1. What is a cataract ?
2. How is the cataract removed?
3. How will I see once my cataract is removed?
4. Will I be able to see better at all distances?
5. My friend says she had a special multi focal lens implanted that enabled her to give up her glasses and contact lenses for good. She can now see at almost every distance. Will I be able to get one of those?
6. Does this type of multi focal lens cost extra, or do I pay just the difference between this special lens and the traditional lens?
7. Astigmatism and Toric intraocular lenses?
8. Can I have my other eye done at the same time?
9. What do I need to know prior to my surgery?
10. Where is surgery done and how long does the surgery take?
11. Will I be awake for surgery?
12. How long does it take to heal?
13. Can I play golf, exercise and wear make up after the surgery?

What is a cataract ?
The natural lens inside the eye behind the pupil becomes cloudy, sometimes slowly and sometimes quickly as we age over time (It can happen to one eye more quickly as well). Cataracts can happen at an earlier age. The only remedy is complete surgical removal when the patient is bothered. Surgery does not require one to wait ‘until ripe’ as in the past; one can have surgery when it becomes a functional interruption of your normal activities.

How is the cataract removed?
Dr. Marshburn uses the most advanced surgical technique available to remove cataracts: Ultrasonic phacoemulsification surgery. This very successful procedure utilizes a small incision through which Dr. Marshburn removes the cataract (the deteriorating, clouded lens), and permanently replaces it with a man made lens that restores focusing to the eye.

How will I see once my cataract is removed?
Once the lens is removed, a substitute man-made lens is inserted in the vacant area, which is like a plastic bag. The lens is called an ‘Intraocular Lens’ (IOL) and is usually made of an acrylic material. This lens is not felt in the eye, nor does it have to be changed or removed ever again, unless there is a problem which is very rare. If no lens were inserted, one would have to wear thick heavy glasses and / or a thick heavy contact lens for adequate vision.

Will I be able to see better at all distances?
Traditionally, the mono focal lens implanted would only give a person back their distance vision or their near vision, but not both (depending on whether they were farsighted or nearsighted prior to getting a cataract). Because of other refractive or optical reasons, if you get one of these lenses, you will probably need the same type of glasses and prescription you are wearing now. There are other multi focal lenses that are discussed in the next question. Traditional intraocular lenses are still the most common lens being implanted and are usually covered as part of the surgery at no extra cost, because it is a needed item.

My friend says she had a special multi focal lens implanted that enabled her to give up her glasses and contact lenses for good. She can now see at almost every distance. Will I be able to get one of those?
There is now an option available that will enable some people to be able to give up their glasses or contact lenses, but not everyone is a candidate. The one most commonly used by Dr. Marshburn is called Restor by Alcon (www Alconinc.com). Others sometimes used are called “Rezoom” (www.Rezoom.com) and “Crystalens” (www.crystalens.com). This lens usually provides good vision at distance and close range, with some help at intermediate distances. Dr. Marshburn’s staff can provide more information at your measurement visit, but please call ahead of time if you have any questions after reading this information. Not every one is a good candidate for these lenses depending on other factors or other eye problems. Because of the way these multi focal lenses work, for optimal vision results, it requires that you have surgery in both eyes within a few weeks of each other, even if the cataract in the other eye is not as advanced. There are halos and glare risks associated with this type of lens, as well as a risk of needing a laser procedure on the cornea(s) later after the surgery to correct for astigmatism (see below) if necessary. There are some multi focal lens patients who use glasses under certain conditions i.e. computer work.

Does this type of multi focal lens cost extra, or do I pay just the difference between this special lens and the traditional lens?
This multi focal lens is considered cosmetic, not a necessity by Medicare and the other insurance companies. Therefore, if you choose to have this kind of lens implanted, you will be responsible for the entire cost of both intraocular lenses, the extra measurements, and the extra time required for these tests. Payment will be required in full prior to the surgery. Dr. Marshburn’s fee is $2400.00 ($1200.00 per eye) which must be paid in full seven days prior to the surgery, or no less than three days with a Visa, MasterCard or cash payment. The surgery center or hospital charges anywhere from $699.00 to $800.00 per eye (depending on the specialty lens choice) which can be paid the morning of surgery on your arrival prior to the surgery or the surgery will be cancelled. Completely separate, Medicare and you’re your insurance will be billed for the usual surgery costs, just not any portion of the specialty lenses.

