing the lens clarity, focus and light transmission properties.
To understand how the aging of the lens affects your vision, let’s take a step back and discuss the anatomy of the eye.
Your eye functions much like a camera. The cornea, which is the clear dome at the front surface of your eye, provides the first focusing of light. If the cornea is too steep, too flat or out-of-round, the light will not be focused on the retina, which is the ‘sensor’ at the back of the eye. These types of refractive error often develop in adolescence and into early adulthood and are the reason individuals need glasses, contacts or LASIK surgery to see their best.
The crystalline lens, behind the iris (colored portion of the eye), provides the second focus of light. Ideally the cornea and lens together will focus light directly on the retina. In early life the lens is a flexible structure and acts like a zoom feature to provide near focus. As time passes, however, the lens thickens and internal hardening results in the loss of accommodation (zoom) usually by the mid-40s. This is the first or three stages of progressive deterioration of lens function, known collectively as Dysfunctional Lens Syndrome. During stage 1, people turn to readers, bifocals or other techniques in contact lenses to compensate for the near vision loss.
Fast-forward a decade or so, and stage 2 begins. The lens is then losing its clarity where haze and yellowing of the lens leads to a decrease in vision quality, including nighttime halos and glare and increased need for light to read. During this phase, Refractive Lens Exchange is often a fantastic surgical option to restore image quality and range of vision before cataracts are fully formed.
What are the symptoms of cataracts?
Left untreated, the aging lens progresses into cataracts, which represents DLS stage 3. Symptoms of cataract will vary depending on the location and type of cataract change but may include:
Cloudy vision: Cataracts decrease the transmission of light to the retina and can make the vision appear generally foggy, less bold or crisp, and less bright.
Halos and glare: Early peripheral layering of the lens will often cause glare and halo around lights at night or in bright morning or afternoon sun, when light is coming from a more direct angle relative to your line of sight.
Difficulty seeing at night: Lens clarity will challenge reading in dim light or at night, night driving (from glare)
Change in color perception: As the lens ages, it gains yellow discoloration, which acts like a filter, making whites appear dingy and colors less vibrant.
Other less common symptoms may include:
- Frequently changing prescription
- Double vision
- Loss of contrast
What does refractive cataract surgery involve?
Refractive cataract surgery is an outpatient procedure, performed one eye at a time, typically a week or two apart. On surgery day, patients should expect to be in our surgery center for 90 minutes, though surgery itself lasts 10-15 minutes.
Before surgery, two forms of topical anesthetic and a mild oral sedative are used to keep you comfortable during the procedure. Next, a small incision is made at the edge of the cornea to allow access to the lens. The removal of the lens is performed using gentle ultrasound and aspiration. A customized artificial lens is delivered into the eye and positioned in place. Finally the incision sealed using a sutureless technique.*
Refractive cataract surgery recovery process:
On the day of surgery, vision will be blurry due to dilation of the eye and early healing. You will be seen for a post-operative visit the day following surgery. Typically patients are noticing a dramatic improvement in vision on that exam and are cleared to return to most normal activities (swimming and heavy-lifting excepted).
Prescription eyedrops are utilized before and after surgery to promote healing and protect against infection and inflammation. These drops are used for the four weeks following surgery at a decreasing interval.
Monitoring your healing and visual progress is key to reaching optimal results, so patients return for examination at 1-week, 1-month, and 3-months post-operatively. Examinations are performed annually or biennially (every 2 years) thereafter.
The difference between refractive cataract surgery and basic cataract surgery
While both basic cataract surgery and Refractive Cataract Surgery replace the clouding lens with a clear intraocular lens (IOL), only Refractive Cataract Surgery aims to correct all forms of refractive error. The technologic improvements in artificial lenses allow us to provide distance, intermediate, and near vision, superb image quality and contrast sensitivity in both eyes simultaneously!
Other differences between Refractive Cataract Surgery and Basic Cataract Surgery are outlined below:
|Refractive Cataract Surgery||Basic Cataract Surgery|
|Multifocal, Trifocal, Extended Depth of Focus lenses available||Monofocal lenses only|
|Toric lenses or LRI astigmatism correction standard||No astigmatism correction offered|
|Laser vision correction included post-operatively if needed to optimize vision.||Glasses/bifocals used to correct residual refractive error|
|Range of vision provided using IOL technology||Readers or bifocals needed for intermediate/near|
Choosing the right lens for your lifestyle
With a multitude of lenses available for use, a significant part of optimal visual outcome following cataract surgery involves appropriate assessment of your individual optics, your visual potential, and the unique visual demands that correspond to your lifestyle. The surgeons at Durrie Vision utilize the most advanced diagnostic technology available along with years of expertise with refractive lens technology to customize a treatment plan tailored to your visual needs. Whether it be your occupational needs, your recreational pursuits or your hopes for the future, choosing the right lens is critical to your functionality. Our doctors spend significant time understanding your needs and setting expectations so you can achieve the best vision possible!
Get started with Refractive Cataract Surgery at Durrie Vision
Our primary goal is to help our patients experience life with the best vision possible. The first step in that process is a comprehensive examination. We begin the process with our signature exam, the Advanced Ocular Analysis. During your AOA we will perform a series of in-depth, advanced diagnostic tests. Following the testing, a surgeon will examine your eyes, review the tests and recommend a customized plan to help you reach your visual goals.
As a refractive surgery practice, we perform all seven of the procedures in Refractive Surgery, from laser vision correction to lens implantation. No matter the procedure, we use innovative technology to maximize precision and tailor the treatment to your specific optics. Our expert staff is here to provide superior service from the first consultation throughout the process of surgery and beyond.
For over 20 years, the doctors at Durrie Vision have been leaders in refractive surgery, specializing in the most-advanced techniques in vision correction. To get started, schedule your AOA or take our easy, online self-candidacy test.