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.
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 ophthalmologists at New England Eye Center offer our patients the best cataract surgery throughout the Boston area.
What is a cataract?
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
What causes a cataract? Who gets it?
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.
When is a cataract ripe?
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.”
What happens if a cataract is left alone? Is it dangerous?
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.
How is the surgery done?
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.
Can it be done with laser?
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.
Can a cataract recur?
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 Cataract Surgery
What is the success rate?
This is one of our most successful surgeries. Approximately 98% of patients experienced improvement in their vision after the cataract surgery was performed. 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.
Physical activity after surgery
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.
How long does a lens implant last?
There are no signs to indicate that a lens implant will “wear out.” They should last the life of the patient.
Can surgery be done on both eyes at the same time?
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.
Preparation for surgery
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: