Cataracts
Cataracts are the most common cause of vision loss for people over 40. A gradual clouding of the eye’s natural lens, they are similar to looking through a smudged camera lens and result in progressive blurring or dimming of vision. Night driving may become difficult or one may see halos or glare around lights. Reading may also become arduous. They are often associated with aging but can also affect babies and small children. In some instances they are hereditary.
CATARACT SYMPTOMS:
Cloudy or blurred vision
Frequent prescription changes for eyeglasses or contacts
Poor night vision
Glare
Halos around lights
Double vision
Difficulty distinguishing the difference between colors
CATARACT SURGERY
A cataract is a clouding of the lens of the eye; cataract surgery is performed to improve vision by replacing the clouded lens with an artificial one. Cataracts affect millions of people in the United States each year. Most cataracts are the result of aging, though some form as a result of genetic factors, disease or injury. Cataract surgery is common, and considered safe and effective.
REASONS FOR CATARACT SURGERY
Cataracts can cause blurry vision, and increase the glare from lights. In their early stages, cataracts usually are not troublesome but, as they thicken, surgery to remove them may be required. Typically, surgery is needed because cataracts are interfering with everyday activities, or the treatment of another eye problem.
CANDIDATES FOR CATARACT SURGERY
Cataracts caused by aging develop gradually, and patients may not notice the early vision changes they cause. It is only when their cataracts start interfering with vision that patients may become aware of them. An ophthalmologic examination will detect cataracts, and rule out other causes for vision issues, such as glaucoma or macular degeneration. Patients who become aware of visual difficulties related to cataracts usually experience, especially at night, clouded, blurred or dim vision.
BENEFITS OF CATARACT SURGERY
Cataract surgery’s benefits are many, greatly enhancing the quality of life. They include the following:
Improved quality of vision (sharper images, brighter colors)
Less difficulty with routine tasks (particularly night driving)
Decreased dependency on eyeglasses
Greater independence, regardless of age or disability
Greater safety
Research indicates that the improved vision provided by cataract surgery reduces the risk of falls, making exercise, sports and hobbies safer. This, combined with the improved ability to read, recognize faces, and perform everyday activities with greater ease, results in improved physical health, increased sociability and longer life expectancy.
THE CATARACT SURGERY PROCEDURE
After the pupil is dilated, and the area in and around the eye is numbed with anesthesia, a tiny incision is made to insert an ultrasonic probe. The probe emulsifies (breaks up) the cloudy lens into tiny pieces that are then suctioned out of the eye. Once the cloudy lens has been removed, an artificial lens is implanted.
The new lens, known as an intraocular lens (IOL), is often inserted through the original incision. Some varieties of IOLs serve multiple purposes, such as blocking ultraviolet light or working as bifocals. Depending on the type of IOL used, sutures may or may not be needed.
Surgery is usually performed on an outpatient basis in a doctor’s office, takes only 20 to 30 minutes, and is relatively painless. A very high percentage of patients demonstrates improved vision after the procedure.
RISKS OF CATARACT SURGERY
Although cataract surgery is a common procedure and considered quite safe, any surgery poses risks. In the case of cataract surgery, there is a slightly increased risk of retinal detachment, a painless but dangerous condition. Other risks of cataract surgery include bleeding and infection. The risk of complications after cataract surgery is greater if the patient has another eye disease or serious medical condition. Danger signs of complications after cataract surgery include increased pain in or redness of the eye, light flashes or floaters, diminished vision, nausea, vomiting or intense coughing.
RECOVERY FROM CATARACT SURGERY
Immediately after surgery, an eye patch is worn; some doctors advise wearing a protective shield, even when sleeping, for several days. Vision may be blurry at first, but improves within a few days. Some itching and discomfort are also present for a few days, but it is important that a patient not rub or exert pressure on the treated eye. Heavy lifting should be avoided. Eye drops to prevent inflammation and infection, and control eye pressure are prescribed.
Even though full healing can take up to 2 months, because cataract surgery is performed on one eye at a time, daily activities can be resumed in a few days. Most patients need to wear eyeglasses, for at least some tasks, after surgery. If the other eye also has a cataract, which is usually the case, the second surgery is scheduled a month or two after the first.
An intraocular lens, or IOL, is the artificial replacement lens implanted when a patient’s natural lens has been surgically removed during cataract surgery. A wide variety of replacement lenses are available to cataract patients, each offering its own advantages for post-surgery vision. The most effective lens to use depends on the patient’s preferences and particular vision goals. Goals for vision differ according to individual occupations and lifestyles. IOLs often eliminate the need for glasses or contacts after cataract surgery, conveniently providing most patients with clear vision.
MULTIFOCAL INTRAOCULAR LENSES
Multifocal intraocular lenses are designed to correct vision at varying distances. They are appealing to individuals who would prefer not to require eyeglasses or contact lenses after surgery, or to require corrective lenses only for certain activities.
ACCOMMODATIVE INTRAOCULAR LENSES
Accommodation is the ability to shift focus between near and distant objects, providing sharper vision at multiple distances in order to minimize the use of glasses. Other IOLs are unable to accommodate and patients may require additional vision correction with glasses or contact lenses.
The most commonly used accommodative intraocular lens is the Crystalens IOLs, the only FDA-approved presbyopia correcting intraocular lens. The Crystalens IOL is made with flexible silicone that has hinges on each side, allowing it to move with the eye muscle, flexing and accommodating seamlessly so the patient can focus on surrounding objects at any distance.
TORIC IOLS FOR ASTIGMATISM
Up until now, patients with astigmatism did not have the same opportunities as other cataract patients to have their vision corrected with available IOLs. Typically, astigmatic patients would require additional surgical procedures, such as LASIK, to correct their vision after cataract surgery. If the patient did not want to undergo another surgical procedure, the only option for correction would be the use of either contact lenses or glasses to address their astigmatism.
Toric IOLs are specially designed to correct for astigmatism when implanted during cataract surgery, offering complete vision correction as a result of one surgical procedure.