CATARACT:
- What is a Cataract?
- Who is at risk for Cataracts?
- How do I know if I have Cataracts?
- How do Cataracts develop?
- What is Cataract Surgery?
- The Procedure
- Phaco
- Extra capsular
- Intra ocular Lens Implants (IOL)
- When is the right time to have Cataract Surgery?
- What type of Anesthesia would be used during Cataract Surgery?
- What happens after Cataract Surgery?
A cataract occurs when the lens in your eye becomes cloudy. Normally, light passes through the cornea (clear outer surface of your eye), through your pupil and to the lens. The lens helps you see clearly by focusing the light onto the retina. Cataracts obstruct the passage of light and thereby impair your vision. The most common symptom of a cataract is blurring of near and/or distance vision. Some patients will experience glare, halos, discoloration, or a loss of depth perception. When you have to change your lifestyle due to the effects of cataracts, it may be time to do something about them. Today, cataract surgery is one of the most common and most successful procedures performed due to advanced surgical techniques and technology.
The largest risk factor for cataract development is age. About half of all Americans ages 65 to 75 have cataracts to some degree. Other factors may increase your risk for cataract development:
- Diabetes
- A strong family history of cataracts
- Previous eye injury
- Certain medications (criticaster)
- Excessive sunlight exposure
- Smoking
How do I know if I have Cataracts?
Either your ophthalmologist or optometrist can make the diagnosis of a cataract by using a special microscope to look into the eye. There are many different types of cataracts and your cataract is really unique to your eye. Although cataracts have different stages of “maturity”, it is no longer necessary to wait for surgery until a cataract becomes “ripe” as in days past.
Cataracts usually develop slowly and pain free leaving many people unaware of their gradual loss of clear vision. A cataract can develop in one or both eyes. Symptoms include:
- Blurred or dimmed vision
- Poor night vision
- Sensitivity to light and glare
- Reduced distance vision
- Brighter light needed to read
- Frequent eyeglass prescription changes
If you are experiencing any of these symptoms, it is time for a careful eye examination and consultation with an experienced eye surgeon to determine if cataract surgery is the answer for you.
The Procedure
Cataract surgery is typically done on an outpatient basis in less than an hour. Generally, local anesthesia is used. The cataract is removed through microsurgery. Your eye's natural lens capsule is left in place to help support the artificial replacement lens that is inserted during the procedure. Depending on the type of cataract, one of two surgical methods will be used to remove it:
After the cataract is removed, a man-made Intraocular Lens (IOL) made of collamer, silicone or acrylic is inserted. This lens is smaller than a dime and has corrective power to meet your eye's specific prescription needs.
Intraocular Lens Implants (IOL)
Lens implants, either hard (plastic) or soft (silicone or hydrogel), are used for the vast majority of patients undergoing cataract surgery in the United States since they provide better vision than thick cataract glasses and avoid the need for contact lenses after surgery. The Intraocular lens cannot be felt nor can it be rejected by the body. When the implant is in place, it is virtually invisible to your friends and family.
A variety of IOL implants are available today. All insurances cover placement of a monofocal lens implant, which corrects distance vision needs in cases without astigmatism. These lenses do not correct reading vision or astigmatism and thus glasses or contacts are needed to correct these vision conditions. Toric lens implants, much like toric contact lenses, correct distance vision as well as astigmatism. Like monofocal lenses, the toric lens does not improve reading vision and glasses need to be worn for near vision after these implants are placed. Multifocal / accommodative lens implants such as the ReZoom, ReStor, CrystaLens, and Technis multifocal lens correct distance vision as well as provide improvement in reading vision. These lenses increase independence from not only distance glasses, but also reading glasses. These lenses can be placed after cataract surgery or in cases of pure vision correction in a procedure known as refractive lens exchange or presbyopic lens exchange (PRELEX). Multifocal, accommodative lenses, toric lenses and PRELEX are not covered by insurance companies.
After the IOL is in place, the microscopic incision is then closed with or without a stitch. The small incision heals very quickly and painlessly. If a stitch is used, you will not feel it because it is only a fraction of the size of an eyelash and will melt away. Since every eye is different, your surgeon will decide at the time of your surgery whether your eye is better off with or without a suture.
When is the right time to have Cataract Surgery?
The right time for cataract removal depends upon the degree of visual impairment. Cataract Surgery is elective, and the decision to undergo surgery is entirely up to you. If the cataract is interfering with your lifestyle, surgery is indicated. We may also be able to modify the operation so that other conditions occasionally present, such as astigmatism or glaucoma, may be improved.
Advanced age or compromised health are rarely obstacles to cataract surgery since most people enjoy and appreciate better vision regardless of age
To our patients scheduled for surgery
If surgery is indicated and you would like to have your cataract removed, an operating date will be given to you. Prior to the surgical date, you will undergo several tests, which help us select the Intraocular Lens. Since these artificial lenses come in different strengths just as glasses do, we depend on ultrasonic measurements of the length of the eye to select a lens individualized for you. Although these tests are quite accurate, some patients may still need a slight correction with eyeglasses for best vision after surgery. You will need a medical history and physical exam from your private doctor. We will review the surgical consents and preoperative medications with you. This preparation is quite easy, yet very important.
What about Laser Surgery?
Although lasers have many uses in ophthalmology, at this point in time, they are not yet approved to remove cataracts. If, in the future, a laser is developed which can remove cataracts more safely than phacoemulsification, we most certainly will use such a technique.
In 10 to 30% of patients, the clear capsule membrane that remains after cataract surgery may become clouded. This may cause symptoms similar to those caused by the original cataract. If this happens, the Yag Laser can be used to make a clear opening. This procedure is performed in our office without returning to the operating room. It only takes a few minutes and is completely painless.
What type of Anesthesia would be used during Cataract Surgery?
Topical Anesthesia
Today, with recent advances in cataract surgery anesthesia, topical or local peribulbar anesthetics are used. These anesthetics allow the eye to be anesthetized without any pain. A patient is given an IV sedative to help them relax and to keep them comfortable during the procedure.
Advantages of Topical Anesthesia
- Faster, more comfortable for the patient.
- Visual recovery begins immediately. The eye muscles aren't paralyzed as with local block anesthesia.
- Eliminates potential complications (i.e. perforation of the eye, hemorrhage or damage to the optic nerve).
- Eliminates need for an eye patch.
What happens after Cataract Surgery?
Post Operative
After cataract surgery, you must usually wear a patch for the next 24 hours unless topical anesthesia is used. The patch is typically removed the next day at the postoperative visit. Several more follow up visits will be made over the next four to six weeks. Recovery time is generally minimal. Your eye may be mildly inflamed and feel a little scratchy and irritated for a couple of days after the procedure.
Although cataract surgery is generally successful, complications may occur including bleeding, swelling, inflammation, infection or retinal detachment. Contact your doctor immediately if any of the following symptoms should occur following surgery:
- Loss of Vision
- Marked increase in eye redness
- Light flashes
- Multiple new spots before your eye
- Nausea, vomiting, or excessive coughing
- Pain that can't be relieved by over-the-counter pain medication
Remember, not all patients after cataract surgery have guaranteed 20/20 vision, but for many people, successful cataract surgery means excellent vision, vivid colors, and an ability to again enjoy activities formerly limited by poor vision.
