If you think of your eye like a camera, the lens of the eye is similar to the lens of a camera. The lens helps to focus the light that hits the retina, or film of the camera. The lens is about the size and shape of a peanut M&M.  In this M&M model, the colored candy coating is the capsule that stays in place to hold the new intraocular lens (IOL) and the chocolate is the part that is removed.

M&Ms representing the structure of a cataract

The lens of the eye grows slowly over time like fingernails grow. However, the lens is in a confined space and therefore becomes denser as it grows (like the nut in our M&M). As it becomes more dense light does not pass through it as well and vision becomes blurred, dim, and cloudy like milk poured into a glass of water.

This cloudiness blocks light and is called a cataract. Just like grey hair, heredity can influence how fast and in what pattern cataracts develop, but we all develop cataracts over time. Since aging is the main cause of cataracts, everyone develops cataracts over time much like grey hair. How many 90-year-olds do you know that don’t have grey hair? We will all get cataracts and just like grey hair the pattern and speed of cataracts that we each develop can run in our family. 

By age 40 nearly everyone has at least the trace beginnings of lens clouding. However, cataracts don’t normally start to affect vision until our 50’s or sometimes even later. Certain conditions such as diabetes, trauma, and previous ocular surgery can speed the progression of cataracts.

There can be other reasons for cataracts to develop. Some are present at birth, some are caused by trauma or eye surgery, and some are caused by medications. There is no definitive, proven action that can be taken to prevent or reduce the progression of cataracts except to stop having birthdays…and that’s no fun. Cataract surgery is the treatment for cataracts.


Zepto cataract surgery is the latest in gentle techniques for creating a lens capsulotomy during cataract surgery. A capsulotomy is the round hole made on the front of the cataract to remove it.  It’s the hole in the candy coating of our M&M.  This is often the most critical and challenging step of cataract surgery.

Zepto is highly precise, creating a round, stencil-like opening.  Zepto is centered on your line of sight rather than an opening made freehand.  This centering helps to produce the best visual outcomes. Zepto technology creates a stronger opening as compared to those made by hand or by femtosecond laser cataract surgery methods.  Thus helping to reduce complications. An added benefit for patients is that Zepto cataract surgery costs much less than the femtosecond laser cataract surgery.


Benefits of Zepto Cataract Surgery:

  • Zepto is faster than laser.
  • Zepto makes the opening stronger than laser.
  • Zepto centers the opening on the center of the patient’s vision better than laser.
  • Zepto can be used when the cornea is not clear while the laser cannot.
  • Zepto costs less than laser.

Zepto is a fantastic option for patients receiving either standard or premium, toric intraocular lenses. It can be used in standard cataract surgery as well as in complex cataract surgery cases. The availability of Zepto allows Dr. Vital to provide more options to customize each cataract surgery for the best possible results. Dr. Vital will explain Zepto during a one-on-one consultation.


Dr. Vital’s secretary will tell you where your surgery will be and what time to arrive. You will schedule the date of your surgery with her. If you have a problem and need to cancel or reschedule your surgery, it is very important to notify her and the surgery center as soon as possible.

You will be given a packet of information about drops and preparations for your surgery. You will be instructed not to eat or drink anything after midnight prior to your surgery. When you arrive at the surgery center, your eye will be numbed by either eye drops or an injection. For your comfort, you will be put to sleep for approximately 5 minutes if the injection is performed.

You will then be brought into the operating room. You will be awake but drowsy. The exception to this is general anesthesia, in which you are put to sleep for the duration of the surgery. Most of the time, cataract surgery is performed under local anesthesia, not general anesthesia.

Most times the cataract surgery itself lasts approximately 15 minutes or less. Plan for the entire outpatient surgery process to last all day, and do not make plans for other activities on the same day as surgery. At the end of the surgery, you will be brought to the recovery room with an eye patch in place and will be given postoperative instructions. You will need someone to drive you home after surgery.


