Once some people have reached the age of 50, they develop cataracts and need to see a cataract surgeon. When the lens in the eye becomes cloudy, it is called a cataract. This condition causes a loss of vision not correctable through contact lenses, glasses, or corneal refractive surgery such as LASIK. Although cataract surgery may sound daunting to some, a cataract surgeon can not only restore the vision of the individual, they can decrease the need for glasses. The majority of cataracts are caused by the process of aging and very common for older individuals. During the course of a typical year, approximately 68.33 percent of all individuals in the United States over the age of 80 will be diagnosed with cataracts. This number is expected to significantly increase due to the aging population.
There were approximately 24.4 million Americans with cataracts in 2010. This number is expected to increase to 50.2 million by 2050. The good news is the cataract surgery of today is one of the most effective and safest of all surgeries currently being performed. In excess of three million surgeries in the United States are performed for cataracts every year. In most cases, the procedure restores the vision of the individual. During the surgery, the cloudy lens inside of the eye is removed. This is replaced with a type of artificial lens such as an IOL or intraocular lens to restore vision. This procedure is usually done on an outpatient basis. Staying in a care facility or a hospital for the night is not necessary. The modern procedure uses an ultrasound device with a high-frequency to break apart the cloudy lens into little pieces. The lens can then be removed gently with the use of suction.
The surgery is referred to as either phaco or a phacoemulsification. In the past, the incisions were much larger, requiring a lengthy healing period. There were also surgical complications including retinal detachment. Modern cataract surgery is much safer with a shorter healing period. Once the cataract surgeon has suctioned away the remains of the cloudy lens from the eye, a clear intraocular lens is inserted. The positioning of the lens is secure, behind the pupil and the iris. This location is the same as the natural lens of the eye. An IOL may be placed to the front of the pupil and iris in special cases. This is not nearly as common as the standard lens and placement.
The implantation of the IOL and the removal of the cataract are then completed by the surgeon by closing the incision. In some cases, a stitch is necessary. To ensure the eye remains safe during the recovery period, the cataract surgeon uses a shield over the eye. The individual is able to return home shortly afterwards.
The Basics of Laser Cataract Surgery
The femtosecond laser is very similar to the lasers used for LASIK surgery to create a corneal flap. The FDA has approved these lasers for cataract surgery within the United States. This has decreased the need for hand-held tools and surgical blades. The laser enables the cataract surgeon to:
- Remove the anterior capsule
- Access the lens through the creation of corneal incisions
- Reduce astigmatism through the creation of peripheral corneal incisions
- Fragment the cataract to decrease the phaco energy required to break apart the lens
According to the latest studies, the accuracy of the surgery can be improved by the lasers during specific steps of the surgery. The laser often has a positive impact on the visual outcome, the period of time necessary for recovery and the safety of the procedure. The best way to learn about the procedure is to schedule a consultation with Dr. Reena Patel, our cataract surgeon, after having an eye exam. This provides the individual with a good opportunity to discuss the specifics of their cataracts and ask questions about the procedure. Before having cataract surgery, a comprehensive eye examination is performed by an ophthalmologist or an optometrist. The exam checks the health of the eyes, determines if the individual will require surgery and identifies any potential risks that may be pertinent to the individual.
Once the individual reaches the age of 50, a refraction will be performed. This shows the amount of astigmatism, farsightedness, or nearsightedness present before the surgery. The eyes are measured to determine the length of the eye and the curvature of the cornea. The cataract surgeon must have these measurements to select the intraocular lens with the correct power for the individual. This ensures the best possible vision after the procedure. Astigmatism can be corrected with a toric IOL. If the individual does not have any issue with wearing glasses after the procedure, a monofocal lens can be used.
In most instances, the individual will only require reading glasses after cataract surgery using a monofocal IOL. If the individual does need prescription glasses, they are usually prescribed by Dr. Patel about a month after the surgery. This generally occurs when the surgery was only performed on one eye. If the individual does not want to wear glasses after their surgery, the best way to decrease the need to wear reading glasses and correct presbyopia is by having one of the monofocal IOL’s adjusted by the surgeon. This can only be done if the surgery was for both eyes. This is referred to as a monovision correction. This is a lot like the monovision performed for individuals wearing contact lenses. All of the available options will be discussed between the individual and the cataract surgeon.
