What is a cataract? All of us are born with a flexible, clear lens in our eye called the “crystalline lens.” As this lens becomes cloudy and less flexible, we call it a cataract, and it is responsible for cloudy distance vision, occasional poor near vision and problems with contrast and glare.

Cataract surgery involves replacing the cloudy lens with a clear, artificial lens (also called an IOL, or intraocular lens). There are different types of technologies available to remove the cataract, and there are different types of implants available that can give distance, intermediate, and near vision. We at Focal Point Vision are pleased to offer our patients the most advanced technology available.

Many people think that cataracts are removed with a laser and that we have been doing surgery this way for the last twenty years! Traditionally, we have used ultrasound energy to remove the cataract, but now we do have a laser to make incisions, correct astigmatism, and disassemble the cataract! This device is called the LenSx Femtosecond Laser, and we have been using it successfully since its FDA approval in 2012.

Dr. Kenneth Maverick and Dr. James Lehmann are nationally recognized experts in cataract surgery. We have performed thousands of successful cataract procedures at Specialty Surgery Center, which was built and equipped specifically for modern eye surgery. Dr. Lehmann is the former Medical Director of the center, and it is both Medicare and AAAHC certified. SSC provides a superior environment and staff for both the patient and surgeon.

At Focal Point Vision, you have options.

Below you will see your surgical options, and it is important to remember that Medicare and commercial insurances typically cover the costs of cataract surgery because it is a medically necessary procedure; however, if you choose to undergo surgery with the LenSx laser and/or a specialized implant (or IOL), Medicare and commercial insurances consider these “non-covered services,” so it would be an out-of-pocket expense. Before surgery, our billing staff will contact you to review your specific situation.

Again, cataract surgery falls under medical insurance, not vision plans, which are used to cover exams for glasses and contacts. Financing may be available. Please see our payment options section to review your financial options.

Option 1: Standard Package

This option includes cataract surgery with a high-quality, standard implant that will improve your distance vision. Every patient needs reading glasses with the standard implant, and most patients need bifocal glasses for distance and near vision. There are no additional fees involved beyond the deductibles and co-pays associated with surgery.

Option 2: Astigmatism Package

This option uses a combination of the LenSx laser and/or a Toric IOL to fix your astigmatism and maximize your distance vision.

Most people have some astigmatism, and it means that the cornea, or clear “window” into the eye, is not perfectly round, but shaped more like an oval, similar to the difference between a soccer ball and a football.

By correcting the astigmatism, you will have excellent distance vision without glasses, and you will use reading glasses for near. These can be prescription reading glasses or “over-the-counter” readers, depending on your preference. This option costs approximately $2000 per eye beyond the deductibles and co-pays associated with surgery.

Patients who choose this option are able to wear nonprescription sunglasses and enjoy many activities such as golf, tennis, swimming, and driving without the hassle of glasses.

Option 3: Premium Package

This option utilizes the LenSx laser to treat astigmatism and the Symfony or Crystalens IOL to improve vision for both reading and distance vision. This option costs approximately $3500 per eye beyond the deductibles and co-pays associated with surgery.

The Symfony IOL extends the depth of focus giving the patient excellent distance and intermediate (computer / phone distance) vision.

The Crystalens accommodating IOL is designed to flex or change its curvature, allowing for more depth of focus, improving intermediate vision. Most patients who choose this lens can see well at distance and intermediate, and use “cheaters,” or low power reading glasses, for small print.

To learn more about Focal Point Vision, or to schedule an appointment, please call us at (210) 614-3600.

Cataract Surgery FAQs

What is a cataract?

We are born with a flexible, clear lens in our eye called the “crystalline lens.” As this lens becomes cloudy and less flexible, it is called a cataract, which causes cloudy vision. Additional symptoms include problems with glare, halos, and driving at night.

Why do people get cataracts?

Aging is the main reason that people develop cataracts. Smoking and exposure to UV light also increase the risk. Almost everybody will develop cataracts if they live long enough. Lastly, some types of eye surgery, such as repair of a retinal detachment, can hasten the development of a cataract.

What is cataract surgery? Will I be awake or see what’s happening? Does it hurt?

Cataract surgery is the most commonly performed surgery in the United States. It is an outpatient procedure that involves removal of the cataract and insertion of an artificial lens, called an IOL (IntraOcular Lens). This artificial lens is made of biocompatible materials and will last forever.

We perform cataract surgery at Specialty Surgery Center, in a sterile operating room, with an anesthesiologist and registered nurses whose goal is to maximize patient comfort. Patients receive local anesthesia with IV sedation, and are in a “twilight” state of sedation and relaxation. The amount of sedation can be tailored to the patient’s preference, and most people see only lights and shadows during the procedure.

In the vast majority of patients, there is little or no pain associated with cataract surgery.

How do I know when my cataract is “ripe” or “ready”?

A cataract is considered “ready for surgery” when the patient has problems with common activities, such as reading, driving, or watching television. Normally, this correlates with an inability to read all of the lines on the eye chart. Some insurers, like Medicare, have rules about the number of lines a patient can’t read before they qualify for cataract surgery.

