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What is a Cataract?
Cataract describes a cloudiness or opacification of the natural lens of the eye. The lens is found within the eye, just behind the colored structure known as the iris. Much like the lens of a camera, the eye's lens functions to focus light entering the pupil upon the retina, a thin membrane in the back of the eye. The retina functions like film, sending what the eye sees on to the brain through the optic nerve. Just as a dirty camera lens will take a blurry photograph, a cataractous human lens can cause a number of visual disurbances, including blurring, haziness, glare, difficulty judging colors, and eventually significant loss of vision in the eye
For most people, cataracts are simply a matter of age. Nearly everyone develops cataracts over time, though the rate at which the lens undergoes these changes is quite variable. Some may note significant visual disturbances in their 40's,while others may live into their 80's and never be very bothered by their vision. The reasons for these differences are not well understood. Genetics may play a part, with some simply more succeptible to cataract at an earlier age. Environmental factors, such as exposure to sunlight or certain diets, may one day be found to play a role, however current data regarding the effects of these elements are not conclusive.
While most cataracts are age-related, some are not. Some people are born with cataracts. Others may develop cataracts due to illness or disease, trauma, or use of certain medications. For example, those on chronic corticosteroids such as prednisone often develop lens opacities. By understanding your full medical history, your doctor can determine whether your cataracts are related to any of these factors.
Presently, the only available treatment for cataracts is surgery. Many often ask if cataracts can be prevented. Given our current lack of understanding of their causes, the simple answer is no. Some eye doctors advocate the use of ultraviolet light-blocking sunglasses. While not definitive, some studies have suggested that ultraviolet light may be partly responsible for cataract progression, as well as for other eye diseases such as age related macular degeneration. The use of sunglasses may therefore help, and certainly will not cause any harm. Similar advice might apply to antioxidants such as vitamins A, C, and E. While studies have produced conflicting information, some indicate that these vitamins may slow cataract growth. Speak with your medical doctor prior to starting any high-dose vitamin program.
Cataract surgery may be right for you if you experience any of the symptoms noted above, such as significant blurring, haziness, or glare. If any of your work or leisure activities are affected by poor vision, a complete eye examination will help your physician determine the cause. Patients with cataracts often complain of difficulty reading or performing close-up work, trouble driving- especially at night due to glare and starbursting around lights, or difficulty seeing a hit golf ball.
Modern cataract surgery is performed without discomfort on an outpatient basis. Gone are the days of large incisions, multiple sutures, and prolonged bedrest. Today, incisions are tiny, typically measuring only three millimeters, or about an eighth of an inch. Stiches are seldom necessary, and recovery, both physical and visual, is rapid. Many patients drive and return to their usual level of activity the day following surgery.
The details of cataract surgery will be described next. Please visit the WILLS EYE SURGERY CENTER page for additional information about your surgical day experience in our state-of-the-art facility.
Once adequate anesthesia has been achieved, the area around the operative eye will be cleaned for sterility and a surgical drape will be placed. A small device known as a speculum will then be placed to keep your eye open during the procedure. There will be no discomfort. A small incision is then made in the cornea, or clear window at the front of the eye, and a viscous gel is injected into the eye in order to maintain space and protect the other ocular structures during surgery. The "main" corneal incision is then carefully made using an extremely sharp and precise blade made of diamond. Next, a circular opening is created in the front of the thin membrane, or capsule, which surrounds the lens, and fluid is injected inside to separate the entire lens from its attachment to the capsule. The cataractous lens is then removed using phacoemulsification, the amazing technology behind modern cataract surgery. The phacoemulsification machine produces ultrasound waves within a tiny handpiece, pictured to the left, which is inserted into the eye. This causes the metal tip of the instrument to vibrate very rapidly, up to 40,000 times each second, dissolving the cataract material which is then aspirated out of the eye. Additional instruments are used to clean all the cataract from the lens capsule, which is then refilled with more viscous gel. An artificial, permanent lens implant, made of a kind of plastic, is then inserted into the capsular "bag," taking the place of your natural lens. This implant, which helps focus the incoming light on your retina, is held in palce by two haptics, or curved hooks, as seen in the photo below. Once the implant is in place, the incisions are closed, usually without stitches, and the surgery is complete.
Prior to surgery, your eye will be carefully measured for the proper strength of lens implant. The implant can be chosen to focus your eye at any distance you desire. While most choose to focus clearest for distance vision, some prefer to see most clearly at near, particularly if they have always been myopic, or nearsighted. At Regional Eye Associates, we perform these measurements with the Zeiss IOL-Master, the most advanced, accurate device for this purpose, which uses a laser to scan the eye in just seconds. While these calculations are extremely accurate in most cases, the expected results are not always achieved. Most patients obtain vision good enough to drive without glasses. Rarely, the post-operative refraction (eyeglass prescription) will be significantly different than exptected. In these unusual cases, additional surgery, including removal and replacement of the lens implant, may be required to achieve the desired result. The appearance of an implant in the eye at the end of surgery is shown below.
The majority of lens implants inserted during cataract surgery are considered 'monofocal,' meaning that they focus light at only one location, usually in the distance. This means that reading glasses will be required for close-up tasks such as reading- without them near vision will be blurred. Another option is the 'multifocal' lens implant. Such implants allow for clear vision at distance, as well as good vision at mid-range and near. However, there can be some loss of overall contrast, and reading glasses may still be needed for some near tasks. You can discuss this option with one of our physicians during your evaluation.
Once removed, a cataract does not return. However, the back side of the lens capsule, which remains intact at the time of surgery in order to support the implant, can become cloudy over time. This opacification, sometimes referred to as a "secondary cataract," can affect vision much the way the cataract once did. If this occurs, a brief, painless laser procedure performed in the office can clear the opacity from the implant. The capsular opacification does not recur once this is performed.
Modern cataract surgery is safe and effective, capable of rapidly improving your vision and putting you back into life. Don't let poor vision slow you down. Call us today to schedule an appointment with one of our doctors to find out if cataract surgery can help you
Cataract Surgery has advanced greatly in the last 50 years. We use the latest technologies in diagnostics and surgical instruments to achieve the best possible outcomes for our patients.
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