Cataracts
A cataract is a clouding of the natural lens inside of our eye. This typically occurs slowly, though in some cases can change rapidly for a variety of reasons. Cataracts can have a dramatic impact on our vision and worsen overtime. However, because the changes often develop slowly you may not fully realize the impact of cataracts until they are removed.
What Is A Cataract/Cataract Surgery?
You may have heard your friends, neighbors, or even your parents talk about their experience with cataracts and cataract surgery. This is because everyone develops cataracts and requires surgery at some point. Approximately 4 million cataract surgeries are performed in the United States per year with an average patient age in the mid 60’s. However, cataract surgery is performed across all age ranges.
A cataract is a clouding of the natural lens inside of our eye. This typically occurs slowly, though in some cases can change rapidly for a variety of reasons. Cataracts can have a dramatic impact on our vision and worsen overtime. However, because the changes often develop slowly you may not fully realize the impact of cataracts until they are removed.
Once vision is affected, cataract surgery is a highly successful procedure that can restore vision. It also provides a unique opportunity for you to reduce the need for glasses and contact lenses through a variety of lens implants known as intraocular lenses or IOLs.
Choosing the implant that is right for you is an important decision. We hope to ensure you have the best information so you can determine what is right for your lifestyle.
Choosing Your Intraocular Lens
Cataract surgery is a unique event. Few things are as precious as our sight and with this procedure you have the opportunity to restore the vision that best fits your needs.
As you consider cataract surgery, it is important to begin thinking about what you want your vision to be like after your recovery is complete. The following information will help you think about what you value most and which lens options will help you achieve your goals. Keep in mind that not every lens option is a good match for every person.
Considerations For Your IOL Choice
Understanding Your IOL Choice
Lens Options
Single Focus Lens
- This intraocular lens will be in focus at one single distance.
- A distance, near, or even intermediate target can be selected.
- Glasses will be needed after surgery for activities done outside of the vision range being targeted.
- Example: lens in focus at distance. Glasses needed for intermediate (computer) and near (phone or reading) ranges.
- Insurance typically covers this option, unless astigmatism management is needed (see below).
Advanced Focus Lens
- These lenses provide vision at 2 to 3 distances simultaneously allowing for less dependence on glasses.
- While spectacle independence is greatest with this option, glasses may be needed for some activities.
- The trade-off with these lenses is some induced glare and halo around lights at night.
- Most, but not all, patients who select these lenses adapt to the glare and halos over time and prefer the extended range of vision without glasses.
- Insurance will cover cataract surgery but an out-of-pocket cost is required for the lens technology.
Astigmatism Management
- This is only a consideration when astigmatism is present.
- Reducing astigmatism decreases blur caused by the shape of the eye and allows for sharper vision.
- Astigmatism can be managed with both single focus and advanced focus lenses.
- Depending on the level of astigmatism, either the lens itself treats the astigmatism (Toric Lens) or additional incisions called Limbal Relaxing Incisions (LRI) may be used to reduce astigmatism.
- Insurance will cover cataract surgery but an out-of-pocket cost is required for the astigmatism management.
Blended Vision (Monovision)
- Provides distance and near vision by setting one eye for near and one eye for distance vision using single focus lenses.
- This works for those who have tried the concept previously in contact lenses or after laser vision correction.
- Insurance typically covers this option, unless astigmatism management is needed.
Surgical Evaluation
In preparation for cataract surgery a thorough eye examination, including dilation, is performed. This allows the surgeon to understand the health of your eye and take into account a number of factors prior to surgery.
A particularly important component of the evaluation is a special set of measurements known as biometry. These measurements are essential to the lens selection process. One component of the eye that plays a central role in these measurements is the cornea or clear dome in front of the iris. The cornea needs to be clear and smooth in order to obtain the highest quality measurements prior to surgery.
Dry eye, also known as ocular surface disease, has a significant impact on the cornea and often negatively impacts these crucial measurements. Studies have shown that upwards of 80% of cataract surgery patients have dry eyes on preoperative testing, though more than half of those patients are not aware of their dry eye. In other words, if you are preparing for a cataract surgery evaluation, there is a good chance you have some level of dry eye and don’t realize it.
