Vision through updates.

Cataracts occur when the eye’s natural lens becomes cloudy with age.

Cataracts don’t harm the eye but can progressively impair vision.

Cloudy lenses can be removed and replaced with artificial lenses designed to correct a range of vision problems.

With a variety of new replacement lenses on the market, it’s wise to talk to your eye doctor about your options.

Like bum knees and crow’s feet, cataracts are the price we pay for getting older. Cataracts form when the normally transparent lens of the eye turns cloudy. At least three out of five people over age 60 will eventually develop them. Today, thanks to a steady march of advances, cataract replacement surgery often gives people better vision than they’ve had in years.

Progress in the field has been nothing short of astonishing, experts say, starting with the development of artificial lenses about 30 years ago.

Patients can now choose from a wide range of artificial lenses. The most common are monofocal lenses, which focus vision at a single distance, the way a pair of standard glasses does. Before surgery, ophthalmologists test the eyes to choose the best prescription for the artificial lens, based on whether patients are nearsighted or farsighted or have normal vision.

Multifocal lenses designed to focus both up close and at a distance, are a newer option. They are particularly appealing because by the time people develop cataracts, usually starting in their 60s, most suffer from presbyopia and require reading glasses. Presbyopia occurs when the body’s natural lens stiffens with age and eye muscles can no longer focus it for close vision.

Techniques to insert the new lenses have also been refined. In the past, doctors had to make a relatively large incision in the clear capsule that contains the natural lens. Now a technique called phacoemulsification breaks up the damaged lens so it can be removed in fragments through a much smaller opening. Replacement lenses are made of a material pliable enough to be rolled up and inserted through the opening. Once inside, they unfold to fill the capsule. The entire procedure usually takes less than 30 minutes and is typically performed using an anesthetic eye drop.

Monofocal lenses, which have long been in use and are covered by insurance, remain the most common choice of replacement lens. But multifocal lenses are growing in popularity.

A variety of multifocal brands are available, but they all work in one of two basic ways. One design presents two images to the retina, one focused close and the other at a distance. The brain then chooses which one to “see.” The second design, called an accommodating lens, incorporates a kind of hinge that allows eye muscles to focus the lens either near or far.

These so-called premium lenses are not considered medically necessary, they aren’t covered by Medicare or private insurance. The additional cost can run up to $3,000 per eye.

Another new artificial lens design, called a Toric lens, corrects astigmatism, which is caused by an abnormal curvature of the cornea. Like multifocal lenses, they are considered premium lenses and aren’t covered by most insurance plans.

But there are drawbacks. Patients sometimes complain about seeing haloes around lights at night. In addition, multifocal lenses designed to present two images to the retina can decrease contrast, making it more difficult to see in dim light.

Some doctors believe the drawbacks outweigh the benefits, especially because the majority of patients end up having to wear reading glasses for very fine print.

Most eye specialists expect multifocal lens designs to improve. One approach under development is a plastic gel that would be injected into the capsule that held the original lens and would form a highly pliable new lens.

Monofocal lenses, meanwhile, are already so refined that the results for many patients are dramatic.

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