Cataracts

A cataract is a loss of clarity, or clouding, of the normally clear lens of the eye. There are many factors which contribute to cataract formation, including age, family history, smoking, sunlight exposure, trauma, diabetes, and certain medications. The cataract itself does no permanent damage to the eye, however if the lens gets cloudy enough to obstruct vision to any significant degree, it is called a cataract. If the cataract progresses to the point that glasses or contact lenses cannot sharpen your vision enough to meet your vision requirements, cataract surgery may be performed.

Reducing the amount of ultraviolet light exposure by wearing a wide-brim hat and sunglasses may reduce your risk for developing a cataract but once developed there is no cure except to have the cataract surgically removed. In most cases, this is done through a small incision using ultrasound (phacoemulsification). This is an outpatient procedure which takes less than 30 minutes. The time to have the surgical procedure is when your vision is bad enough that it interferes with your lifestyle.

Cataract surgery is a very successful operation. One and a half million people have this procedure every year and 95% have a successful result. As with any surgical procedure, complications can occur during or after surgery and some are severe enough to limit vision. But in most cases, vision, as well as quality of life, improves.

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Frequently Asked Questions About Cataracts

Options for Rehabilitation of Vision after Cataract Surgery and Refractive Lens Exchange

Understand that the primary goal of cataract surgery is to remove the cloudy lens (the cataract) and replace it with a clear lens (the intraocular lens [IOL] or “implant”). Replacing the cloudy lens with an implant allows the eye to regain its potential for vision. In order to get the best vision after cataract surgery, it is often necessary to wear glasses or contact lenses. The vision obtainable with glasses or contact lenses after surgery is what we call “Best Corrected Visual Acuity” (BCVA).

A secondary goal of cataract surgery is to reduce your dependence upon glasses and contact lenses. Because of recent advances in IOL technology, as well as technology used to measure the eye and plan surgery, we can often make our patients less dependent on eyeglasses. Some patients are able to eliminate glasses entirely, although it is impossible to guarantee with any of these technologies that you will be able to function without glasses for all tasks.

For patients without clinically significant cataracts who undergo Refractive Lens Exchange, the goals are somewhat different. Because these patients already have adequate vision with glasses (whereas cataract patients do not), the primary goal of Refractive Lens Exchange (also called “Refractive Lensectomy” or clear lens exchange) is to reduce your dependence on glasses and contact lenses. Understand that although most of our patients who undergo Refractive Lens Exchange will have decreased dependence on glasses and contacts, it is impossible to guarantee that you will be able to function without glasses for all things.

Whether you are having Cataract Surgery or undergoing Refractive Lens Exchange, you have three basic options for correcting your vision with surgery:

  1.  Aim for distance vision in each eye using a monofocal lens

    This is the option that most of our patients choose. It uses the tried and true technology of monofocal IOL’s that has been developed with great success for over 50 years. Using the sophisticated technology of A scan ultrasound to measure the eye, along with third generation formulas to calculate lens powers, well over 90% of our patients with otherwise healthy eyes will achieve vision that is 20/20 or better.

    Patients with monofocal lenses and good distance vision generally require reading glasses or bifocals to see up close. Reading glasses have the virtue of being inexpensive (generally around $10) and readily available without a prescription.

    Monofocal lenses are covered by Medicare and private insurance. If you have astigmatism and wish to have it corrected at the time of cataract surgery, this can be done. Understand that Medicare and most private insurers do not cover the costs of surgery for astigmatism and that this represents an additional expense. (Relaxing limbal incision, RLI and toric intraocular lenses are examples).Aim for monovision with monofocal lenses
  2. With monovision, we typically aim for distance vision in the dominant eye. We aim for reading vision in the non-dominant eye by making it nearsighted. Having one eye set for distance and one eye set for near increases the number of things that you can do without glasses. Monovision after cataract surgery or refractive lens exchange works best in patients who have previously worn contact lenses for monovision.

    The disadvantage of monovision is that both eyes no longer work together for distance or near vision. Some patients, realizing the advantage of increased freedom from glasses and contacts, tolerate this disparity extremely well. Other patients are unable to tolerate the imbalance between the two eyes.

    The monofocal lenses used to create surgical monovision are covered by Medicare and private insurance. If you also have astigmatism and wish to have it corrected at the time of cataract surgery, this can be done. Understand that Medicare and most private insurers do not cover the costs of surgery for astigmatism and this represents and additional expense.Aim for both near and distance vision in each eye with multifocal lenses

  3. Multifocal lenses offer the best potential for reducing your dependence on glasses and contact lenses after Cataract Surgery or Refractive Lens Exchange. Our practice has extensive experience with multifocal lenses. Multifocal lenses work by providing simultaneous near and distance vision in each eye, thus allowing both eyes to work together for distance and near. In 2005, the FDA approved multifocal IOL’s with advanced optics having fewer aberrations than previous multifocal IOL designs.
  • The Restor lens: manufactured by Alcon, provides excellent distance and reading vision. Its intermediate vision (computer screens, etc.) is not quite as good as the distance and reading vision typically achieved by most patients with this implant.
  • The Rezoom lens: manufactured by AMO, provides excellent distance and intermediate vision. The near vision magnification is not quite as good as the Restor lens, and there may be more tendancy to notice halos at night.

