There is only one opportunity to have cataract surgery and the decision you make will affect how you see for the rest of your life. It is important to thoroughly understand your options and to have realistic expectations. The information on this page will help you understand what a cataract is, what cataract surgery is, the different lens options, and much more. Please read through all the materials and answer all questions in the Cataract Surgery Pre-Op Questionnaire. Reading through this page will allow you and your doctor to make a more informed decision.
All of this information will be discussed during your pre-operative consultation
What is a Cataract?
A cataract is a clouding of the natural lens inside the eye. Like a camera, the normal eye has a transparent lens that focuses images at the back of the eye. While the camera focuses the image on a film, the eye focuses the image on the retina. If the lens is cloudy, the image on the retina is not clear and vision becomes blurry. There are currently limited medical treatments for cataracts. Updating glasses and increasing light in your environment may improve your vision to some extent, but the cataract will worsen with time. Cataract surgery is the only way to restore vision. That is why cataract surgery is considered the gold standard.
What is Cataract Surgery?
It is a common, outpatient surgical procedure, performed by an ophthalmologist. The cataract is removed by making a small incision in the cornea, using ultrasound power to break up and remove the cataract. An artificial intraocular lens is then implanted into the eye to replace the human lens. The small incision created usually does not require stitches.
What is the Cost of Cataract Surgery?
Cataract surgery is covered by the Ontario Health Insurance Plan (OHIP) and is free. An intraocular lens impact to replace the natural lens of the eye and measurements to select the appropriate lens power are also included.
There are optional uninsured services that are not covered by OHIP. These would include measurements with laser technology and a number of intraocular lens implants that the patient and the surgeon decide on together to meet the patient’s lifestyle needs. In most cases, selecting these options may allow the patient to spend less time wearing glasses. Uninsured services are optional and have a cost; however, private health insurance may cover some of the cost of the intraocular lens implant.
What is an Artificial Intraocular Lens Implant?
At the time of surgery, an artificial intraocular implant is inserted to replace the natural lens. This lens is needed to help direct the incoming light into your eye, giving you vision. In addition to the implant provided by OHIP, there are several other lens options available at a fee. These are called non-medically necessary lenses since they are designed to improve the quality of vision and to minimize the need of glasses after surgery. These lenses are provided by and purchased at THE OTTAWA HOSPITAL before the cataract surgery. These lenses may be covered by your private health insurance plan. Please consult with your doctor for pricing.
How is the Intraocular Lens Implant power calculated?
Every patient requires a unique implant power. This is calculated by advanced mathematical formulas which can be done in two ways, either using Ultrasound or by a more precise procedure using Laser Light Technology. Accurate measurements are very important to allow selection of the correct lens implant power. Laser testing is an option available for patients who would like the best possible accuracy for their lens selection. Laser testing is not covered by OHIP.
Why are other lenses being offered to you and why do they cost money?
Selecting a certain type of lens for cataract surgery addresses a lifestyle choice of decreasing the need for spectacle correction (glasses) after surgery. Implanting intraocular lenses (covered by OHIP) will most likely result in requiring glasses after surgery. If you want to decrease the need for glasses, then choosing another lens may be the best option for you. Upgrading your lens to decrease the need for glasses after surgery is not considered medically necessary and therefore, is not covered by OHIP. For patients who are interested in an implant not provided by OHIP, an in office CORNEAL TOPOGRAPHY is highly recommended to assist in selecting the correct implant for you. This service is not covered by OHIP. Please consult with your doctor for pricing. For information on additional lens options, please visit the Refractive Cataract Surgery page.
What is the difference between Traditional and Refractive Cataract Surgery?
The Refractive Cataract Extraction Package has a more predictable outcome as it adds a laser vision enhancement procedure, and the technology involved is much more advanced and is not available at the hospital. Also, several additional advanced diagnostic measurements are included in the Refractive Cataract Extraction Package that will be performed at a private surgical centre. This is all included in the fee. On top of this, your surgery will be performed by one of our surgeons, there are no interns or trainee participants.
5 Things to know about Cataract Surgery
Referenced from: Canadian Medical Association Journal, Cataract Surgery Jonathan A. Micieli and Steve A. Arshinoff CMAJ October 04, 2011 183 (14) 1621; DOI: https://doi.org/10.1503/cmaj.110549
Cataract Surgery is one of the most common surgical procedures performed in Canada and worldwide
More than 9.5 million cataract surgeries are performed worldwide each year. The number of procedures has more than doubled between 1992 and 2004 in the province of Ontario. Through a small incision (< 3.0 mm), a phacoemulsification probe that oscillates at ultrasonic speeds breaks up and removes the opaque cataract lens, and a permanent artificial lens is inserted into the original capsule that held the cataract.
Serious Post-Operative complications are uncommon
Serious complications from cataract surgery include retinal detachment (0.8%) and endophthalmitis (0.1%). Posterior capsular opacification, a more common postoperative condition (4.2% within 90 days), results from the proliferation and migration of retained lens epithelial cells across the posterior capsule and can be easily treated with a laser to create a clear aperture in the visual axis.
Patients require glasses for near vision after standard cataract surgery
Traditional artificial intraocular lenses, now usually made of acrylic polymers, cannot change shape to allow for clear vision at different distances like young human lens can.
One way to eliminate the need for glasses is to use Multifocal Intraocular Lenses
Multifocal intraocular lenses simultaneously focus images of targets located at different distances from the eye, allowing the brain to choose the best focused image from each eye. Although patients are generally satisfied with these lenses, some may be intolerant of the halos, glare and reduced contrast sensitivity associated with them.
Another way to eliminate the need for glasses is Monovision, whereby the power of the intraocular lens is chosen to enable mid-range or near vision in one eye and distance vision in the other eye
After a period of adaptation, which can take several weeks, the brain learns to select the clearest central image from one eye at a particular distance and suppress the image from the other eye. Because there may be some loss of three-dimensional stereo vision with this approach, it may not be suitable for all patients.