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Cataracts
A cataract is cloudiness in the usually clear
lens of the eye. Common cataract symptoms include poor night vision,
sensitivity to light, a painless blurring of vision and a fading
or yellowing of colors. Cataracts may develop slowly, over a Period
of years, and may not be immediately apparent if the cloudiness
is not near the center of the lens.
Cataracts are most commonly caused by aging, but
may be related to family history, eye injury, eye surgery or some
medications and long-term exposure to sunlight.
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A cataract may cause
cloudy or blurred vision.
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Surgery is the only method of removing a cataract,
though a change of glasses may be sufficient to correct the vision,
if the symptoms are mild.
The eye is very much like a camera. They both
have an internal lens that focuses an image onto film. In the eye,
the lens is focused using muscles rather than your hand, and the
film consists of a thin film of nerves called the retina. If the
lens in the camera were to be smudged or scratched, your pictures
would be blurred. Similarly, when the lens in your eye becomes cloudy,
you see the world as blurred or not clear. When the lens becomes
cloudy, we call it a cataract
Everyone eventually gets cataracts if they live
long enough. It is part of aging, much like getting gray hairs.
Aging is the most common cause of cataracts. Other causes include
medical conditions such as diabetes and medications such as certain
steroids. Some people are born with cataracts, and some develop
a cataract after trauma.
Different people have different visual needs.
If you are visually limited from performing your daily activities
from cataracts, then you may be a candidate for cataract surgery.
One does not have to wait until the cataract is "ripe."
Leaving a cataract in the eye is not dangerous
except for rare situations. Cataracts in general do not harm the
eye. In most cases, surgery can be postponed for as long as the
patient desires or not done at all. The only side-effect would be
the bluffed vision from the cataract. With time cataracts do increase
in size and hardness, and if the cataract is very advanced, the
surgery can be slightly more difficult to perform. However even
in these situations the result is usually very good.
In the not so distant past, cataract surgery used
to involve making a large incision to remove the cloudy lens, and
patients were often brought into the hospital overnight or for several
days. Now with the aid of new technologies, the surgery can be performed
through a very small incision, less than 1/8th of an inch, and the
recovery time is significantly shorter. Through this small opening,
a slender instrument can gently break up the cloudy lens using sound
waves and remove the pieces by vacuum. This process is called phacoemulsification.
Once the cataract has been removed, a new clear
implant lens is folded, inserted through the small incision, and
allowed to open up in the same "bag" that used to hold
your own lens in place. In some cases, an implant lens may not be
implanted, or a different type of lens implant may be placed outside
of the "bag" if your surgeon feels this is best for your
eye.
The surgery typically takes 20-40 minutes to perform
and is done as outpatient surgery. This means that the patient has
the surgery and goes home on the same day. It is performed with
local anesthesia and thus does not carry the risks of general anesthesia.
After the surgery, the patient typically goes to the recovery room
and then home.
Cataracts are removed with sound waves not laser
light. In 20-30% of patients undergoing cataract surgery, a thin
film of scar tissue will form behind the implant lens and cause
the vision to be blurred. Often patients will feel that their cataract
has "grown back." In these cases, an opening can be made
in the scar tissue with a laser, and the vision will usually be
restored. Some people hearing of this might think that all cataracts
can be removed with laser.
No. Once the cataract has been removed, it will
not recur. Sometimes a thin film of scar tissue can form behind
the new lens implant, creating blurred vision and the sense that
the cataract has recurred. However, this thin film can usually be
easily treated with a laser and does not require repeat surgery.
What to expect from surgery
This is one of our most successful surgeries.
Approximately 98% of patients exPerience improvement in their vision.
How much improvement is dependent on the initial health of the eye;
certain diseases of the retina can limit the final visual result.
As with any surgery, there are risks associated
with cataract surgery, and complications (such as bleeding, infection,
corneal decompensation, macular swelling, and retinal detachment)
can occur during or after surgery in spite of the best care. It
is impossible to predict in which patients these complications will
occur. Fortunately, the risk of these complications is quite low.
After surgery, you will be seen in the clinic
to ensure that you are healing properly. Typically these visits
occur 1 day, 1 week, and then 1 month after surgery. During this
time you will also be using eye drops to help the eye to heal.
On the morning after surgery, your eye patch will
be removed, and you can often begin using the eye. The vision is
usually blurred from ointments and from swelling associated with
the surgery, but over the following weeks, the vision will usually
progressively improve. At one month after surgery, the eye is typically
healed and ready for a refraction for new glasses.
Your surgeon will discuss with you any limitations
on your physical activities. In general, you can resume most of
your normal activities but will be asked to minimize lifting, bending,
and straining for the month after surgery. Carrying a purse, light
briefcase, or a small bag of groceries is usually fine. You will
also be asked to avoid getting water in the operated eye for 1 to
2 weeks. Although water from the shower or tap is safe for showering
and drinking, it still has some bacteria and can cause an infection.
Lastly, your surgeon may give you a shield to wear over the eye
at bedtime; this is to protect you from rubbing or pressing on the
eye in your sleep.
As for returning to work or driving, this varies
from one patient to another. This should be discussed with your
doctor.
There are no signs to indicate that a lens implant
will "wear out." They should last the life of the patient.
No. It is best to perform the surgery on one eye
at a time so that you can use one eye while the other is healing.
Once you and your doctor have decided to do cataract
surgery, you will need to be measured for a lens implant. This is
usually done in the clinic. You will then need to meet with the
anesthesiologist and your medical doctor to make sure you are healthy
enough to undergo the procedure. When the surgery date is set, you
will be given a list of preoperative instructions.
Additional sites pertaining
to cataracts:
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Cornea, External Disease & Cataract Features
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