Raymond Pekala, MD
Board-Certified Ophthalmologist

215 White Horse Pike
Haddon Heights, NJ 08035
Phone: (856) 547-1646

Raymond Pekala, MD
Board-Certified Ophthalmologist

(856) 547-1646 215 White Horse Pike
Haddon Heights, NJ 08035


Related Information

What is a cataract?

As your eyes age, certain natural changes take place. One of these aging changes is the development of haziness in the clear lens of the eye. In most people this change is very gradual usually starting after 50 years of age. Even though there is the beginning of cataract formation, it is not noticeable and vision is fine. Eventually vision does become blurry. This might be noticed as more glare while driving, difficulty reading or watching TV, particularly the small print at the top or bottom of the screen, double vision in one eye, or fading colors. These changes are not unique to cataracts, so you need to have a thorough eye exam to exclude other causes of decreased vision.

Sometimes cataracts can develop very quickly, especially when associated with eye trauma, other types of intraocular surgery, the use of steroids, or a family history of early cataract. When symptoms start to occur you may be ready for cataract surgery.

What is the treatment of cataracts?

Sometimes a change in your eyeglass prescription will improve your vision with cataracts. Eventually this will not be enough and surgery will be necessary to improve your vision.

Although all surgery must be approached with caution, the outcome of the vast majority of cataract surgery is extremely successful in my hands, provided the eye has no significant cause of decreased vision such as glaucoma, macular degeneration, or diabetic retinopathy to name a few. Each patient’s circumstances must be approached with intelligence and honesty. Rarely there can be complications such as infection, retinal detachment, and swelling in the cornea or retina that can be treated but the vision sometimes is not optimum. In conclusion, the benefits far outweigh the risk of cataract surgery in most people. Age alone is not a reason not to have cataract surgery.

The surgery will be performed in an outpatient setting in an operating room in a surgicenter or in a hospital with same day discharge. I perform cataract surgery at the Wills Surgery Center in Cherry Hill and at Virtua Our Lady of Lourdes Medical Center. The operation is essentially painless. You will get IV sedation to relax you during the procedure.

A small incision is made into the eye to remove the cataract. This incision is self-sealing and rarely needs a stitch. In the event that you do need a stitch, the knot is buried so you will not feel it. Recovery is very rapid and you can resume most activity in a day or two. All surgery and follow-up care will be performed only by me.

Once the cloudy lens, or cataract, is removed from the eye, an artificial lens is placed into the eye in order to provide good vision. This intraocular lens is usually put in place at about the same position in the eye as the original lens that was removed. It is held in place by the clear capsular bag, a part of the original lens that is left behind to support the new lens implant. After the cataract surgery, the posterior surface of the capsular bag can sometimes become hazy, usually years later. This is fixed by a simple laser procedure in the office.

Intraocular Lens Choices

The type of lens implant and how powerful to make it are decided prior to your surgery. The eye is measured by ultrasound or by light to calculate the power of the lens implant. Depending on your lifestyle preferences and the unique anatomy of your eye, the right type of lens will be chosen. There a few options from which to choose.

Monofocal Lenses

These lenses allow the eye to see well at a specific distance. Most people choose to see well at long distance. Even with these distant lenses, some patients may still see at near but will not be comfortable. Most, if not all, will need reading glasses. Some patients want to see well at near without glasses and this can be accomplished by choosing the correct power for the lens implant. With a monofocal lens, however, this eye will not see well for both long distance and near without glasses. So, with a monofocal lens you need to choose where you would like to see. Some patients choose to see well with one eye for distance and the other for near without glasses. This is called monovision and works well for selected patients. The monofocal intraocular lens is a lens implant that medical insurance will cover.

Multifocal Lenses

These lenses have the potential to allow you to see well in each eye for both distance and near. I have put these lenses in many people and they tend to be my happiest patients. However, there are some drawbacks. Most insurances will not pay for them so it will be the patient’s responsibility. All intraocular lenses, even the basic monofocal lens, may cause some glare and halos. With the newer generation of these multifocal lenses, any increase in these symptoms is kept at a minimum and the advantage of much wider range of good vision oblained with these lenses usually makes up for this. Though I have had patients who love them from day one, in others it can take time to adapt to their full potential. Multifocal lenses may never completely eliminate the need for glasses though they will definitely cut down the times when you need them. About 80% of patients feel no need to wear glasses after bilateral implantation.

Toric Intraocular Lenses

These lens implants correct for astigmatism. Astigmatism is an optical condition of the eye whereby the eye is not spherical but curved more in one direction than another. The best example of this is if you take a tennis ball and squeeze it, the curvature of the ball between your fingers and thumb will be more curved than the curvature 90 degrees away. These lens implants correct for the difference in this curvature. If your astigmatism is significant, it is an excellent way to eliminate your astigmatism and allow you to see well at distance without glasses. It is not associated with any increased glare or halos but unfortunately, the extra cost for this lens is the patient’s responsibility. The cost for these lenses, however, are less than for multifocal or extended depth-of-focus lenses.You will still need glasses for near unless one eye is corrected for distance and the other for near, as can be done with monofocal lenses. 

Increased Depth-of-Focus Lenses

These lenses, notably the Vivity lens made by Alcon, can deliver good uncorrected distance and intermediate vision with less glare and halos than the standard multifocal lenses and really not any more than the standard monofocal lens.  They tend to not work as well for very close reading compared to the other lens that Alcon makes, the Panoptix lens, which I will talk about in the next section. These newer lenses with greater depth of focus can also correct for astigmatism and give excellent distance and intermediate vision and sometimes near as well.

Trifocal Lenses

The Alcon Panoptix is a new type of multifocal lens which gives much better distance, intermediate (computer distance), and near vision than the previous generation of mutifocal lenses and does this with less glare and halos than older generations of these type of lenses. It also corrects for astigmatism. It has become my go-to lens for any patient who wishes to be as independent from glasses as possible. As with any multifocal lens, there really should be no other significant ocular problem such as macular degeneration, advanced glaucoma, or retinal wrinkling. A healthy cornea is also necessary.