What is a Cataract?
The function of your eye can be compared to the workings of a camera. Just as a camera focuses light rays onto film to register a picture, the lens of your eye focuses light onto your retina to form an image. If the camera lens is scratched or dirty, your picture will not be perfectly clear. Similarly, abnormalities of the lens of your eye (such as a cataract) will affect how well you can see.
A cataract is a clouding of the natural clear lens located inside the eye in front of the retina. As a cataract progresses and grows cloudier, it blocks the retina's ability to receive images, colors and light. This condition is most commonly caused by the aging process. Just as aging changes occur throughout the body (wrinkles, liver spots, etc.), changes occur in the lens of the eye.
Thus, a cataract is not a "film" or "skin" on the outside of the eye, but rather a natural breakdown in the chemical makeup of the lens inside the eye. Cataracts may also occasionally result from injury, disease, heredity, drugs or birth defects. Cataracts are the leading cause of treatable vision problems in the U.S. Six out of 10 people over age 60 have some form of cataract, and almost everyone over age 80 has cataracts. At present, the only effective cure is surgical removal of the lens—diets, drugs and eye exercises have not been shown to retard or prevent the development of cataracts. Cataract removal is one of the most common and successful medical procedures in existence. More than three million Americans undergo cataract surgery each year.
A healthy lens enables light to properly focus on the retina to be transferred into a clear image.
Vision with Healthy Eye
A cloudy lens scatters light, which results in an image that is out of focus and hazy.
Vision with Cloudy Lens (Cataract)
Problems with your eyesight may occur at any time during the development of a cataract. Usually, you will first notice a slight fogginess. There is no pain or discomfort. As the cataract progresses, your vision will become blurry and dim. Occasionally, some people temporarily experience "second sight," or the ability to suddenly be able to read up close without glasses. However, once the cataract progresses, vision for distance and close will become cloudy.
Detection & Diagnosis
A comprehensive eye examination is necessary to evaluate your cataract and to determine whether treatment would be beneficial. At Eye Care Specialists, the following instruments and tests may be used.
Refraction: A test to see if new glasses would be able to improve your vision enough to avoid or delay cataract surgery.
Pinhole Test: Light is focused in your eye to find "windows" in the cataract. Through these openings, we can evaluate if the vision capability behind the cataract is worth performing surgery.
Potential Acuity Meter (PAM): Similar in concept to the Pin-Hole Test, this sophisticated instrument projects a tiny vision-testing chart into the eye via a narrow beam of light. Measuring vision behind the cataract helps estimate how well you could see if surgery were performed.
Ophthalmoscope: This instrument allows us to check the health of your optic nerve and retina for such conditions as macular degeneration (AMD) or retinal detachment. Very advanced cataracts can sometimes make it difficult to see the back of the eye.
Slit Lamp: A special microscope for seeing inside your eye to determine what type of cataract you have and how far it has advanced.
K-readings: Measurements of the curvature of the cornea (the transparent front part of your eye), which are used to help determine lens implant prescription power.
Ultrasound Test: Sound waves are used to measure the length of your eye from front to back. This information, along with the K-readings, helps to calculate the lens implant power needed to restore vision after cataract removal.
Endothelial Cell Counter: This instrument takes pictures of the cells in your cornea to determine its health and, therefore, which method of cataract removal is best for you.
Contrast (Glare) Test: Cataract patients often have adequate vision in normal room light, but experience glare or a "washed out" effect when outside. This test measures the effect of outdoor lighting on your ability to see.
Orbscan: Orbscan testing simply involves focusing on a flashing red light that appears in the middle of a series of rings. Once focused, the Orbscan takes a series of pictures of each eye in just three seconds and then uses a complex method of triangulation to determine the exact position and shape of the ocular structures. These pictures provide specific information about your cornea's elevation, curvature and thickness across all meridians of its surface. This data is then translated into colored maps for interpretation by the surgeon to help determine the best surgical technique and customized lens implant to utilize.
Depending on the type of cataract, the clouding of your lens may take years or just weeks to months to progress. The following symptoms may indicate that you have a cataract:
Hazy, fuzzy and blurred vision
Sensitivity to light and glare
"Starbursts" around lights
A "shadowing" or "ghosting" effect
Difficulty driving at night
Lens prescription changes don't help
Color changes of the pupil from black to yellowy or white
Holding items closer to read or work
Loss of color brightness
Needing brighter light to see or read
If you notice one or more of these signs, you should arrange for a proper evaluation of your condition.
Diabetes (doubles the risk for cataracts and glaucoma)
Previous eye injury
Precautions You Can Take
The following measures may help you to "see" life to the fullest now and in the future:
Schedule a comprehensive dilated eye exam every other year
Wear UV-blocking sunglasses and hats with brims (Studies have linked ultraviolet light exposure with the development of AMD and cataracts.)
