Cataract

What is a Cataract?

Many people think that a cataract is a film growing over the eye, this is incorrect. Normally, the lens focuses light onto the retina. A cataract is opacification or clouding of the lens of the eye. Think of it as a dirty “window” in the eye, one which you can not clean. The clouding may be uniform and thus dim vision (like a sunglass), or it may heterogeneous and scatter light. Cataracts that scatter light tend to cause more visual difficulty. In general, the denser the cataract the blurry vision becomes . The greater the scatter the more bothersome the cataract. Scatter is more important than density in the degradation of vision. A cataract extraction consists of removing the dirty “window” and replacing it with a clean new one. After the cataract is removed, a plastic lens is inserted into the eye. The new plastic lens has a predetermined power determined by your doctor. If there is no astigmatism then the standard implant should eliminate the need for glasses at distance or near, but not for both distances . Often astigmatism can be corrected by a simple surgical procedure. If astigmatism is surgically eliminated then glasses can be eliminated in most cases with the newer multi-focal implants.

When Should a Cataract Be Removed?

There are two reasons to remove a cataract. The cataract is interfering with quality of life, e.g., driving is compromised, reading is difficult, daily tasks such as walking are difficult. A recent study showed that seniors with un-operated cataracts were twice as likely to be involved in accident that results in a fatality than patients who have had their cataracts removed. Thus, if you drive and your cataract either causes a visual loss of 20/40 or worse; and/or significant glare we suggest that the cataract be removed.

The only other reason to remove a cataract is that the doctor can not get a good view of the back of the eye. This is important in diseases such asglaucoma, diabetes, and/or macular degeneration. Medically it doesn’t make much difference when you take out the dirty “window” and replace it with a new “window”. However, it should also be kept in mind that it is surgically easier to remove a softer, less dense cataract than one than has become overly ripe or hard. Thus, the complication rate is less with an earlier cataract.

What Happens if I Wait to Remove the Cataract?

Time is on your side. Cataracts generally progress slowly. Some take as long as 25 years from beginning until maturity while others a couple of months. The average is over years. We really don’t know what makes cataracts develop or how to slow down cataract progression.

Is a Laser Used to Remove a Cataract?

Rarely today (they are in the developmental stage). Cataracts must be surgically removed. Surgery has improved tremendously in the last 15 years. In the old day the whole lens was removed, which dragged on the jelly of the eye (vitreous), which in turn pulled on the retina. The result was a significant number of retinal detachments and thick glasses. This has all changed with modern cataract surgery.

First, the eye is numbed either with drops or by injection near the eyeball. Drops allow for a less complicated, quicker recovery time. A small incision is made into the cornea, the window of the eye. The incision is a self sealing lock so that sutures or stitches are rarely required. Then the lens is entered. Think of the lens as a semi-flexible egg. An opening is made in the front (the capsule of the lens); the contents are removed (the cataractous lens); and a new plastic lens is slipped into the pouch of the egg. The lens (IOL- intra-ocular lens or implant) placed into eye has been carefully chosen by calculating the power of the IOL using measurements of the length of your eye measured with an ultra-sound devise, and the front curvature of the eye measured with a keratometer. Based on these measurements and your life style the appropriate lens is selected. The capsule of the lens is undisturbed and the new artificial lens holds back the vitreous, thus, decreasing the number of retinal complications.

If topical drops are used the patient need not be patched the first day. If an injection is used for anesthesia then a patch is needed for the first 24 hours.

Will My Cataract Grow Back?

No. However, sometime in the future the lens capsule may opacify and the patient will think that a new cataract has developed. Only the thin shell of the former lens has clouded up. This can be opened with an in-office laser.

Will I Need Glasses After Cataract Surgery?

Depends. Sometimes we create mono-vision (one eye for near and the other for distance); other times we create modified mono-vision which provides reasonable distance and near vision; and sometimes we prescribe one of the new multi-focal implants to provide uninterrupted distance and near.

There are currently three new approved FDA multi-focal lenses which we can use. One is call ReStor which provides for good distance and excellent reading vision, with limited intermediate vision; another is called ReZoom which provides excellent distance with good intermediate and fair near vision; and the last is called Crystalens which actually restores some accommodation or focusing to the patient (the down side is that it takes awhile to work, and is limited in its restoration abilities; its advantage is that the optics are excellent). Sometimes, we use a combination of ReStor, ReZoom, or Crystalens. We determine the lens which will be implanted on the basis of your life style.

Based upon your visual needs we will decide which lens is for you. These new multi-focal implants generally give excellent distance and near vision. Most patients receiving these lenses will not need distance or near glasses after surgery. However, depending on visual needs and outcomes, some patients may need a mild prescription to either enhance distance and/or near vision.

Are All Surgeons the Same?

Absolutely not. Though the majority of patients obtain a good result with most surgeons. The better surgeons perform “quieter surgery” with less disturbance to the eye. The result is quicker healing with less long term complications.

Our surgeon, Dr. Panariello, uses topical anesthetic drops, with a 2 mm self-healing incision. the patient goes home without a patch and vision is usually good the next day. Drops are used for 4 weeks to decrease the possibility of inflammation or infection after surgery.