Understanding Cataracts
Are you or someone you know suffering from cataracts? You’re not alone. Cataracts are an inevitable part of the aging process. Over time, everyone will experience some sort of vision impairment due to cataracts. The bad news is that the only permanent correction to cataracts is cataract surgery. The good news is that cataract surgery is one of the safest and most effective procedures performed in the United States.
The truth is, everyone gets cataracts
As we age, the lens inside the eye gets cloudy…and eventually it becomes difficult to see through. People decide to have cataract surgery when the cloudiness gets bad enough where their vision cannot be improved with glasses or contacts.
For most people, cataract surgery is an elective procedure; some people
want to do it right away, others wait until they cannot see anything.
What is a cataract?
When the lens of your eye gets cloudy, it’s called a cataract. Most cataracts are related to aging and by the age of 60, more than half of all Americans have cataracts or have had cataract surgery. Generally both eyes develop cataracts at the same rate.
How do you know if you have a cataract?
Some of the symptoms include:
- Cloudy or blurred vision
- Nighttime glare from headlights
- Sensitivity to light
- Difficulty reading fine print
- Faded colors
What is the lens and why is it so important?
The lens is the part of the eye that helps focus light on the retina. In a normal eye, light passes through the lens and is focused on the retina. To help produce a clear image, the lens must remain clear.
Light passes through the clear transparent lens in a normal eye, and after it reaches the retina it is sent to the brain by nerve signals. If the lens isn’t clear, the retina will not send a sharp image to the brain, and this is exactly what happens with a cataract. Because the lens is cloudy, the image will be fuzzy.
How Do Cataracts Form?
Cataracts that are related to an increase in age form in a couple of ways:
1. Clumps of protein reduce the sharpness of the image
The lens is made mostly of water and protein. As you age, the protein can clump together and start to cloud small areas of the lens, which blocks light from reaching the retina and interferes with vision. This clumping of protein causes a majority of age-related cataracts.
In its early stages, a cataract may not cause a problem. However, over time the cataract may grow larger, making it harder to see. Because less light reaches the retina, your vision may become dull and blurry. More than half of the American population ages 60 and older have cataracts.
2. The lens changes to a yellowish- brown color, giving everything a brown tint
As your lens begins to turn color, your vision will slowly have a brown tint to it. At the beginning the discoloration may be slight and not very noticeable…but with time, an increase in brownish tint will make it more and more difficult to read or do other normal activities. If you are at an advanced stage, you may have trouble identifying purples and blues. Once you have the cataract removed from one eye, it becomes very apparent how altered your color perception has been.
Who is at risk for a cataract?
As we discussed earlier, the risks increase for everyone as they age. But other factors can put you at a higher risk. They include:
- Diabetes or other diseases
- Lifestyle—poor diet, smoking and alcohol
- Chronic use of steroids
- High nearsightedness
- History of vitrectomy eye surgery
- Inflammatory eye conditions
Common Symptoms of Cataracts
Some of the most common symptoms caused by cataracts are:
- Blurry, cloudy or hazy vision
- A halo affect with lamps, sunlight or headlines
- Faded colors
- Frequent changes in your eye prescription
- Bad night vision
- Double-vision
Keep in mind these symptoms could also mean there is a different or more serious problem, so don’t wait to get checked if you have any of these issues.
How are Cataracts diagnosed and detected?
Cataracts are diagnosed and detected during a complete medical eye exam. This exam can include …
- Dilated eye exam: Eye drops are administered which enlarge (dilate) the pupils, and your doctor uses a special magnifying lens to examine your retina and optic nerves. After the exam, your close-up vision will be blurry, but only for a few hours
- Tonometry: A special instrument that measure the pressure inside your eye.
- Visual test: The eye chart test measures how well you see at distances
Your eye doctor may perform other tests depending on your symptoms and your age.
How are Cataracts treated?
