Cataract Surgery

A cataract is a clouding of the normally clear, transparent lens of the eye.  A cataract is not a tumor or growth of new tissue over or in the eye, rather a fogging and loss of clarity of the lens itself. When a cataract forms, the lens is no longer able to focus the light clearly and your vision becomes cloudy. An early cataract may cause few problems with vision. If the cataract gets worse, sight may be partially or completely lost until the cataract is removed.

Although cataracts result from many conditions, the most frequent cause is the natural aging process. Other causes may include eye trauma, chronic eye disease, and other medical conditions such as diabetes.

Cataracts can take from a few months to several years to develop. Certain medications can accelerate the development of cataracts. Sometimes, the cataract stops developing in its early stages and vision is only slightly decreased. But if it continues to develop, vision is impaired, and surgical treatment is required.

Pepose Vision is a worldwide leader in the research of cataract treatment and removal. We utilize the latest technology and provide the convenience of a surgery center in our building. Our surgeons are involved in your entire surgical process, including pre-op, and are recognized each and every year among the very best.

Cataracts St. Louis

How do I know if I have cataracts?

You may not notice any symptoms with early cataracts. As a cataract becomes more advanced, decrease in clarity of vision, not fully correctable with glasses, is noticed. There is a loss of contrast sensitivity, so that shadows and color vision are less vivid. Disturbing glare may be noted as light into the eye is scattered by the cataract. Halos may be observed around lights. Night vision will be diminished. In certain types of cataracts, double vision may be noted in the affected eye. Some patients note that they require frequent changes in their eyeglass or contact lens prescriptions and may be aware that their near vision is improving as their distance vision declines.

A cataract does not routinely cause discomfort or pain in the eye or alter the external appearance of the eye.

The only way to determine if your vision problem results from a cataract is to visit an eye care professional for a complete examination. At Pepose Vision Institute, we use state-of-the-art diagnostics to evaluate your eyes. Our wavefront diagnostic technology generates thousands of data points about your eyes in a matter of minutes. We are the only cataract surgeons in the Bi-State area to provide this level of thoroughness during your exam.

Vision through cataract Pepose Vision

We are St. Louis’ leading cataract surgeons and always provide our patients with compassionate and customized care.

How do you treat cataracts?

The only effective treatment for a cataract is surgery to remove the diseased, cloudy lens. Neither diet nor medications have been shown to stop cataract formation.

In a cataract operation, the eye’s natural lens is removed. Vision can then be obtained by implanting a permanent intraocular lens (IOL), which replaces the natural lens. This artificial lens is made of plastic and is usually inserted at the same time the cataract is removed. Depending on the individual case, the lens is placed directly behind or, less frequently, in front of the iris, the “colored” part of the eye.

There have been remarkable advances in the treatment of cataracts, namely in the use of premium lenses (IOLs) that not only help make vision clearer but can also help improve near and far vision.  Often patients that select these lenses do not need to use their glasses anymore.

crystalens     logo_restor     2_3c_toriciol_logo

logo_tecnis     tecnis-symfony-logo

Our doctors will explain all of your exciting cataract lens implant options during your appointment, but if you would like to learn more in the meantime, please click here.

Please review these frequently asked questions


A cataract is a clouding of the normally clear, transparent lens of the eye. A cataract is not a tumor or growth of new tissue over or in the eye. It is a fogging and loss of clarity of the lens itself. The lens is located in the eye just behind the iris and the pupil. The function of the lens is to focus light entering the eye onto the retina. When a cataract forms, the lens is no longer able to focus the light clearly and your vision becomes cloudy. An early cataract may cause few problems with vision. If the cataract gets worse, sight may be partially or completely lost until the cataract is removed.

Although cataracts result from many conditions, the most frequent cause is the natural aging process. Other causes may include eye trauma, chronic eye disease, and other medical conditions such as diabetes.

Cataracts can take from a few months to several years to develop. Certain medications can accelerate the development of cataracts. Sometimes, the cataract stops developing in its early stages and vision is only slightly decreased. But if it continues to develop, vision is impaired, and surgical treatment is required.

The only way to determine if your vision problem results from a cataract is to visit an eye care professional for a complete examination. At Pepose Vision Institute, we use the same advanced, state-of-the-art diagnostics to evaluate your eyes as we use for our laser vision correction patients. Our wavefront diagnostic technology generates thousands of data points about your eyes in a matter of minutes. We are the only cataract surgeons in the Bi-State area to provide this level of thoroughness during your exam. We ensure that your treatment plan addresses the primary reason for your diminished vision.

Also important, Pepose Vision is highly experienced in the diagnosis and treatment of other eye conditions, such as glaucoma, and is able to provide the continuity of care you deserve, irrespective of the ultimate diagnosis.

