CATARACT

Introduction

Cataract are the leading cause of
blindness in the world. The frequency
increases with age, as 90 percent of
those over the age of 70 have some
degree of a cataract. The cataract is
actually a clouding of the natural
human lens. This clouding is a result
of a breakdown in protein molecules.
This usually occurs as one ages, but
has a higher association with diabetes,
trauma, radiation and the use of
steroids. This lens is analogous to a lens of a camera. When a camera lens is cloudy, this light that hits the film is fuzzy, so replacing it with a clear lens will allow a better picture.

Symptoms

Since cataracts are a clouding of the natural lens, the only symptom is visual. They are not associated with pain, redness, or burning. At first the symptoms are minor, but then progress to a dull blur or yellowing of vision. One may report a "film" over the eye or feeling they need more light to see. Patients will often report trouble with glare such as when they see oncoming headlights at night or in bright sunlight. Some will even report a doubling of vision in one eye. The symptoms do vary from person to person.

When to have Surgery

The decision is elective and best made when weighing your personal needs as well as advise from your doctor. Your doctor can educate you about the risks versus the benefits of the surgery for you which can help you in your decision. Most of the times the motivation is to improve vision and quality of life. For some with higher visual requirements such as an accountant or golfer, a slight reduction in vision is unacceptable, therefore the decision may come early. Others may delay until the cataract significantly interferes with their lifestyle. Sometimes the doctor's view to the back of the eye can be obstructed by a dense cataract which can also be an important factor in considering surgery (especially in diabetics and others who need close monitoring or treatment of the back of the eye)

Surgery

The treatment is surgical removal with replacement with an intraocular lens. Over one million people in the U.S. undergo this elective, sight restoring procedure yearly. This procedure is done in our AAAHC certified surgery center where the atmosphere is sterile to lower the chances of infection. Recent advances in cataract surgery include:

1) Local anesthesia (no need for a needle to numb the eye
2) Small incision (no need for sutures) and
3) Faster recovery (no patch and other previous restrictions)

The procedure itself takes 5-8 minutes on the average. However, you would be in our center for roughly two or three hours since pre and post-op teaching is involved. In the center, an IV is started which does hurt (needle stick in the arm). Numbing and dilating drops are given as well as a brief interview to uncover and medical problems not previously known. Just prior to the procedure stick pads are placed on your chest, so that we may monitor you during the procedure. When you are ready, we will roll your bed into the OR. At this point, we will clean your lid with a brown colored solution that kills bacteria. Then sterile drapes are placed over the eye to keep it clean. A lid speculum is placed to prevent blinking during the procedure. We will talk to you during the procedure will ask you how you are doing. The procedure is over in about 5-8 minutes at which point we wheel you back to the post op area. Here, the nurse will ask you some questions as well as take the IV and pads off. You will be given an appointment for the next day as well as a phone number to call if you have any questions or concerns.

Technique

The method used today is called extracapsular cataract extraction by phacoemulsification. Remember, the cataract is located inside the eye, so a small incision is made to access the cataract. This clouded lens is analogous to a cherry. It has a hard substance in the center called a nucleas which would be like the pit of the cherry a surrounding substance called cortex which is like the pulp of the cherry. This nucleas and cortex is removed by phacoemulification. This device is ultrasonic and vibrates at 40000 cycles per second to pulverize the nucleas and aspirate it out. After this the cortex is removed and the capsule (which would be the skin of the cherry) remains. This capsule is used to support the intraocular lens that takes the place of the natural human lens. The incision is roughly 3.0 millimeters and self seals which obviates the need for sutures.

Lens Implants

Lens implants are necessary to replace the refracting ability of the natural human lens. Long ago, people had to wear thick glasses or contact lenses after cataract surgery when implants were not available. Prior to surgery, the doctor uses and A-scan and Keratometer to measure the length and curvature of the eye, so that a precise calculation of implant power can be made. After surgery, one needs to change his glasses since the implant changes the prescription. The new prescription will fine tune your vision.

Also see Intraocular Lens (IOL)

Secondary Implants

If for some reason and implant was not used in the original surgery, one can be placed years later. Because this is a secondary procedure, these implants are called secondary implants. Patients may be motivated to obtain secondary implants because of their dependence on their thick glasses or contact lenses.

Complications

Unfortunately, not surgery is without risk. There is always a risk or retinal detachment, glaucoma, infection, etc. However, these risks are low and can be minimized by the many techniques employed at our surgery center. If one of these complications do occur, they can be frequently treated and corrected.

Yag Laser

The capsule is necessary to support the implant during cataract surgery. However, after months, the implant is fixated and is no longer dependent this capsule. In 30-50% of patients, this capsule can get cloudy while it heals. The patient will report some of the same symptoms they did when they had the cataract such as blurriness. When this is bothersome to the patient, we perform a Yag laser in our center. This is a simple procedure done with a laser light. Drops are given to the patient, after which they sit down at the laser which is just like the examination. The light shines in and opens the capsule. One may hear some clicks, and see some lights, but feel absolutely nothing. The actual laser takes just seconds to open this capsule and the patient resumes all normal activities immediately.

OTHER USEFUL INFORMATION ON CATARACT:

What is a cataract?

Can Cataract be prevented?

Can UV Radiation Damage Our Eyes?

How Can a Cataract Be Treated?

New Study Indicates Nutrition May Play Greater Role In Preventing Cataract

It's Not Your Grandfather's Cataract Surgery

Financial Assistance Information

Additional Questions and Answers