Cataract Treatment & Surgery
A cataract is a common condition that causes a clouding of the eye's natural lens. The amount of cloudiness varies with the the type of cataract. A cataract is not a film over the eye, which is a common misconception.
Risk for Developing Cataracts
Cataracts are part of the normal aging process, putting everyone at risk. It affects millions of people each year, including more than ½ of all Americans over the age of 65. The natural lens of the eye hardens and becomes less flexible with a loss of clarity. The following factors are associated with increased cataracts:
- Age
- Family history
- Prolonged steroid use
- Diabetes
- Smoking
- Sunlight exposure (cortical cataract)
Causes of Cataracts
The lens inside your eye continues to add layers. These additional layers on the lens surface cause a hardening of the lens and a loss of clarity. This can lead to blurry or cloudy vision. This occurs eventually in most people, and is known as the age-related cataract. Depending on how much of the lens area is affected, the visual disturbance can range from minimal to severe.
Other types of cataract can include CONGENITAL, which may occur in children, SECONDARY, to other conditions such as diabetes (Subcapsular cataracts), and TRAUMATIC, due to an eye injury.
Cataract Symptoms
Cataracts may not cause you to have any symptoms when they first occur. Cataracts may continue to progress and symptoms include:
- Trouble seeing at night or in low illumination
- Sensitivity to light, glare or halos around lights
- Colors are yellowish and/or faded
- Trouble reading with bright lights
- Double vision in one eye
- Blurry, cloudy or dim vision without pain
- Frequent changes in eyeglass or contact lens prescriptions
Click the example images below to view symptoms of cataracts.
Yellow Vision
Blurry/Cloudy Vision
Dull Vision
Light Scatter
Diagnosing Cataracts
In order to diagnose cataracts, a series of tests will be performed including:
- Dilated retinal exam: inspection of the back of the eye, looking for diseases of the retina and optic nerve
- Slit lamp used to evaluate the front of the eye, including the cornea, iris, pupil and lens.
- Visual acuity and refraction
Treatment of Cataracts
Phacoemulsification
Early cataracts, with minimal blurring of vision, may benefit from a change in eyeglass prescription. If the vision after a prescription eyeglass change limits your ability to work, read or do the things you enjoy, then cataract surgery should be considered.
Most cataracts are removed through a small incision, a procedure known as phacoemulsification. A very tiny probe is inserted using ultrasound to break up the lens into small fragments that are then suctioned out of the eye through the probe.
After removal of the cataract or cloudy lens, the lens power has to be replaced. This can done with thick cataract glasses, which are less attractive and have more visual distortion, or contact lenses, which require removal from the eye and maintenance.
IOL Implant
The majority of patients choose an intraocular lens implant, made of acrylic, plastic, or silicone. The lens then helps to focus the light rays on the retina. The small incision is virtually self sealing, and stitches are typically not required.
After surgery, you may need glasses such as bifocals to read, and sometimes for distance. Other lens implants, such as multifocal or accommodative IOLs, may reduce your dependence on glasses or eliminate them entirely.
Secondary Cataracts
Posterior Capsulotomy
Following cataract surgery, months or years later, the support structures of the intraocular lens can become cloudy. This is called a secondary cataract and if the vision is sufficiently blurry, a laser procedure is performed in the office, creating a small opening into the eye.
This office based procedure, known as posterior capsulotomy, is quick and no recovery period is required.
IOL Implants
In the past, following cataract surgery, you would have to wear cataract glasses or contact lenses to see. Intraocular lenses provide better vision and no contact lens maintenance.
There are different types of intraocular lenses to choose from:
- Single vision (monofocal)
These lenses correct vision set at near, intermediate or distance. The most common implant choice is one that corrects for distance, requiring glasses for reading. If the vision is corrected for near, then you would need glasses for distance.
- Monovision
Another option with single vision (monofocal) is to correct one eye for distance and the other for reading, called monovision. This frequently reduces the need for reading glasses. For those requiring sharp, detailed vision, this may not be the best choice. A trial of monovision is done to determine your ability to adapt.
- Multifocal
This lens has a number of rings that focus the light rays, allowing you to see both at near and at distance.
- Accommodative lens
The intraocular lens moves forward and backward, much like a natural lens, allowing you to see near and distance.
Both the Multifocal and Accommodative lenses may reduce, but not eliminate, your need for glasses. Sharp or crisp vision at near or distance may require glasses. You may have glare or halos around lights or decreased sharpness of vision at night or under dim conditions. Usually, in time, your brain adapts to the changes (neural adaptation), but for others, single vision (monofocal) is a better choice.
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