Cataracts occur as part of the normal aging process. Studies show that virtually everyone over age 65 has some cataract formation in their eyes! Cataracts can severely reduce your vision. At one time, cataracts were a leading cause of blindness in the world. But today, fortunately they can be treated. Modern surgical techniques, intraocular lens implantation and "same day surgery" make cataract surgery safe, fast and effective.
A cataract occurs when the normally clear lens of the eye becomes cloudy. As the cataract develops, the cloudiness no longer allows the lens to properly focus light on the back of the eye. This unfocused light causes the vision to look blurry or hazy. Development of cataracts has been associated with exposure to ultraviolet radiation. They are particularly prevalent in persons who spend a lot of time in the sun, such as fisherman. There is nothing you can do to prevent the formation of cataracts.
Treatment is indicated when decreased vision affects your everyday activities or hobbies.
Cataract surgery, in which the normal cloudy lens is removed, is now a very successful procedure. The most widely used technique is called phacoemulsification. A very small incision is made and a tiny ultrasonic probe is used to break up the cataract and gently suction it away. A clear membrane is left in your eye where an intraocular lens is placed (IOL). This IOL is necessary to replace the focusing power of the natural lens, which was removed. With insertion of an IOL, there is little need for thick cataract glasses and contact lenses that were used years ago.
Small incision surgery has several benefits. The procedure is very quick, sometimes taking less than 20 minutes. Also, recovery time is short. Patients are able to eat a light snack and drink immediately after the surgery. The results of the surgery are almost immediate. Most people notice an improvement in their vision soon after surgery. You will still need glasses to read after the surgery. Your new prescription is given a few weeks after the procedure.
The eye is a marvelous optical instrument which takes the images from the real-world and focuses them on a tiny spot in the back of the eye. The ability to focus these images comes from two parts of the eye, the lens of the eye and the front cover of the eye, or the cornea. The lens accounts for about 1/3 of the focusing power.
The Natural Lens is Removed During Cataract Surgery:
A cataract occurs when the lens of the eye becomes cloudy so that it can no longer focus the real-world images. Patients with cataracts see the world as very hazy, because light cannot pass freely through the lens to be focused on the back of the eye. The only way to remove a cataract is to remove the lens itself.
Cataract Surgery Procedure:
Cataract surgery is a procedure that removes the cloudy lens from the eye. Today, this procedure can be accomplished very quickly and no stitches are needed. A local anesthetic is used and the surgeon makes a small incision in the outer covering of the eye. Then a technique is used, called phacoemulsification, which removes the lens through the small incision.
At least 99% of the patients receive an artificial lens implant after the cataract is removed. This lens is called an intraocular lens or IOL and is made from the same plastic as certain types of contact lenses. In some cases, a special tiny foldable IOL is used for implantation. This type of lens is inserted into the eye through a very small opening, only 1/8th inch. Once in the eye, the lens unfolds to its full size.
The IOL replaces the 1/3 of the eye's focusing power of the natural lens. Without this lens, the eye cannot focus. In a small number of cases, an IOL is not used and the patients must wear glasses or contact lenses to help them see. IOLs are beneficial because they are permanent in the eye. They do not get lost, like glasses, or have to be replaced, like contact lenses. Also, many times the focusing power of the IOL can be determined so that it closely matches your eye. With an IOL, glasses for distance vision may not be needed.
This cataract surgery technique has many benefits. No hospital stay is needed, there is no pain, no injections are required, there is quick recovery and the vision after surgery is typically very good.
Are There Any Risks?
Cataract surgery and IOL implantation is quite safe. The IOLs must pass through a very stringent approval process before they can be used. The benefits of the implant greatly outweigh the small added risk of implantation.
As with any surgery, complications can occur. There is a possibility of hemorrhage or infection. Your eye doctor will discuss potential complications of cataract surgery and lens implantation with you.
Toric IOLs are specially designed for patients with astigmatism. Traditionally, surgical correction of astigmatism required making a series of small incisions (called LRIs) around the cornea to make it more spherical instead of football-shaped. Implanting toric IOLs often improves vision due to astigmatism without the need for these extra incisions, and also allows patients to enjoy a faster, more comfortable recovery.
What is the Capsule?
The natural lens of the eye is held in place by a thin clear membrane called the lens capsule. The capsule completely surrounds the lens and separates it from the thick fluid in the back of the eye, called the vitreous, and the thinner fluid in the front of the eye, called the aqueous.
Cataract Surgery Effects the Capsule:
Cataract surgery is necessary when the natural lens become cloudy and must be removed. When cataract surgery was originally performed, surgical techniques were not as refined as today, and both the natural lens and the capsule were removed during surgery. Newer techniques allow the capsule to remain in the eye and hold the implanted lens (or intraocular lens, IOL) in place. Leaving the capsule in place during surgery is a great advancement because it allows the vision after surgery to be more stable and provides for less surgical complications.
Sometimes the posterior, or back, portion of the capsule becomes cloudy after cataract surgery. The reasons for this cloudiness are unknown. If the posterior capsule becomes so cloudy that it detrimentally effects vision, then a capsulotomy is performed.
What is a Capsulotomy?
A capsulotomy is a procedure in which an opening is created in the center of the cloudy capsule. The opening allows clear passage of the light rays and eliminates the cloudiness that was interfering with the vision. A laser beam is used to create this opening. This procedure is painless, very safe and typically the results can be seen immediately. For capsulotomy, as with any surgery, rare complications can occur, such as swelling or retinal detachment. These complications can cause loss of vision.
A cloudy capsule will many times appear the same way as the original cataract. The vision is cloudy or hazy and the patient is heavily bothered by glare. In fact, vision is so similar that some patients think that the cataract has come back or regrown. This is impossible, cataracts cannot return once the natural lens has been removed.
If your vision is getting worse after cataract surgery, it could be that your capsule is becoming cloudy. Your eye doctor should give you a thorough eye examination to determine the cause of your vision loss. If your capsule is becoming cloudy, your eye doctor can then determine whether a capsulotomy is necessary to improve your vision.
Cataract Surgery (Phaco)
Secondary Cataract (YAG)
AcrySof® IQ PanOptix® IOL
AcrySof® IQ PanOptix® Toric IOL
Tecnis® Toric IOL
Standard Monofocal IOL
Monovision with IOLs