Treatment will depend on what stage your cataracts are at. At early stages cataracts can sometimes be improved with eyeglasses. If eyeglasses don’t help, then surgery is the only option. Because this is an elective procedure, it is up to each patient to decide when they feel the need to see better to do their daily activities. So some patients choose to do the surgery right away and some wait until they cannot see anything!
This is not your parents’ Cataract Surgery!
Like many things, the technology advances in Cataract Surgery have dramatically improved patient results. The horror stories you may have heard your parents or their parents talk about are just not a problem any longer, matter of fact …
Cataract Surgery is one of the most commonly performed surgeries in the United States
More than 2 million people have cataract surgery each year, making it one of the most commonly performed surgeries in the United States. It is an outpatient procedure, which typically takes about 10-15 minutes to complete.
At ProEye Care, cataract removal is performed through a procedure called phacoemulsification. In this procedure, high-energy ultrasound waves are used to gently remove your cataract. In most cases, we use only eye drop anesthesia, allowing our patients the fastest possible recovery. Once the cataract is removed a permanent, artificial lens is inserted. It is not uncommon for our patients to have the benefit of dramatically improved vision within a few hours of their procedure
The Procedure
Cataract surgery is considered an outpatient procedure. It takes about 20-30 minutes, and patients go home the same day (with a driver). This procedure has very little, if any discomfort. During the surgery, the patient cannot see what the surgeon is doing, and they basically just see colors and shadows.
Numbing eye drops are used for most patients; no shots or injections are necessary. A small incision is created, which works like a trap door. The pressure inside the eye keeps the door shut. The small incision size allows the eye to recover much faster. Most patients require no stitches.
Some patients are given medication to reduce anxiety, although it is not required for most people. Cataract surgery is very successful as long as no other eye disease is present (such as macular degeneration).
95-98% of patients get significant improvement in vision.
Step 1– The first step is to make a small hole in the front of the capsule that holds the natural lens or cataract.
Step 2 – The next step is to insert the small ultrasonic probe into the eye. The probe breaks up the lens into tiny pieces and removes them.
Step 3 – A permanent, artificial lens is then folded and inserted into the eye.
Step 4 – The new lens then unfolds and is positioned permanently into place.
After surgery with traditional monofocal lenses, most people experience very good vision either near or at a distance. In most cases, the monofocal lens provides good distance vision for driving, walking and some everyday activities. However, most people receiving monofocal lenses still require reading glasses or bifocals to have a full range of vision.
What are the risks of cataract surgery?
Like any surgery, there are small risks each patient needs to take to get the vision improvement. You may be asked to stop certain medications before the surgery such as prostate medications or blood thinners. The doctor will prescribe eye drop medications to lower the risk of infection or inflammation. It is important to talk to Dr. Launer before the surgery and he will discuss your medications and the risks of surgery with you
What problems can develop after surgery?
Problems after cataract surgery are very rare, but they do occur. Infection, bleeding, redness, swelling, pain and loss of vision do happen, but very rarely. The most common occurrence is what is called an “after-cataract. This usually happens months or even years after the surgery and can be totally fixed with an out-patient procedure called a YAG Posterior Capsulotomy.
When will my vision be back to normal?
You can return to your normal activities the day after surgery with some exceptions. Most patients will see better the next day and this will continue to improve each day. To get your best vision may require changing your glasses which is usually done about three weeks after the surgery.
Major advancements in cataract surgery and lens replacement eliminates the need for glasses
What’s even more exciting are all of the advancements that have been made in the field of cataract surgery and clear lens replacement. Traditionally, these procedures remove the natural lens of the eye and replace it with a single focus, or monofocal, Intra-Ocular Lens (IOL). This is a clear lens that is put in place of the degenerated natural lens. While the results are wonderful, these lenses only correct the cataract condition. Often they do not fully fix visual errors such as nearsightedness, farsightedness or astigmatism that were present prior to surgery. The patient will still have to wear contacts or glasses to see clearly.
Thanks to recent developments in lens and surgical technology, there are now a number of different options available to patients that could have them seeing clearly at all distances, without the need for glasses or contacts.