Presbyopia-correcting IOL’s are available in a wide variety to improve the vision for reading without impacting the distance vision. The presbyopic IOL’s include multifocal IOL’s and accommodating IOL’s. Both of these lenses were created to provide the individual with a better vision range after surgery than the more conventional monofocal IOL. It is important to understand that not every individual is a good candidate for an IOL. This determination is made by the cataract surgeon. Before the individual has cataract surgery, they will be told exactly what to expect prior to, during and after their cataract surgery.
It is extremely important to discuss any concerns or questions regarding the surgery with Dr. Patel before authorizing the procedure. The surgeon must be informed of all prescription medications, over-the-counter medications, nutritional supplements and vitamins currently being used. There are specific supplements and medications linked to complications during this surgery. The individual will be told which medications should be stopped before the surgery and for how long. The majority of surgeries do not have any complications and generally require approximately 15 minutes. It is important to allow a minimum of 90 minutes for the procedure because additional time is necessary for the individual to be prepared for cataract surgery.
Prior to the surgery, there will be a short post-operative exam, the pupils of the individual will be dilated and preoperative medications will be administered. The individual will be given instructions for their recovery prior to leaving the facility. It is important to make arrangements with a friend to provide a ride home after surgery. The individual must not drive until Dr. Patel has tested the individuals vision one day after the procedure. Once the person’s vision has been tested, they will be given confirmation that it is safe to drive. A prescription will be issued for medicated eye drops. These are used numerous times every day for approximately three weeks after the procedure. A protective eye shield is worn for roughly one week after the procedure when the individual is sleeping.
Post-operative sunglasses are used to protect the eyes from the sun during the recovery period. If the individual receives anesthesia, it is a good idea to have a friend stay with the person for a day or two. In some cases, the individual may experience some blurred vision or redness of the eye for a few days after the surgery. This is normal and no reason for alarm. For approximately one week after the surgery, it is extremely important the individual avoids:
- Lifting anything weighing more than 25 pounds
- Strenuous activities
- Splashing water in the eye, the eyes should be closed while bathing or showering
- Exercising, bending or any activity placing stress on the eye while healing
- Hot tubs and swimming should be avoided for a minimum of two weeks
- Anything exposing the eye to contaminants, grime, or dust during the healing period
The cataract surgeon may provide additional recommendations and instructions to help ensure a smooth recovery. This is dependent on the outcome of the surgery and the specific needs of the individual. If surgery is required in both eyes, Dr. Patel will usually recommend having the procedure one to three weeks apart. This provides the time necessary for sufficient healing of the first eye. This means the individual will be able to see well out of one eye prior to having the second procedure. Unless presbyopia-correcting IOL’s are chosen, the chances are good the individual will require reading glasses to see close objects clearly.
Even when the premium IOL’s are chosen, reading glasses can be helpful for reading very small print or specific close-up tasks. Even if the individual has excellent vision after cataract surgery without the need for glasses, they often decide to wear glasses after the procedure to ensure their eyes are fully protected. If the individual has become used to wearing glasses for a long period of time prior to the procedure, they often continue because it helps them feel like themselves. When the person decides to continue wearing glasses after the procedure, photochromic and anti-reflective lenses are recommended highly to achieve the best possible vision, appearance, and comfort level. These lenses can be demonstrated and fully explained by the eye care professional.
When to See a Cataract Surgeon
There are currently no eye drops or medications proven to reverse or prevent the formation of cataracts. If a cataract is responsible for nearsightedness or the prescription of the individual has changed, blurred vision can sometimes be improved with a prescription for new glasses. The only solution for cataracts is to surgically remove the eye’s natural lens. No surgeon will remove a cataract simply because it is there. There are numerous individuals with cataracts that are not interfering with their daily routines, causing blurred vision, or preventing them from living a productive and active life. In these instances removing the cataracts through surgery is unnecessary.
If the individual is having a hard time reading the signs on the road or fine print, has a difficult time pursuing hobbies like card games, crocheting or knitting or is unable to drive at night due to a glare caused by blurred vision, cataract surgery should be considered. The bottom line is if the person has a cataract causing blurred vision making it hard to do the things they desire or fulfill their responsibilities, cataract surgery must be a consideration. If the individual is uncertain as to whether or not they have cataracts or if they need surgery, the best option is to have a complete eye examination. Dr. Patel can determine if cataracts are present.