Due to the importance of measurements during your evaluation and the prevalence of dry eye we strongly recommend you begin using preservative free artificial tears prior to your appointment. These can be purchased over-the-counter. For the few weeks leading up to your appointment, use these tears 4 times per day. In addition, applying heat to your eyelids for 10 minutes a day can be helpful. You can do this by placing a heating pad on your closed eyelids. This allows necessary oils from your eyelids to cover the surface of your eyes and contribute to your tear film in a natural way. Visit the “Dry Eye” page on our website to learn more.
Frequently Asked Questions About Cataracts
What is a cataract and how does it develop?
- Inside the eye is a lens. The lens helps the eye focus light to create vision.
- A cataract is a cloudiness or opacity of the lens that affects its ability to focus light.
- Causes of cataract and some other factors that contribute to its development include: aging, sun exposure, diabetes, smoking, medications, trauma, and genetics.
Who develops cataracts?
What are the symptoms of cataracts?
How are cataracts diagnosed?
What treatments are available for cataracts?
- Surgery is the only available treatment.
- A new eyeglass prescription may allow you to defer cataract surgery until a later time. However, cataracts continue to progress, thereby worsening vision, until they are removed.
When should I have cataract surgery?
- Cataracts should be removed when you feel your vision is interfering with your daily activities.
- In some circumstances, cataracts may cause other problems with your eye. In these situations, the cataract may need to be removed even before it interferes with your daily activities.
What does cataract surgery entail?
- It is a short outpatient procedure in which the cataract is broken up by ultrasound energy and removed from the eye. A lens implant known as an intraocular lens (IOL) is then placed in the eye.
- Typically, the patient is awake during surgery but receives light sedation to ensure comfort. Surgery is usually painless, though you may feel pressure at times during the procedure.
- While the procedure is quick, you will spend 1-2 hours at the surgery center.
- If both eyes need surgery, they are performed on separate days a few weeks apart.
- Patients are seen several times after surgery, including the day after the procedure.
What are the risks and complications associated with cataract surgery?
- Studies have shown serious complications associated with surgery occur less than 1% of the time.
- Some of the risks associated with cataract surgery include: infection, bleeding, inflammation or swelling of other parts of the eye, retinal detachment, pain, blurred vision, halos or shadows, glare, dislocation of the lens implant, trauma to the iris, retained cataract material, dry eye, and vision loss.
- In some conditions, such as macular degeneration, glaucoma, diabetic retinopathy, and prior trauma, cataract surgery may not fully restore vision.
What is recovery after surgery like?
- The eye may feel irritated, scratchy, or sore for a few days. This typically improves quickly.
- Some patients see fairly well the next day but some may require several days or weeks to months to recover good vision.
- There are a few limitations in activities for the first several days after surgery. However, many regular activities are permissible as soon as the day after the procedure.
- Driving is not allowed on the day of surgery but is often possible as soon as one day after surgery.
Will I need glasses after cataract surgery?
- Glasses are typically needed, at least to some degree, after surgery. How often you need to wear glasses depends on the type of IOL implant chosen.
- If you have prism in your glasses prior to surgery, prism is often still needed afterwards.
How is the lens implant selected?
- Special measurements are taken prior to surgery. These allow your surgeon to select a lens power that “fits” your eye.
- These measurements depend heavily on the health of the surface of your eye. Using lubricating drops in preparation for these measurements is quite helpful.
- Your visual goals after surgery will play a central role in selecting the lens implant.
What is posterior capsule opacification or “secondary cataract”?
- The natural human lens is held in place by a very thin capsule. The capsule is not removed during cataract surgery as it holds or supports the new lens.
- Frequently, this capsule becomes hazy after surgery and is known as posterior capsule opacification (PCO). This may occur at any time after surgery is not a complication of surgery.
- Symptoms of PCO may be similar to those of a cataract.
- PCO is treated with a brief laser procedure known as a YAG laser capsulotomy. The procedure takes just a couple of minutes and is painless.