Blurry vision due to cataracts
increases the risk of accidents and falls.
When to Remove a Cataract
It's Your Decision...
Although it is no longer necessary to wait until a cataract is so "ripe" or dense that almost all vision is blocked, its mere presence does not necessarily warrant surgery. Generally, the right time to remove a cataract is dependent upon your personal situation. When visual impairment interferes with your daily tasks or job, or if it poses a threat to your health, wellness and safety, then the potential benefits of surgery may be a consideration. If so, the following criteria should be met (with occasional exceptions):
Your vision is significantly decreased and cannot be improved, even with new glasses.
The cataract is the major cause of the decreased vision, and there is a reasonably high expectation that removing it will improve your vision.
You are bothered by your decreased vision and want to see better. (This can vary depending on individual tolerance levels, needs and lifestyle.)
The cataract is blocking the ability to evaluate and treat an underlying condition, such as diabetic eye disease or macular degeneration (AMD).
The goal of cataract removal is to improve eyesight and quality of life. You are the only one who, with your physician's counseling, should decide if and when cataract surgery should be performed.
Cataracts can cause difficulty
with night vision and driving.
Expectations for Cataract Surgery
Cataract surgery is a highly successful procedure. The overwhelming majority of patients enjoy a marked improvement in vision—as long as there are no underlying problems or other conditions affecting the health of the rest of their eye and, therefore, the ability to see clearly.
Potential Risks of Cataract Surgery
Cataract removal is considered one of the safest operations in this country. As with any procedure, however, complications can occur. In rare cases, glaucoma, retinal detachment, bleeding, inflammation and other diseases or conditions may develop, and there is even an extremely remote chance of losing vision in the operated eye. Fortunately, however, the probability of success greatly exceeds the very small chance of complications.
Modern Surgical Techniques
Cataract treatment requires making an opening in the eye and then surgically removing the cloudy lens, or cataract, inside. (Click on video) Advanced techniques and new equipment have made cataract surgery one of the most commonly performed and successful operations in medicine.
Cataract surgery is typically performed on an outpatient basis using local anesthesia—which is faster, simpler and safer than general anesthesia, especially for very elderly patients. At Eye Care Specialists, the anesthesia process has been further simplified so that, in most cases, eye drops alone are used to numb the eye—eliminating the need for needle injections. With either method, discomfort is extremely rare.
Cataract surgery is performed at one of several excellent outpatient centers or hospitals in the area. These facilities offer a relaxed atmosphere in which patients are typically able to rejoin family or friends for recovery and a snack just minutes after their procedure. And, patients are pleased to find that they are usually finished and back home in less than three hours.
Intraocular Lens Implant (IOL)
An IOL is placed where the eye's natural lens was positioned, thus enabling light to once again focus on the retina for transferring into images.
An intraocular lens implant (IOL)
is about the size of an aspirin.
Ultrasonic Cataract Removal
At Eye Care Specialists, our surgeons use phacoemulsification, the most advanced and sophisticated technique for cataract removal. Phacoemulsification (phaco=lens, emulsification=dissolving) uses high frequency ultrasound to break up the cataract and gently vacuum out the particles through a tiny incision (about 1/8 inch).
Phacoemulsification requires additional training, equipment and expertise to perform, and is especially advantageous for most patients. Because the phacoemulsification incision is tinier than that used for other removal methods, it reduces surgical time and offers more rapid recovery. Most patients are good candidates for phacoemulsification. Rarely, however, pre-operative tests show corneal degeneration or other conditions which require a different, larger incision removal method.
Restoring Sight with Lens Implants
After the cloudy lens (which is about the size of an aspirin) has been removed, it is replaced with an intraocular lens implant (IOL) to once again focus light rays onto the retina—often improving sight to levels not seen in years.
Because the IOL is positioned inside the eye where the natural lens used to be, it provides full peripheral (side) vision and good depth perception. IOLs stay permanently in place and do not require maintenance. Each IOL is chosen for the shape and prescription needed. Most patients, however, still need to wear glasses for close-up tasks or fine-tuning their vision.
Innovations in Lens Implants
Eye Care Specialists was the first practice in Wisconsin to use lens implants that speed healing and vision restoration by folding and fitting through the tiny incision made during phacoemulsification removal. Our team continues to stay abreast of the latest developments and offers an ever-growing variety of options to meet each patient's anatomy, lifestyle and budget as described below.
Monofocal (or single-focus) IOLs are like miniature internal contact lenses set for a single prescription power—usually to provide clear vision in the distance (for watching TV, driving, etc.). As such, most monofocal IOL patients still need to wear reading glasses or bifocals after surgery to compensate for “presbyopia,” the decreased ability of the eye to focus on near objects as you age.
