Cataract:

Perhaps no vision problem is as prevalent in our older population as cataract. While it can certainly affect younger people as well, it clearly becomes increasingly more common the older we get.

Simply stated, a cataract is a cloudy lens inside the eye. It is NOT a growth, not a film, not a covering nor any additional structure in the eye.  It is just a change in the clarity of the lens of the eye, and it probably would be better identified as a cataractous (or "cloudy") lens.  Cataracts can vary tremendously from just a minimal degree of cloudiness, which may have no effect on one's vision, all the way to being fully "ripe."  A ripe cataract, by the way, is one in which the entire lens itself is basically opaque. While the designation of ripe is still a correct term, cataracts generally do not become fully ripe unless they have been in the eye (developing) for many years.

What is the significance of cataract?
If the lens of the eye becomes cloudy enough, it can cause blurring of vision, light sensitivity, glare or a general haziness to the vision. If the problem is in one eye only, it may cause a sensation of visual imbalance such as difficulty reading with both eyes together.  Pain is never a symptom of cataract.  On some occasions, a cataract may not be bothersome to you, the patient, but it may interfere with our ability, as physicians, to properly examine the eye or to treat the eye for other conditions such as glaucoma or diabetic retinal problems.

What is the treatment?
Very early ("incipient") cataracts often require no treatment.  If the vision is not affected, and the cloudy lens is not interfering with other conditions, it may be left alone.  In some circumstances, a change in the eyeglass prescription may temporarily improve the vision although, as the cataract progresses, this effect will usually be lost. At the point where treatment is needed, removing the cataract is the only option.

How are cataracts removed?
The lens of the eye is approximately the size and shape of an "M&M" candy, and it is inside the eye. When it becomes cloudy (cataractous), it must be surgically removed from the eye since there is no way of simply restoring visual clarity while leaving the cloudy lens inside the eye.  Under a local anesthetic, a small incision is made into the eye, and using specialized microsurgical instruments, the cloudy lens is removed. Through that same tiny incision, then, a new (and clear) lens is surgically implanted to replace the cloudy one that was removed. The new lens is plastic, and it is called an
intraocular lens implant.  It is designed to remain inside the eye permanently without its ever having to be replaced. The entire operation usually takes approximately 20 minutes to perform and is done as an outpatient. Unlike the operation of years ago, your activity right after the surgery is not nearly as limited.

Should the cataract be ripe before being removed?
As stated before, a ripe cataract is totally opaque and takes many years to get that way.  With a ripe cataract, you would not even be able to see your hand in front of your face.  Ripe cataracts are usually very dense and very hard (as compared to soft). Modern day cataract surgery utilizes an ultrasonic tip to fragment the lens inside the eye and then remove it by a suction type device. The softer a cataract is, the more easily this is accomplished. There is less surgical manipulation, and there are fewer complications.  So you should NOT wait until the cataract is truly ripe. This would also deprive you of many years of having the enjoyment of clear vision as well. The term that is preferred is
ready rather than ripe.  A cataract is ready (to be removed) when it is creating a problem for you, the patient, whatever that is or, less commonly, when its presence is interfering with our ability as ophthalmologists to treat the eye for other problems.

Will the new plastic lens provide clear vision both far away and close up?
Under usual circumstances, the artificial lens (IOL) is a single focal point lens.  Generally, we want to use a lens that will get your eye into focus for distance vision (with or without eyeglasses) and then have you wear your usual reading glasses or bifocals afterwards.  New technology has brought about the multifocal lenses such as the Restor, Rezoom and Crystalens.  These are lenses which can focus light rays from distance and from close up at the same time.  They work best when used in both eyes, and their purpose is to get you to be able to see most everything you want to see, distance and close up, WITHOUT needing glasses after the surgery.  Not all patients are candidates, and the decision to use these lenses must be made on a highly individualized basis.  Talk to one of our doctors is you are interested in this technology.

How about removing the cataract by laser?
We have said that the cataract is a solid structure inside the eye.  Laser beams can burn tissue, disrupt its structure or "vaporize" it, but they cannot make any tissue simply disappear into nothing.  No matter what, the cataractous lens material must still be surgically taken out of the eye. Therefore, lasers simply CANNOT remove cataracts.  An operation is needed. The reason for the popular misconception is probably that the highly technical ultrasonic fragmentation equipment that we use has been miscalled a laser.

Is the surgery safe and effective?
You bet it is! Modern day cataract surgery has a success rate well into the high 90% range.  While problems may occur (as with any operation), it enjoys one of the highest levels of safety and efficacy of any operation done on any part of the body.  Our ophthalmologists have had state-of-the-art training, are familiar with all the aspects of cataract surgery and routinely perform this operation regularly.

If you are experiencing progressive blurring of vision, increased glare sensitivity or haziness, let us examine your eyes. If cataract is the problem, it is comforting to know that it is readily and safely treatable.

 

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