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What is a Cataract?

A cataract is a clouding of the eye’s natural lens. This lens is responsible for focusing light and producing clear sharp images. Often times, if a cataract has developed you may see double or blurred images. Much like looking through a camera if the camera’s lens is out of focus. The lens is contained in a sealed capsular bag. As the old cells die, they become trapped inside this capsular bag. Over time, the cells accumulate causing the lens to become cloudy, which is what makes images look blurred or fuzzy. Cataracts are usually related to the aging process of the eye. However, radiation, diabetes, systemic diseases, injury to the eye, or certain medications, may also cause cataracts to develop.

Symptoms of a cataract:

The amount of cloudiness within the lens may vary, but common symptoms include:

  • Blurred vision
  • Glare and reduced vision in light
  • Halo around light
  • Double vision in one eye
  • Frequent eyeglass prescription changes
  • Need for brighter light when reading
  • Poor night vision
  • Fading of colors, particularly the inability to see blues and purples

How are cataracts treated?

There have been many significant advancements in cataract surgery. At this time, there are no drops or medication to treat, reduce, or eliminate a cataract.

Cataract surgery is usually performed under local or topical anesthesia. During surgery, the cloudy natural lens, or cataract, is removed and a permanent intraocular lens (IOL) is implanted. In most cases, this brief outpatient procedure restores natural vision. After this new lens is implanted many patients also enjoy less dependency on glasses for the majority of their activities, but may occasionally need glasses for reading. Cataract removal can be accomplished in several ways:

Extracapsular Extraction:

Extracapsular cataract extraction is one of the oldest surgical methods in which the eye’s natural lens is removed through a large 10-12 millimeter incision. The cataract nucleus is manually removed in one piece. Numerous stitches may be required to close the incision.

  • May take up to three months to achieve return to best vision
  • More restrictions on post-surgical activities
  • Higher risk complications

Phacoemulsification:

Phacoemulsification is a technique in which a small ultrasonic probe is used to break the cataract into very tiny pieces and remove it through a small incision. Widely used, this technique provides efficient removal of the cloudy lens, or cataract. A smaller incision, usually no more than 4 to 6 millimeters is used. Minimal sutures or a single “one stitch” suture method is used to close the wound following the surgical insertion of the implant. Phacoemulsification is the most advanced technique for the removal of cataracts.

  • Can require 2-7 weeks recovery time
  • Some restrictions on post-surgical activities

Small Incision/No-Stitch

A recent technique, no-stitch cataract surgery, involves removing the cataract through a small, tunnel-like incision with a tiny ultrasonic probe, again using the phacoemulsification procedure. The natural outward pressure within the eye allows the micro-tunnel incision to self seal. Patients may experience a more comfortable recuperation without stitches. This technique significantly reduces the chance of developing astigmatism (distorted vision) because there are no sutures that can alter the shape of the cornea. Though recovery may take up to three weeks, many patients report improved vision even within the first few hours after surgery.

Frequently Asked Questions

Must I have my cataract removed?

Only if delay in its removal could cause permanent irreparable damage to the eye. If the cataract is causing glaucoma or is preventing necessary treatment of the back of the eye, then the cataract should be removed immediately to prevent further injury. If removing a cataract only for improvement in vision, then surgery is elective. However, patients who do not delay surgery will receive the best visual results. Such a delay means that the cataract, by its nature, will become more dense and, thus, more difficult to remove. In addition, patients who delay surgery tend to have higher complication rates than those who have regular check-ups and opt for surgery when visual difficulties are no longer improved by a change in glasses. The surgeon and patient must together discuss the goals of surgery. The goal should not be simply to improve vision, but to significantly improve your vision and your lifestyle.

How is a cataract diagnosed?

Your eye surgeon can detect a cataract by examining the interior of the eye with a microscope. Most cataracts associated with the aging process develop gradually over a period of years. The rate at which a cataract progresses varies with each person. Surgical removal of a cataract is recommended when vision problems, due to cataract formation, sufficiently interfere with a person’s daily activities.

Will my medical problems prevent me from undergoing cataract surgery safely?

Pre-operatively your ophthalmologist may ask a family physician to evaluate you and ensure that your blood pressure, blood sugar, and general medical problems are under control. As the procedure is likely to be performed with anesthetic drops alone (no injections), there is minimal risk associated with the procedure. Because the same types of topical medicines are used during the pre-operative exam, if you tolerate the examination well then you will tolerate the surgery well.

What about my age?

Any patient who can undergo a thorough eye examination can undergo surgery if the procedure is performed with a topical anesthetic-drops alone method.

Should I bring someone with me on the day of surgery?

Because you will not be able to drive, you should ask a family member or friend to accompany you for the procedure, which usually takes no more than 15 minutes. Time for the pre-operative preparation varies, but in most practices takes approximately 90 minutes. You will also be observed for a short while following surgery to ensure safety and to review any post-operative instructions with you.

What if my family doctor tells me I can't be put to sleep for the surgery?

Patients are typically not put to sleep during cataract surgery. With topical anesthesia, most practices will administer only minimal relaxing medicine and you will continue to be conscious during the surgery. This means that you will recover more quickly post-operatively while remaining comfortable throughout the entire procedure.

What if I am using blood thinners like Coumadin?

Unlike other surgery, cataract surgery is virtually a bloodless procedure, even more so when using topical anesthesia. Therefore, you may safely undergo this surgery while remaining on blood thinners. In fact, in most cases, patients are asked to take all their medications up to, and including, the day of surgery. However, this should be discussed with your surgeon.

Do I have to avoid all activities post-operatively?

No. Typically your doctor’s staff will demonstrate how you may bend over immediately after surgery, pick up 20-30 pounds, and shower, provided you don’t get water into your operative eye. You will be asked to wear an eye shield at bedtime for the first few weeks after surgery so you do not inadvertently rub the eye during sleep.

Will I need to see my doctor after surgery for any follow-up visits?

Follow-up evaluations vary, but are always scheduled within 1 day, and usually scheduled for 1 week, 3 weeks, and 6 weeks, with glasses being prescribed between the 3rd and 6th week visit.