Choosing the right lens implant
There are many different types of lens implants available today. They include…
- Traditional lens, which are a single-focal lens that allows you to see distances very clearly, but require reading glasses.
- Premium Lifestyle lenses–Implants that address multiple vision issues
- Single Focus Lens Implants
- Multi-Focus Lens Implants (TECNIS)
- Lens Correction for Astigmatism (TORIC)
- Accommodating Lens Implants (Crystalens)
Choosing the appropriate lens can oftentimes be confusing for patients, but if you simply understand that by removing the cataract you have much better vision…by choosing a specific lens implant, you can reduce the dependence on glasses, eliminate your astigmatism, or choose a premium lens that addresses all of your vision issues.
1. Traditional Lens–Single focal lens implants
for distance vision
Single focus lens implants, or Monofocal IOLs, are the traditional type of lenses used when performing cataract surgery. These lenses are designed to replace the cloudy natural lens of the eye, and provide clear distance vision. This means you will be able to see objects that are far away clearly. However, you will need glasses for reading and any type of close, detailed work following surgery.
Virtually every cataract patient who receives a single focus lens reports a dramatic improvement to the clarity of his or her vision. The only downside to these lenses is that since they do not correct for most refractive conditions, patients will still have to wear glasses or contacts for reading or to correct for any pre-existing astigmatism. Single focus lens implants are considered the ‘standard,’ and when used for cataract surgery, the cost is most often covered by insurance.
2. Premium Lifestyle Lenses
Multi-Focal Lens—correction for any distance
Recent advances in lens technology now provide many exciting options for cataract patients looking for vision correction at all distances. One of these new advancements is the development of multi-focus (or multifocal) IOLs. These Premium Lifestyle Lenses are designed to function similar to multifocal glasses, such as bifocals. The lenses are designed with three specific “zones” for distance vision, intermediate vision, and reading vision, thereby providing clear object viewing at all distances, and potentially eliminating the need for glasses
The newest multi-focal technology available at ProEyeCare is the TECNIS Multi-focal IOL. This premium lens is unique because its aspheric design not only provides vision correction at all distances, but in most light conditions as well. So if you have problems such as reading in low light then this may be the best lens option for you.
Multi-focal IOLs have consistently shown to provide satisfactory vision at all distances, including up close for reading. Their all-encompassing ability makes them an extremely popular option for patients looking to reduce or even eliminate their need for glasses or contacts.
Click here for more details about the Tecnis lens.
Lens Correction for Astigmatism
As mentioned earlier, traditional cataract surgery does not correct astigmatism. People who receive the standard monofocal lenses either have to have additional surgery, such as LASIK, or wear specialized glasses or contacts to see clearly.
Now there is a Lifestyle Lens, called a Toric IOL, which is specifically designed to provide you with not only clear distance vision, but also eliminates any pre-existing astigmatism present. Toric IOL’s are engineered to counterbalance the irregular curvature of the cornea that causes astigmatism. The lens collects and refocuses the light rays so your vision appears sharper and less distorted. These lenses have a very high success rate at eliminating any need for glasses or contacts to correct astigmatism.
While these lenses do correct astigmatism and will provide the patient with clear vision at a distance, it should be noted that this lens does not correct presbyopia, and most people who choose this lens would still need to wear glasses to see objects up close and for actions such as reading.
Accommodating Lens Implants – Flexing for all distances
The major disadvantage of single focus IOLs is that they are rigid lenses designed solely for clear distance viewing. They do not ‘accommodate,’ or change their focus, for viewing things up close.
Accommodating Lens Implants, such as the Crystalens, are special single-focus lenses designed to ‘flex’ like the natural youthful lens of the eye. They contain hinges that bend in response trying to focus on an object up close. So for example, when we attempt to read our computer screens, the lens position is shifted naturally within the eye, allowing clear focus on the objects or text within the screen. This action mimics the behavior of the natural lens prior to the onset of presbyopia. Clinical experience has shown these lenses work best for distance and computer use, but patients require glasses for line reading.
