Cataract Treatment a Luxury Many Can Now Afford

Changes to Medicare extend coverage for cutting-edge therapies

FRIDAY, Aug. 18, 2006 (HealthDay News) -- The single biggest advance this year in the treatment of cataracts has come not from science but from the U.S. bureaucracy.

Changes to Medicare guidelines mean more older folks than ever can take advantage of the latest technologies to sharpen their eyesight, ophthalmologists say.

"The new rules allow patients to make a decision whether they want to pay for these advances," said Dr. Donald Schwartz, associate clinical professor of ophthalmology at the University of California, Irvine, and the University of Southern California's Doheny Eye Institute.

More than 20 million Americans are afflicted with cataracts, a clouding of the lens that diminishes vision. And that number is expected to balloon to 30.1 million by 2020, according to Prevent Blindness America, an eye health and safety advocacy group.

The elderly are particularly vulnerable to cataracts, which typically occur as part of the aging process. By age 80, more than half of all Americans either have a cataract or have had cataract surgery, according to the National Eye Institute, part of the National Institutes of Health.

But two new types of synthetic replacement lenses are available that can restore a cataract patient's vision better than ever. The lenses are called multifocal, because they allow people to focus both far and near, while older replacement lenses provided clear vision only at one specific distance.

One type, called an accommodating lens that comes with the brand name Crystalens, acts much like a normal human lens when focusing, said Dr. James Salz, attending ophthalmic surgeon at Cedars-Sinai Medical Center in Los Angeles, and spokesman for the American Academy of Ophthalmologists.

"It replicates what the eye does when you go from far to near," Salz said. "The lens changes its shape, actually becoming thicker in your eye and focusing."

The other type of lens, marketed under the brand names ReZoom and ReSTOR, replicate normal vision through a "bull's-eye" design. Formed with concentric circles resembling a practice target, the lens allows a patient to shift his or her focus through slight eye movements.

"You might think of them as appearing as an archery target, with a bull's-eye and zones around the bull's-eye that allow for different distances," Schwartz said.

But up to now these new lenses were financially out of reach for many senior citizens because Medicare would only pay for the old-style basic lens replacement.

A guideline revision last year changed all that, however. Patients still receive up to $2,000 for a basic lens replacement, same as always. But, they also now have the option of applying that money toward the more expensive lenses that provide close-to-normal sight.

"When patients get these new lenses, over 90 percent say they never wear glasses again," Salz said. "But they have to pay for it, up to a couple thousands of dollars per eye."

The multifocal lenses also can cause some problems with night vision, with patients suffering from halo effects and glare, a fact they should be aware of. "If I have somebody that does a lot of night driving, I don't think it's necessarily a good idea to put one of these lenses in because it will bug them," Salz said.

On the surgical front, the operation to correct cataracts has improved to the point where it enjoys a 95 percent success rate, with patients back to normal in a few days, according to Prevent Blindness America. It is the most commonly performed surgical procedure in people age 65 and older.

Most doctors now use a technique called phacoemulsification to remove the clouded lens, Schwartz said. The procedure involves a small incision that is made on the side of the cornea, the clear, dome-shaped surface that covers the front of the eye. A tiny probe inserted into the eye emits ultrasound waves that soften and break up the lens, and the tiny fragments are vacuumed out of the eye. This sets the stage for inserting a replacement lens.

Inserting a replacement lens also has become easier. The new synthetic lenses can be folded and then slid into the eye through a self-sealing incision as small as an eighth of an inch.

Cataracts form in one of two ways, according to the National Institutes of Health. Clumps of protein can adhere to the lens, reducing the sharpness of the image reaching the retina. Or the clear lens can slowly change to a yellowish/brownish color, adding a brownish tint to vision.

Cataracts generally are painless, and their development over time is subtle. You should visit your eye doctor if you experience any of following:

  • Blurred vision, double vision, ghost images, or the sense of a "film" over the eyes.
  • Lights that either seem too dim for reading or close-up work, or strong enough to "dazzle" eyes.
  • Needing to change eyeglass prescriptions often, without experiencing improvement.
  • Finding that a milky or yellowish spot has appeared in the pupil, which is normally black.

More information

To learn more, visit the National Eye Institute.

SOURCES: Donald Schwartz, M.D., associate clinical professor of ophthalmology at the University of California, Irvine, and the University of Southern California's Doheny Eye Institute, Los Angeles; James Salz, M.D., clinical professor of ophthalmology at the University of Southern California, attending ophthalmic surgeon at Cedars-Sinai Medical Center in Los Angeles, and spokesman for the American Academy of Ophthalmologists; National Eye Institute; Prevent Blindness America
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