Weakness inherent in all multifocal IOL designs include aberrations that can cause glare and halos, especially at night. About 1 in 20 patients describe the glare and halos with multifocal lenses as “severe.” Multifocal lenses work best with binocular vision (both eyes working together), therefore, you will not get the full effect of multifocal vision until you have had multifocal lenses implanted in both eyes.

Although multifocal lenses may represent your best option for reducing your dependence upon glasses and contact lenses, it is impossible to guarantee that you will be able to throw away your glasses. Reading glasses, for instance, will always magnify near objects, thus making them easier to see, even with multifocal lenses.

Because Medicare and private insurance companies generally consider multifocal lenses to represent a luxury technology that is not absolutely necessary for good vision, multifocal lenses are not covered by Medicare and insurance.

A Few Words Regarding Intraocular Lens Power Calculations

Although the techniques we use to measure the eye and calculate the IOL powers are state of the art, they are not perfect. We make every effort to ensure that our patients’ refractive results are as intended. Because of some inherent limitations of these technologies, a small percentage of patients may have an unpredictable outcome after surgery, especially in patients who have had prior refractive surgery such as RK, LASIK, or PRK. Regardless of the option you choose for rehabilitating your vision after Cataract Surgery or Refractive Lens Exchange, understand that further surgery such as PRK, LASIK, intraocular lens exchange, or YAG laser capsulotomy may be required to fine tune your vision.

Remember that all of the options presented above represent efforts to reduce your dependence upon glasses and contact lenses. None of these options can guarantee you to throw your glasses away. Talk with us about which of these options might be best for you.

For more information, try these links:
General information from the American Academy of Ophthalmology

The Eye Surgery Education Council

Information About Cataract Surgery

To determine if your cataract should be removed, your ophthalmologist at Physicians Eye Care and Laser Center will perform a thorough eye examination. If you and your doctor feel that the cataract should be removed, your surgery will be scheduled. Prior to your surgery you will need to see your primary care physician for a routine pre-operative physical exam. We will also make an appointment at Physicians Eye Care and Laser center to measure your eye to determine the proper power of the intraocular lens that will be placed in your eye. Your ophthalmologist will also talk to you about the possible use of special lenses or procedures to decrease astigmatism, and about the new multifocal lens implants. Talk to your ophthalmologist about use of your usual medications before surgery.

You must make arrangements to have someone drive you home after surgery.

The Day of Surgery

Surgery is done on an outpatient basis, either at the Snowden River Surgical Center, St. Agnes Hospital outpatient surgery center, or the ambulatory care center at Howard County General Hospital. You will be asked to skip breakfast, but generally should take any medications you normally take in the morning, especially blood pressure medications. These may be taken with a small amount of water.

When you arrive for surgery, you will be given eye drops and a mild intravenous sedative to help you relax. A local anesthetic will numb your eye. The skin around your eye will be thoroughly cleansed, and sterile coverings will be placed over your eye and around your head. Your eye will be kept open by an eyelid speculum. You may see light and movement, but you will not be able to see the surgery while it is happening.

Under an operating microscope, a small incision is made in the eye. In most cataract surgeries, tiny surgical instruments are used to break apart and remove the cloudy lens from the eye using a combination of suction and ultrasound. The technique is called phacoemulsification. The back membrane of the lens (called the posterior capsule) is left in place to help support the lens implant for the first few weeks while the eye is healing. The lens implant becomes a permanent part of your eye; you will not see or feel it, and it will last for your lifetime.

After surgery is completed, your doctor may place a shield over your eye. After a short stay in the outpatient recovery area, you will be ready to go home.

Following Surgery
You will need to:

  • Use the eye drops as prescribed
  • Be careful not to rub or press on your eye
  • Avoid strenuous activities until your ophthalmologist tells you to resume them
  • Ask your doctor when you can begin driving
  • Wear eyeglasses or an eye shield, as advised by your doctor

You can continue most normal daily activities. Over-the-counter pain medicine may be used, if necessary. You will receive full instructions in writing after the surgery. You will need to be seen at one of the Physicians Eye Care and Laser Center offices the day after surgery, then again one or two weeks later. By two to four weeks after the surgery, the eye is usually stable enough to give a prescription for glasses, if needed. Surgery can be scheduled for your second eye as soon as two weeks after the first surgery.

After Cataract

In some eyes, over the course of time after cataract surgery, the lens capsule (the part of the eye that holds the lens in place) sometimes becomes cloudy This can occur several months or years after the original cataract operation. If the cloudy capsule blurs your vision, your ophthalmologist can perform a second surgery using a laser. During the second procedure, called a posterior capsulotomy, a laser is used to make an opening in the cloudy lens capsule, restoring normal vision. Unlike the original cataract surgery, there are no external openings made in the eye, so there is no restriction on your activity and no special eye drops needed after this office procedure.

Complications After Cataract Surgery
Though they rarely occur, serious complications of cataract surgery are:

  • Infection
  • Bleeding
  • Swelling
  • Detachment of the retina

Call your ophthalmologist immediately if you have any of the following symptoms after surgery:

  • Pain not relieved by nonprescription pain medication
  • Loss of vision
  • Nausea, vomiting, or excessive coughing
  • Injury to the eye

Even if cataract surgery is successful, some patients may not see as well as they would like to. Other eye problems such as macular degeneration (aging of the retina), glaucoma or diabetic retinopathy may limit vision after surgery. Even with these problems, cataract surgery may still be worthwhile.

Columbia Medical Center

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Columbia, MD 21044
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Baltimore, MD 21229
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