What is laser cataract surgery?

Many people think that cataracts are removed with a laser and that we have been doing surgery this way for the last twenty years! Traditionally, we have used ultrasound (not laser) energy to remove the cataract, but now we do have a laser to make incisions, correct astigmatism, and disassemble the cataract!

This device is called the LenSx Femtosecond Laser and we have been using it successfully since its FDA approval in 2012. We were among the first surgeons in San Antonio to use this exciting laser cataract surgery technology.

The laser is the same type used to perform LASIK surgery, and it creates the incisions, unseals the cataract, and divides it up into small pieces that are easy to remove.

What are my options regarding cataract surgery?

Option 1: “Standard Package”

This option involves traditional cataract surgery with a high-quality, standard implant that will improve your distance vision. Depending on the amount of astigmatism you have, you will need glasses for distance and near vision. There are no additional fees involved beyond the deductibles and co-pays associated with surgery.

Option 2: “Astigmatism Package”

This option uses a combination of the LenSx laser and a specialized implant to treat your astigmatism and maximize your distance vision.

Astigmatism is very common, and it means that the cornea, or clear “window” into the eye, is not perfectly round, but shaped more like an oval, similar to the difference between a soccer ball and a football.

By correcting the astigmatism, you will have excellent distance vision without glasses, and you will use reading glasses for near. These can be prescription reading glasses or “over-the-counter” readers, depending on your preference. This option costs approximately $2000 per eye beyond the deductibles and co-pays associated with surgery.

Patients who choose this option are able to wear nonprescription sunglasses and enjoy many activities such as golf, tennis, swimming, and driving without the hassle of glasses.

Option 3: “Premium Package with the LenSx Femtosecond Laser”

This option involves the LenSx laser to treat astigmatism and either the Symfony or Crystalens IOL to improve distance and intermediate vision. This option costs approximately $3500 per eye beyond the deductibles and co-pays associated with surgery.

 

Why doesn’t my insurance cover options #2 and #3?

Medicare and/or commercial insurances do not cover the treatment of astigmatism or presbyopia (the need to use reading glasses).

The use of the LenSx or special IOL for the treatment of astigmatism and/or presbyopia is considered a “non-covered service,” and payment is the responsibility of the patient.

Before surgery, you will be contacted by our billing staff to address your specific situation. Additionally, financing may be available through Care Credit (www.carecredit.com).

Do I need to stop blood thinners prior to cataract surgery?

Common blood thinners include aspirin, Plavix, Xaralto, Pradaxa, Eliquis, and Coumadin. We do not routinely stop these blood thinners prior to cataract surgery. There is a small risk associated with bruising or hemorrhaging with the local anesthesia, but that risk is smaller than the systemic risks of stopping the medication.

Do I need get preoperative clearance by my internist prior to cataract surgery?

No, a preoperative exam by your internist and preoperative testing are not necessary. A large study published in the New England Journal of Medicine in 2000 examined almost 20,000 patients that underwent cataract surgery. Preoperative testing did not increase the safety of the surgery. Since we do not stop any blood thinners preoperatively, and we use local anesthesia with sedation, preoperative tests are not necessary.

How long do I need to take off from work? What are the limitations postoperatively?

Most patients take off of work the day of surgery, and the day afterwards. If you have a job that does not require much physical activity, you can go back to work two days after the surgery. If your job is strenuous, requiring much physical exertion, we recommend a week off of work. If you are retired, we recommend two days of limited activity, and advise you to refrain from heavy exertion for one week after surgery.  Most people can drive 2 days after the surgery.

Do I have to use any drops after surgery?

Our patients use drops for about three weeks postoperatively.

Specifically, what eye drops are used after cataract surgery?

We offer patients the choice between generic and compounded drops. It is difficult to predict how much a patient will have to pay for their drops. We use electronic prescribing which helps to see if the medications are covered by the patient’s formulary, but the system is very complex, and sometimes a generic medicine can cost more than a name-brand or compound medicine!

Because of this, we offer each patient the following choices:

All generic drops:

  • A steroid three times a day for three weeks
  • An NSAID three times a day for two weeks
  • An antibiotic three times a day for one week

Compounded drops:

  • A combination of the three drops above, used for three weeks

Can I get a cataract again if I’ve had cataract surgery?

A cataract occurs when the natural lens gets cloudy, and cataract surgery involves removal of this natural lens. Therefore, it is impossible to get another cataract if you had cataract surgery. However, sometimes scar tissue does form behind the artificial lens, and we have to perform a laser polishing of the lens in the clinic. This is sometimes called a secondary cataract, but in reality is just some scar tissue around the lens.

What are the most common complaints after surgery?

Most patients have some blurry vision the day after surgery, with clearing of the vision over the next few days. The more severe the cataract, the slower recovery of vision after surgery. Most patients have some scratchy feeling, variable blurry vision, and some sensitivity to light. The symptoms only last 2 to 4 weeks. Other common issues after cataract surgery include a flicker in the peripheral vision, or an arc in the peripheral vision.

To learn more about Focal Point Vision, or to schedule an appointment, please call us at (210) 614-3600.