A cataract is a haze on the lens in the eye (like a smudge on a camera lens) which sits right behind the iris or coloured part of the eye . A cataract causes blurred vision at distance and near, even with the best possible glasses correction.
Cataract surgery is the most commonly performed surgery in Canada, during which the cloudy natural lens is removed and a clear permanent artificial intraocular lens or IOL is implanted (like a contact lens, but inside the eye behind the iris). Different powers and designs of implant lenses can be used which can drastically reduce the spectacle prescription and in some cases even eliminate the need for glasses entirely. Cataract surgery is very safe and low risk (but not no risk). It is a fairly quick outpatient procedure during which the patient is lightly sedated for comfort and requires only drops after to prevent infection and inflammation.
Historically, OHIP covered the entire procedure except for an optional $200 pre-surgical measurement and the surgeries were all done at St. Mary’s Hospital and Cambridge Memorial Hospital using a standard implant lens. In the last few years, private clinics in Waterloo Region have been offering cataract surgery (involving upgraded lenses with different options) at a cost of about $1700-$5000 per eye with dramatically reduced wait times. Recently the Ontario Government has announced they will be funding some entirely OHIP funded procedures with the standard implant lens at these private clinics, in order to clear the now extensive backlog of cataract patients.
Monofocal IOL – This is either the same basic lens that is covered by OHIP or a paid upgrade for better optics. The surgeon will usually try to get the patient as close as possible to fully corrected for one distance (usually the far distance) but will still require at least reading glasses, and sometimes multifocal glasses. Myopic patients who can currently read at near without glasses (and only put glasses on for distance) can request this outcome instead, but only one distance can be corrected with a monofocal lens.
Toric Monofocal IOL – This lens still only corrects one distance, but for patients with significant astigmatism, it has a better chance of giving them the best uncorrected vision at that one distance. These still usually require at least reading glasses and sometimes multifocal glasses after surgery.
Multifocal IOL or Multifocal Toric IOL–This is similar to a multifocal contact lens where the patient sees distance and near images at the same time, which usually reduces dependence on glasses after surgery. This may provide independence from spectacles, however depending on pupil size and lighting, glasses for specific tasks may still be necessary even with a multifocal IOL. There will also likely be some ghosting of images or halos even with spectacles overtop.
Multifocals are the most expensive of the IOLs but may be the “best” choice if independence from glasses is the primary motivation. For patients who are happy to wear glasses after cataract surgery and whose primary motivation is clarity of vision then a monofocal IOL with continued use of glasses for distance or near or both may still be a better option.
So what are my choices as a patient with cataracts?
- Do you want to have a no charge consultation visit to a private clinic to find out about paid options (no obligation and can still opt for OHIP funded), or do you just want a consultation referral for entirely OHIP funded surgery?
- If you want a private clinic consultation, do you want to go to TLC in Waterloo or to Clear Vision Surgical in Kitchener and/or do you have a specific surgeon you would like to consult?
- If you want a referral for entirely OHIP funded surgery, would you like a specific surgeon or would you like the surgeon with the shortest wait time?
Please think carefully about your options and ask your questions early as this is generally a decision that cannot be reversed.
Dr. Ellison, Dr. Singh, Dr. Faria and Dr. Dippel
Pierce Family Vision
107 Erb St W, Waterloo ON, N2L 1T4