When we remove cataracts, we make a hole in the front of the capsular bag (candy coating of the M&M), the nucleus (nut) and cortex (chocolate) are removed, and the capsular bag is left in place. The new, clear, artificial lens is inserted into the capsular bag which holds it in place.

Intraocular lenses (IOLs) are artificial lenses that are placed inside the eye to take the place of the natural human lens. Usually, this is performed immediately following the removal of a cataract as part of cataract surgery. These lenses are most commonly made of acrylic and are not able to be felt in the eye.  

Be aware that intraocular lenses are very different from contact lenses because IOLs are inserted into the eye and are considered permanent. They can be removed or exchanged, but this is performed rarely and only in extreme circumstances. Intraocular lenses are similar to cars in that there are many makes and models. Personal preference, performance, and cost factor into the best-individualized choice.

IOL implantation
Intraocular lens implant resting on a finger

Monofocal Lenses

Most IOLs are monofocal, meaning they provide the best focus at one distance. The focal distance of the lens is determined by the doctor and the patient and is usually set for near (reading), intermediate (computer), or distance (driving) vision.  A majority of patients choose to have both eyes focused for distance and use reading glasses for near vision. Some patients choose monovision in which the dominant eye is targeted for near or intermediate, and the non-dominant eye is targeted for distance. This helps to minimize the need for reading glasses after cataract surgery.

Multifocal Lenses

Some IOLs are multifocal or extended depth of focus, meaning they provide focus at more than one distance. These IOLs use special optics to allow for both distance and near vision, or distance and intermediate vision for each eye. The con of these types of lenses is that the vision is usually not as sharp for the distance or near as it would be with a monofocal IOL.

Additionally, they have extra associated costs and some patients do not like the perceived “soft focus” of their vision with these IOLs.

Toric Lenses 

Some IOLs are toric, meaning they provide some correction for regular astigmatism. These IOLs can be useful to help reduce or eliminate the need for astigmatism correction in glasses or contacts. They are only able to correct certain types and certain degrees of astigmatism and therefore are not appropriate for all patients. Again, these types of lenses have extra associated costs. I usually only recommend toric IOLs for patients with moderate to high levels of regular astigmatism.

Light Adjustable Lens

Often, the natural assumption when patients hear they need cataract surgery is to anticipate that they will no longer need glasses. Modern cataract surgery is very precise and very successful. However, even with top-of-the-line diagnostic equipment and cataract surgery techniques, achieving patient determined perfect vision in every case is still difficult to achieve.

Most cataract surgery today is like being precisely measured for a suit or dress and then purchasing it online. Once it arrives, you’re likely to get a good fit but you can’t be sure until you try it on.

With the Light Adjustable Lens from RxSight, now your cataract surgery can be refined like a custom-tailored garment. Precise measurements are still taken prior to surgery. But now after surgery, the Light Adjustable Lens can be painlessly modified in the office to the visual refinement that you prefer without more surgery.

This advancement allows for surgical correction of astigmatism and adjustable monovision customized to your liking in the weeks following surgery. Light Adjustable Lenses achieve precise sharp vision without the significant issues of glare and halos associated with other types of premium and multifocal cataract surgery lens choices.

The Light Adjustable Lens is available here in Houston through Dr. Vital! Watch the video below to learn more about this new lens technology:


The primary goal of cataract surgery is not to eliminate the need for glasses or contacts. The aim is to clear the opacities in the visual axis so that light can be focused on the retina to improve functional vision. It is important to keep in mind that after any type of cataract surgery with any type of intraocular lens, glasses or contacts may be necessary in order to get the best possible vision.

Read Dr. Vital’s Blog: What are cataracts and what do they look like?

If your vision is getting blurry and it cannot satisfactorily be improved with glasses or contacts, you may have a cataract that is ready to be removed. Book your cataract surgery consultation with Dr. Mark Vital in Houston today.