The key to living with cataracts is knowing when it’s time not to live with them any more. Usually, this happens when your normal lifestyle reading the morning paper, driving to the grocery store or seeing the expression on the face of a child or grandchild is jeopardized by impaired vision. Please understand that cataract surgery is just that – surgery – and your surgeons at Pepose Vision believe that the right time to have such surgery is an individual, personal choice that depends on one’s individual lifestyle requirements. And that should be a fully informed decision, something we can help you make.

The only effective treatment for a cataract is surgery to remove the diseased lens. Neither diet nor medications has been shown to stop cataract formation. In a cataract operation, the eye’s natural lens is removed. Vision can then be obtained by implanting a permanent intraocular lens (IOL), which replaces the natural lens. This artificial lens is made of plastic and is usually inserted at the same time the cataract is removed. Depending on the individual case, the lens is placed directly behind or, less frequently, in front of the iris, the “colored” part of the eye.

Cataract surgery must be customized for each patient. Once it’s determined that your natural lens should be replaced, an extensive pre-operative evaluation is required to ensure that the optimal synthetic lens is implanted.

Like contact lenses and prescription eyewear, intraocular lenses differ in terms of refractive power. The length of your eye must be carefully measured and the curvature of the cornea evaluated. Calculation of the implant power is based on this information. Because your cornea plays a central role in determining the appropriate IOL, we strongly recommend that you consult a cornea subspecialist for your cataract surgery. At Pepose Vision, our cornea subspecialty trained surgeons have the skill and experience required to ensure the very best vision result possible. This is particularly important if you have had previous cornea surgery, such as laser vision correction. In such a situation, calculating the appropriate IOL requires special expertise in order to incorporate the corneal changes resulting from this earlier procedure.

Until recently, a monofocal intraocular lens, which cannot change shape, has been the standard implant for cataract surgery. Its power is usually calculated to maximize a patient’s distance vision so that the patient can see well enough to do most things without glasses. Reading glasses must still be worn to see up close up. In most cases, patients notice rapid and significant improvements in vision as a result of the IOL.

In 2005, the FDA approved the first major innovation in IOL technology in decades the multifocal IOL. This deluxe implant, which replaces the natural lens in the same fashion as the monofocal lens, gives good “walk around” distance and near vision, thereby lessening dependence on glasses. The FDA has a number of multifocal lens designs, each of which has been optimized for a slightly different vision zone. Pepose Vision Institute is the only cataract surgery practice in the region that has been certified to offer all three of these IOLs – Crystalens, Symfony and Restor. This gives us a unique opportunity to “mix and match” the IOLs used in each of your eyes and to personalize your vision outcome for your needs and lifestyle,

There are three materials presently used for intraocular lenses: polymethylmethacrylate (PMMA), silicone, and acrylic, with other materials currently under development. Each has advantages and disadvantages. PMMA must be implanted through a larger incision than the other materials. Silicone and acrylic can each be placed through a smaller incision than PMMA. Silicone lenses are usually avoided in diabetic patients and patients with severe retinal problems. Acrylic affords a very controlled unfolding of the lens. Today’s intraocular lenses are very safe and effective. We use the most advanced lens material available and we tailor the choice of lens material to the needs of each individual patient.

One of the newest advances in cataract surgery is the ability to remove the cataract and implant an intraocular lens through a small incision. New techniques for making incisions have, in most instances, eliminated the need for sutures following cataract surgery. For some individuals, other types of incisions, ones that require sutures, will provide a better visual result. We select the surgical procedure that is best suited for each patient’s situation.

Over 90% of people achieve a vision better than 20/30 after cataract surgery, as long as no other eye diseases are present (for example, a retinal condition). Reading glasses are required after cataract surgery (in many cases they were also required before surgery) when a monofocal IOL is used. Multifocal IOLs substantially reduce a patient’s dependence upon reading glasses for near vision tasks.

Originally, cataract surgery was performed under general anesthesia, requiring patients to stay in the hospital. Later advances used a local anesthesia injected behind the eyeball. Although this procedure allows patients to return home the same day and is safer than general anesthesia, it is not entirely free of risk.

Pepose Vision Institute has adopted the latest, safest approach to anesthesia, using topical anesthetics when medically permitted. The eye is anesthetized using eye drops rather than through an injection of anesthetic under the eyeball with a needle. Avoiding the needle reduces the risk of bleeding, bruising and inadvertent damage from the needle itself. Visual recovery begins immediately since the eye muscles are not paralyzed as with local block anesthesia. Even when topical anesthetics are used, patients may be given an IV sedative to help them relax and keep them comfortable during the procedure.

