Options in Cataract Surgery

This post doesn’t have an appealing title and will be a curious mixture of economics and technical data, so I wouldn’t blame you if you didn’t read it. However anyone who might be contemplating cataract surgery in future might find my experience helpful so here goes.

First of all, getting a cataract removed and a lens implanted is a lot like buying a car. You can go for basic transportation or you can start piling on the options. Every buyer is different and what I find of value another purchaser may not.

The very basic operation is covered by OHIP (my local government Medicare.) The options you pay for out of pocket. The majority of folks just go with the basics and that does the job. Lets get into details on the options.

To begin with I have a slightly more complicated lens situation (slight astigmatism – focal length is different in a different axis.) This is reflected in my normal eyeglass prescription. More about this later.

There are two parts to cataract surgery – pre-op eye measurements and the operation and implant.

Pre-Op Measurement

This is necessary because the eye surgeon needs to match the appropriate implant lens to your eye. The size of your eye and the curvature of your cornea is important. OHIP pays for an ultrasound measurement. There is a more accurate laser measurement that costs about $200 extra. The surgeon recommended this and so I went ahead and paid for it. This was the first option and in my mind a no-brainer if you can afford it.

The Implant

I had three choices of lens implant:

  1. Standard (generic) – this is paid in full by OHIP and in most cases works fine. You are going to need to wear eyeglasses for final correction in my case and the standard lens is a spherical one – some aberration can reduce contrast in night driving situations. I felt I could afford a bit better.
  2. Tecnis Monofocal Aspherical (about $250 extra for the set.) This gives improved contrast, is most similar to the “natural” lens it replaces and is better for night driving. You are still going to need eyeglasses to get pinpoint focus – due to my astigmatism.
  3. Tecnis Toric (about $1400 extra for the set.) This is the latest and greatest in implant optics and would in theory correct for both distance vision and astigmatism. Folks who go this way can get out of eyeglasses for most activities.

Now $1400 may seem like a lot but hey, I paid quite a bit more than that for hearing aids a year or so ago. Would it be worth it to eliminate glasses?

As it turns out I would (at my advanced age) still have to wear glasses for reading fine print. So the Toric lenses would not be guaranteed to get me out of them entirely.

Not needing glasses for anything but reading is a hassle as far as I am concerned. You either need a granny chain with the spectacles, or you go with zero prescription in the top and reading prescription in the bottom of a set of progressive lenses and wear them all the time. Besides that, after 30 years I sort of like wearing glasses.

And the clincher for me is that the best visual acuity does not come with the Toric lenses anyway. The aspherical Tecnis with an eyeglasses prescription will correct my vision right back to 20/20. I can live with that.

For some people who aren’t as worried about night driving the Toric lens might be the way to go. But I felt that I would get the best value and the best distance vision with the Tecnis Monofocal. So that was my choice.

And I think it’s worked out for me. I can already see much more clearly with my “bionic” eye and in fact have eliminated a pair of glasses I needed to see the computer screen. I won’t have a final eyeglass prescription until I get the second eye fixed but based on my first evaluation at the optometrist things are looking pretty good.

Your financial and life situation may be different from mine, but I feel I did well with the moderate upgrade in lenses and continuing on with eyeglasses where needed. Now you know the rest of the story.




Well I am now halfway there in the cataract surgery game. I had my left eye operated on last Tuesday and my right eye is scheduled to get fixed on December 5.

Compared to some surgery which shall remain nameless (prostate biopsy) the eye stuff is pretty benign. The worst part by far is wearing the eye shield afterwards – the tape the hospital gives you is like crazy glue. The eye drops aren’t too bad aside from some really nasty ones you get just prior to the surgery itself.

I went to the Smiths Falls hospital for my eye and I am glad I did. The drive is far more convenient than going into the city and the staff there are very kind and efficient.

After I paid for my Technis lens upgrade (better contrast at night) I went up to the surgical floor. They have special chairs where they work on you and then you are just wheeled down to the operating room in the chair. The back reclines, they put you under the microscope and start a process called phacoemulsification on your cataract. This involves a tiny ultrasonic probe that they use to break up your old lens and suck it out. Sounds gross but aside from bright lights you don’t experience anything. Then they unroll a new bionic lens in its place and you are done. Total time 15-20 minutes.

After surgery everything was blurry but after one day I could already see a lot better. I note how much whiter and more colorful the world looks in my left eye now. I can hardly wait to get my right eye fixed.

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