What Are Cataracts?
Cataracts are a clouding of the normally clear or transparent lens of the eye resulting in cloudy vision. The lens focuses the light onto the back of the eye (the retina) in much the same way that the lens in a camera focuses light onto film. The lens of the eye is located behind the colored part of the eye (the iris). When a cataract forms, the lens can become so opaque and unclear that light cannot be easily transmitted to the retina. Many cataracts take years to develop to the point where a person’s vision is seriously affected.
There are many misconceptions about cataracts. Cataracts and cloudy vision do not spread from eye to eye, but usually develop at different rates in each eye. They are not a tumor or a cancer. They are not caused by using the eyes too much. Because it is not a film over the lens, it can’t be removed with a laser or eye drops. There are no medications, dietary supplements, or exercises that have been shown to prevent or cure cataracts. Eye surgery is the only way to treat cataracts.
Having regular eye examinations from an eye doctor is the best way to detect cataracts. If you have cataracts, you may experience these symptoms (which also may be indicative of other eye problems):
- Blurry or cloudy vision without pain
- Glare or sensitivity to light
- Frequent changes in your eyeglasses
- Change in the way you see colors
- Problems with night driving
- Double vision in one eye
- The need for brighter light to read
Most cataracts occur as a result of the normal aging process. Cataracts can also occur due to eye injuries, medications, certain diseases, and heredity. Sometimes cataracts are found in children or in newborns because of problems with a pregnancy or due to heredity.
Eye surgery to remove cataracts involves removing the cloudy lens and replacing it with a synthetic intraocular lens implant (IOL). After numbing the eye, the surgeon removes the natural lens with gentle ultrasound (phacoemulsification) and replaces it with an intraocular lens (IOL). Often, however, a cataract only covers a part of the lens; if the sight is not greatly impaired, there is no need to remove the cataract.
A cataract may need no treatment at all if the vision is only a little blurry. A change in your eyeglass prescription may improve vision for awhile. While many factors go into the decision to have cataract surgery, the most important factor to consider is how the cataract interferes with your activities and interests. Cataracts do not need to be fully developed before they can be taken out. How soon to have cataract eye surgery depends on how poor your vision is and how healthy your eyes are otherwise.
How Is Cataract Surgery Performed?
Our Cataract Surgeons utilize the latest in microsurgical techniques for the removal of a cataractous lens. Collectively they have performed thousands of cataract surgeries with a better than 99% success rate.
Almost all cataract surgeries done by Fava and Maria are performed at the onsite outpatient surgery center (Valley View Surgical Center) on a same-day surgery basis. The anesthesia for most cataract surgeries involves topical drops and mild IV sedation. It is rare to need general anesthesia for cataract surgery and injections near the eye are administered infrequently.
The small incision/no stitch surgical technique is performed under the operating microscope, where a small incision is made into the eye. Microsurgical instruments are used to fragment and suction the cloudy lens from the eye. This ultrasound procedure is called phacoemulsification. The back membrane of the lens (the posterior capsule) is usually left intact. An intraocular lens implant is inserted where the old lens was removed. Most often, no stitches are required.
Are Other Techniques Used?
Yes. The field of cataract surgery is constantly changing, and some surgeons get excellent results using older surgical techniques, such as extracapsular cataract extraction with a larger incision. However, these techniques have been replaced predominantly with more modern, small-incision surgery.
When Is the Laser Used?
Dr. Maria notes that Femtosecond laser cataract removal is a technique that has been gaining wider use. A laser is used to make the initial incision, open the front of the lens and soften the lens material. Thus far, there appears to be no significant advantage over current techniques.
YAG Laser surgery is currently used to treat a clouding of the posterior capsule that can sometimes occur months to years after the original cataract surgery. If this clouding of the capsule blurs your vision, a clear opening can be made quickly and painlessly in the center of the membrane with a YAG laser. YAG Laser surgery is available in our accredited Valley View Surgical Center.
What Is a Lens Implant or Intraocular Lens (IOL)?
An implant is a replacement lens which serves to focus the light on the retina after removal of the cataract. It is made out of a plastic, silicone or acrylic material and is usually placed in the eye at the time of the original surgery. Unlike a contact lens, which must be removed periodically for cleaning, an intraocular lens (IOL) implant is permanent. IOL’s do not magnify images like the bulky cataract spectacles of prior years. An IOL is usually centered within the pupil, either in front of or behind the iris. The common placement site today is behind the iris where the eye’s natural lens is located. If such an implant cannot be done, a lens can often be placed in front of the iris, with excellent visual results. Lens implants have been performed since the 1950’s with great success. With modern IOL’s and surgical techniques, a lens implant should last a lifetime without problems. Cataract glasses or contact lenses are still used for those rare patients for whom an IOL implant would not be a safe choice.
Are There Different Kinds of Lens Implants?
Yes. Intraocular lenses come in different designs and materials to better simulate the eye’s natural lens and correct for pre-existing optical abnormalities. The most commonly used lens is called a monofocal lens and is generally used to replace the cataract lens in those patients who desire good distance vision and have minimal preexisting astigmatism. Astigmatism refers to the eye’s natural curvature being more oblong than circular, like a football rather than a basketball. The monofocal lens is usually covered by insurance, but does not correct astigmatism or allow for good near vision without glasses.
For those patients with astigmatism, a toric lens can correct the vision so that only reading glasses are needed and driving vision is achieved without glasses. This lens involves some out-of-pocket cost to the patient. For those patients with minimal astigmatism who desire freedom from glasses for distance and near vision, a multifocal lens is often a good option. The multifocal lens allows many people to be only minimally dependent on glasses for specific tasks. There is an additional charge for this technology as well and not everyone is a good candidate. Different options will be discussed with you at your preoperative evaluation.
How Is the Lens Implant Chosen?
Measurements are made of the length and the front curvature of the eye and the doctors use a computer program to help determine the proper IOL. The technologies now available in Intraocular lenses (IOL’s), such as the toric and multifocal lenses, help reduce dependence on glasses. Although they are more expensive, many patients feel it is an investment in their vision. If you might be interested in these technologies, more information is available through our office.
Are There Any Possible Complications with the Cataract Surgery?
As with all surgical procedures, the decision to have cataract surgery is a complex one involving many factors which you and your ophthalmologist should fully discuss. Although it is one of the most commonly performed procedures and, certainly, one of the safest in experienced hands, it should never be considered as “routine”. Complications are rare, but can include infection, bleeding, and swelling or detachment of the retina. Most of these can be treated, but in rare instances, some or all vision can be lost.
What Happens After Cataract Surgery?
Most people can return to their normal activities within a day or two. Those with strenuous jobs will need more time before returning to work. Drops will be used to speed the healing process and prevent infection for the first weeks. Other than those patients choosing the new technology intraocular lenses, most people will still need glasses for their best vision. Many people still need reading glasses for some fine tasks.
Who Performs Cataract Surgery?
Only ophthalmologists perform cataract surgery. An ophthalmologist is a medical doctor with specialized training in diagnosing and treating all eye diseases and disorders and is the only eye care provider professionally qualified to perform eye surgery and laser treatments.
Dr. Maria and Dr. Fava are ophthalmologists who perform microsurgical techniques, including small-incision and no-stitch cataract surgery and releasable suture glaucoma filtration surgery as well as laser, refractive, reconstructive and cosmetic eyelid and brow surgery.
Where Is Eye Cataract Surgery Performed?
Both Dr. Fava and Dr. Maria perform most cataract eye surgeries at Valley View Surgical Center, a state-of-the-art Medicareaccredited facility located adjacent to the office of Fava & Maria Eye Associates.