Standard cataract surgery, using a monofocal IOL, is typically covered by most medical insurance plans as a “functional” eye surgery. Medicare covers this procedure, subject to the usual deductibles and co-payment requirements.

Because cataract surgery is the most common procedure surgery covered by Medicare, and accounts for a large percentage of Medicare expenditures, the Federal government has decided that it will not cover the additional costs associated with premium multifocal lens implants. Not only do these lenses cost more (8 to 10 times the cost of a monofocal lens), but the pre-operative and post-operative care required is substantially more resource intensive. Medicare has, however, agreed to cover the cost of cataract extraction and monofocal lens implantation, leaving the patient responsible only for the incremental fees associated with the deluxe multifocal lens. These fees are tax-deductible as a necessary medical expense, and are eligible for reimbursement through a medical flex spending account, should you or your spouse participate in one.

Did you know Pepose Vision
is also an advanced research facility?

Why choose Pepose Vision for your cataract surgery?

At Pepose Vision Institute, we know that “one size does not fit all.” We’re one of the first in the nation to offer the latest diagnostic and surgical technologies to our cataract patients.

We’ve worked with some of the leading developers of eye technology to perfect both the technology and the procedure, and our state of the art diagnostic tests for cataract surgery are the most advanced available today. These tests, and our unparalleled experience in interpreting the results, ensure that your procedure is tailored exactly to your needs.Top-Doc

Though cataract surgery has become “routine” in terms of occurrence, it is still SURGERY. We recommend that the best way to ensure a successful outcome is to choose a highly experienced surgeon who is involved in developing state-of-the-art treatments to enhance your vision outcome.

Our state-of-the-art diagnostic tests

A Wavefront analyzer objectively measures tiny aberrations in the optics of the eye, in addition to accurately measuring the degree of near or far-sightedness and astigmatism. Tiny aberrations in the eye cause some patients to complain that the letters on an eye chart appear “ghostly”, that headlights at night have “tails” on them, and that streetlights have “halos” — factors that are not as readily correctable with contact lenses or glasses.

Wavefront analysis generates thousands of complex data points that must be accurately interpreted to have a beneficial impact on your vision correction surgery. This technology derives directly from the optics advances used to create and fix the Hubble space telescope.

Our wavefront analyzer accurately assesses your nearsightedness, farsightedness and astigmatism in a matter of seconds, simply by having you look into a target image in the machine (nothing touches the eye). This process eliminates the subjectivity introduced when a patient is asked, “Which image is better, number one or number two?” The accuracy of our wavefront analyzer is 25 times greater than this subjective approach, meaning that the calculations we use in determining the appropriate lens implant will inevitably be 25 times more accurate as well! Over the past four years, applying wavefront analysis to our cataract patients has led a vast majority to achieve uncorrected vision of 20/20 or better and has substantially improved the quality of their nighttime vision.

Our doctors have had the most experience in the region in applying wavefront analysis pre-operatively to enhance our surgical outcomes. We are one of only a handful of practices nationwide to perform this analysis on our cataract patients at no additional charge! Our clinical studies have contributed to advancements in wavefront analysis, including 3-dimensional versus 2-dimensional results.

Pepose Vision is one of just a few centers in the nation to evaluate all of its patients using both the Orbscan and Atlas corneal topography instruments. Topography is a way to measure the shape of the cornea. We evaluate your cornea at over 8,000 points and the various elevations are then represented color maps. Just as the height of land can be viewed from a helicopter circling above, the elevated peaks of the cornea can be printed in hot colors such as red and orange, and the valleys printed out in cool colors such as blue.

Using the Orbscan device, we measure both the front and back surfaces of the cornea. Its orbscanthickness at all locations can be plotted out and a 3 dimensional reconstruction of the shape of the eye can be created that can be rotated and viewed by our surgeons at all angles. The Orbscan instrument, coupled with the Atlas topographer, gives us a better understanding of pre-existing eye conditions. This information is crucial to calculating the very best lens implant for each patient’s eyes, resulting in crisper vision. This is particularly important for patients who have had LASIK or other forms of vision correction surgery.

The Atlas topography device provides specialized computerized screening to rule out a progressive condition of the cornea called keratoconus, which can also affect cataract outcomes and intraocular lens calculations.

As cornea subspecialists, Pepose Vision surgeons have the experience and know-how to appropriately use this pre-operative information to assure our cataract patients the very best outcome possible.

Each and every patient who has cataract surgery at Pepose Vision Institute benefits from the Holladay Professional Surgical Outcomes Program, which assures that your lens implant will be precisely calculated using advanced mathematical relationships. The accuracy of your lens calculation requires careful measurement of the length of your eye and ocular structures, the thickness of your lens and shape of your cornea. Only the most meticulous pre-operative information can assure you the very best outcome that cataract surgery has to offer.