Astigmatism and Toric intraocular lenses
Astigmatism is caused by the lenses of the eye being more curved in one direction than the other, much like a football or a spoon. This difference in curvature is common with varying degrees from mild to severe. In most mild to moderate or worse cases, if not corrected, the vision will be unfocused or blurry, sometimes causing eyestrain or headaches as well.
Toric intraocular specialty lenses are now available to offset the imbalance and blurred vision created by the irregular shape of the front lens of the eye, called the cornea. Until these lenses were available, people with astigmatism could only have their farsighted or nearsighted vision corrected, with the residual astigmatism only being corrected with eyeglasses or contact lenses, or another surgery or laser procedure. Toric intraocular lenses, also known as “AcrySof Toric” (www.Alcon.com) are implanted in the same way a standard or a multi focal lens implant is used, with no additional risks to the patient. Since it is masking the corneal astigmatism, there is a possibility that a minor amount of residual astigmatism will be present after surgery. Clinical studies have shown that 97% of patients who have had this type of lens implanted achieved freedom from glasses for their distance vision while only 50% of the control group who received a standard or traditional lens implant achieved the same result. These are also not covered by insurance and the cost to you is $1,445.00 per eye, in advance of surgery.

Can I have my other eye done at the same time?
No. Because there are a possibility of risks associated with any eye surgery (Infection, bleeding, retinal detachment, increased intraocular pressure, macular or corneal edema or swelling etc.) Only one eye at a time is done just in case there is a complication and the vision is extremely blurry in the post surgical eye.

What do I need to know prior to my surgery?
Although we will give you all the information and important paperwork at your next measurements appointment, you should know that you will be asked to see your primary care physician 6 to 7 days prior to your surgery to do a brief physical and some lab tests. At your next appointment we will give you the forms that the Doctor will need to complete and fax back to our office directly no later than 3 days prior to the surgery.
If for any reason you would like those forms sooner than your next visit, please call ahead.

Where is surgery done and how long does the surgery take?
The actual surgery time takes usually 15 to 20 minutes, but you will be asked to arrive one to two hours prior to your surgery depending on where your surgery will be. If you have just one primary insurance with no secondary coverage, you will be scheduled at a surgery center in East Whittier on a Monday morning (to help with less out of pocket costs that you may incur. If you have a primary and secondary medical insurance, and / or you live closer to the office and choose the following, your surgery will be scheduled at Placentia Linda Hospital on a Wednesday morning. If you have a special need or preference, please call our office immediately, as that may require rescheduling any future appointments.

Will I be awake for surgery?
You will be awake and an anesthesiologist will be monitoring your vital signs and providing medication to make you feel comfortable during surgery. This is called “MAC” = Monitored Anesthesia Care and there will be anesthetics for the eye itself. If you feel you must be completely be asleep under general anesthesia, please call the office as soon as possible.

How long does it take to heal?
The eye is usually well enough to give you a glasses prescription in about six weeks. The cornea where the incision was made has full strength usually within six months. These estimates are not guarantees, because different people heal at different rates. There is no way to predict how you will see after surgery, and you should plan to expect at least some blurriness in the surgery eye. You must not drive after the surgery for at least 12 to 24 hours, and transportation can be provided if your surgery is at Placentia Linda Hospital.
Please ask us for more details as soon as possible if this is needed.

Can I play golf, exercise and wear make up after the surgery?
You will be asked not to do anything that will put you at risk for injury. There are no major restrictions, although you are asked to not rub or touch the operated eye, and do not swim or use mascara or eye liner for two weeks. You will be able to carry on with your normal routine and you may even take a plane trip, as long as you can keep all post operative scheduled appointments. We will provide you with more information when you leave the outpatient surgery center and at your next pre operative and post operative appointments.