Advanced technology IOLs, however, can reduce the need for glasses or bifocals by providing vision at multiple focusing zones, near-to-far, reading-to-distance (Multifocal and Extended Depth-of-Focus IOLs) and/or by reducing the distortion caused by astigmatism (Toric IOLs).
More detailed information, including realistic expectations, higher costs, potential night glare, and other concerns are reviewed with patients who are candidates for advanced technology IOLs.
Advances in Treatment
Eye Care Specialists' surgeons are proud to be on the cutting edge of new technologies and techniques. Your surgeon will analyze your individual health and lifestyle situation to determine if any of these advances can be used to make your operation even more convenient, safe and beneficial.
"No-Stitch" or "Self-Sealing" Surgery
This innovation involves removing a cataract through an incision made to heal on its own without the need for stitches. This is appropriate for most all patients.
"Topical" or "No-Shot" Surgery
This development enables eligible patients to have surgery with only topical anesthesia (drops on the eye’s surface) rather than an injection to numb the eye. Topical surgery requires advanced skill and training to perform. Benefits include a faster recovery and, if no patch is required, an immediate return to vision.
Glaucoma Treatment Procedures
Glaucoma is a condition in which increased fluid pressure inside the eye damages the optic nerve, leading to permanent “tunneling” and vision loss. Traditionally, glaucoma is treated with prescription eye drops to lower pressure. Our doctors, however, also utilize SLT and ECP laser treatment as well as new Minimally Invasive Glaucoma Surgery (MIGS) procedures to improve outflow, lower pressure, AND reduce the need for prescription drops. Some of these procedures can be performed during cataract surgery. Your surgeon will let you know if you qualify.
What to Expect After Surgery
After your operation, following a short period of rest and observation, you will be free to go home and do most normal, non-strenuous activities. Because you are given medication to relax during surgery, you must have someone drive you home.
The day after surgery, you will be examined, and your course of treatment will be reviewed. You will wear a protective shield at night and may be told to wear glasses or sunglasses during the day to prevent inadvertently touching your eye.
While your eye is healing, you may have blurring of vision. Now that the clouded cataract has been removed, you may also notice that things seem brighter. Both the blurriness and brightness are not unusual. It is also common to have a scratching sensation for a short period of time.
With the modern surgical techniques used by our practice, you can resume most daily activities almost immediately, including reading (although there may be some initial blurriness), watching television, using stairs, walking outside, cooking, cleaning, shopping, and driving. You should, however, avoid getting water in your eye, heavy lifting or exercise, and excessive stooping or bending. (Detailed guidelines will be provided with your post-op instructions.)
As your eye heals, you may be able to enjoy activities that were halted or affected by your cataracts, such as needle-pointing, playing cards or golfing. Many people notice significant improvement in vision within a few days. However, individual results may vary, and vision generally will not reach its optimal level until the end of the three- to four-week recovery period. At that time, a final check-up will be arranged to "fine-tune" your eyesight with a prescription for a new lens for your glasses.
Treatment After Cataract Removal
Once a cataract is removed, it cannot grow back. Occasionally, however, months to years after surgery, the sac that was left behind (to protect the back of the eye) becomes cloudy through a process of normal cell regeneration, causing vision to blur. If this occurs, a quick, painless outpatient procedure, called a “YAG capsulotomy,” is scheduled at the surgery center. During this procedure, the patient simply sits at a machine while the surgeon focuses a “YAG” laser pulse of light to make an opening in the center of the cloudy capsule. Within just minutes, most patients experience a noticeable improvement in vision.
The Key to Satisfaction
The most satisfied patients are those who are educated, active partners in their own care. As with any medical procedure, you should feel free to contact your doctor’s office with any questions or concerns. Also, it is extremely important that you keep your follow-up appointments. Observation and counseling are essential to achieving the best possible final vision.
Once you understand and accept the potential risks and benefits of cataract surgery and elect to proceed with treatment, you can look forward to a new “outlook” on life. Patients often note experiencing such simple joys as seeing faces clearly again, rediscovering the colors of a garden, following a golf ball through the sky, or renewing a driver’s license without dreading the eye exam.
At Eye Care Specialists, we have had the privilege of enhancing the vision and lifestyles of tens of thousands of cataract patients. We’d like the opportunity to make a visible difference in your life. Let us show you how.
For more information or a comprehensive examination . . .
Since 1985, Eye Care Specialists has provided comprehensive medical, surgical and laser care for virtually every eye condition to more than 200,000 people. If you would like our free educational booklet on the eye concern reviewed above, please complete this form or call our Communications & Education Department at 414-321-7520 ext. 217. To schedule a comprehensive eye examination or a second opinion evaluation, call any of our three convenient Milwaukee-area locations directly.