Historically, eye doctors measured the eye’s length by applying a probe to compress the front of the eye. With A-Scan Biometry, we use a gentle water bath technique called Immersion A-Scan. With this newest technology, the ultrasound probe does not come into direct contact with the cornea. We use this diagnostic test to confirm your intraocular lens calculations as well as assess lens thickness. It is especially useful in cases where patients have very dense cataracts.

IOL lenstarThe FDA has approved new tools for measuring the dimension of the eye prior to cataract surgery, such as the IOL Master Lenstar. These laser systems offer the most precise measurement of eye length and surface curvature, greatly enhancing the accuracy of each patient’s intraocular lens calculation. This is done without ever touching the eye and within a minute or two. Simply put, this is the most accurate method now available to ensure that our cataract patients have the very best vision outcome possible.

Our advanced surgical procedures

Our surgeons have had a great deal of experience using the latest foldable lenses to replace the natural lens of your eye. These lenses permit the lens exchange to occur through a micro-incision, thereby eliminating the need for stitches. The result is less discomfort after surgery and a faster recovery period.

Whenever possible, our surgeons will use topical anesthesia to perform cataract surgery instead of using shots to deliver anesthesia. Initially, cataract surgery was performed under general anesthesia, requiring patients to stay in the hospital. Later advances led to the use of a local anesthesia injected behind the eyeball. Although this procedure allows patients to return home the same day and is safer than general anesthesia, it is not entirely free of risk.

At Pepose Vision Institute, we use the safest, most advanced anesthesia system available. When medically advisable, we anesthetize your eye using eye drops rather than through an injection of anesthetic under the eyeball with a needle. Avoiding the needle reduces the risk of bleeding, bruising and inadvertent damage from the needle itself. Moreover, visual recovery begins immediately since the eye muscles are not paralyzed as with local block anesthesia. Even when topical anesthetics are used, patients may be given an IV sedative to help them relax and keep them comfortable during the procedure.

Until recently, a monofocal intraocular lens, which cannot change shape, has been the standard implant for cataract surgery. Its power is usually calculated to maximize a patient’s distance vision so that the patient can see well enough to do most things without glasses. Reading glasses must still be worn to see up close up. In most cases, patients notice rapid and significant improvements in vision as a result of the IOL.

In 2005, the FDA approved the first major innovation in IOL technology in decades themultifocal-lens-implant deluxe multifocal “accommodating” IOL. This implant, which replaces the natural lens in the same fashion as the monofocal lens, gives good “walk around” distance and near vision, thereby lessening dependence on glasses. The FDA has approved a number of multifocal lens, each of which has been optimized for a slightly different vision zone. Pepose Vision Institute is the only cataract surgery practice that has been certified to offer all four of these lenses Crystalens, Restor, Symfony and Technis multifocal lens and was among the first in the nation to offer these IOLs. This gives our surgeons a unique opportunity to “mix and match” the lenses used in each of your eyes and to personalize your vision outcome for your unique lifestyle

What is the cataract surgery process?

1) Schedule Your Cataract Screening at Pepose Vision
Call us at 636-728-0111 or contact us online to schedule your private 30 minute cataract screening with one of our doctors. We’ll check your eyes to confirm that your vision problems can be addressed through cataract surgery. You will also have time to ask questions and be given additional educational materials for your review. At the end of the consultation, we will schedule your pre-operative examination with one of our surgeons.

2. Come in for your pre-operative exam
We will check and re-check your eyes using multiple, state-of-the-art diagnostic instruments, because the precision of the pre-operative measurements dictates the quality of your vision outcome. During this visit, your surgeon will answer any questions you still may have, and will discuss the cataract treatment that is most appropriate for your eyes and medical condition.

3. Schedule Your Procedure
Our surgery schedulers will obtain pre-certification from your insurer, if required, and will review all pre-operative instructions with you. They will also schedule all of your post-operative visits at this time. Each of your eyes will be treated on a separate day, approximately two weeks apart.

4. Come In for Your Brief, Pain-free Procedure!
Take one last look at the world through your clouded natural lens a blurry world devoid of vivid colors! Your procedure will be totally painless, thanks to topical and/or IV anesthesia. Within an hour of your surgery, you are ready to go home and treat yourself to a nap, via doctor’s orders!



Patient testimonials

What's your next step?

If you think you might have cataracts, or any vision issues, please come see us.
Our experienced doctors will use advanced diagnostics to determine exactly how to help you see your very best, patiently answer your questions and carefully explain all your options.

Contact us