CATARACTS

WHAT IS A CATARACT?
The natural lens is the fine focusing control of the eye.  This lens is located behind the pupil and focuses light onto the retina in the back of the eye so that we can see clearly.  Much as the lens in a camera is focused, the lens in your eye is designed to focus light rays to give you a clear picture.  The crystalline lens of the eye is normally transparent. When the lens becomes cloudy, it is called a "cataract". The word cataract comes from the Greek word for waterfall, as it was once thought that a cataract was formed by opaque material flowing into the eye. A cataract obstructs or deflects the light rays, preventing them from reaching the retina in a sharp focus, and a decrease or distortion in vision results. A cataract is NOT a film over the eye or the lens; it is NOT a tumor or growth in the eye, and it is NOT caused by overusing the eyes. It is simply the natural lens of the eye that has become cloudy.

Symptoms of a cataract include blurred vision, double vision in one eye, sensitivity to light and glare, distortion or ghost images, dimming of colors, and decreased depth perception. Often, a brighter light is needed to read.  Poorer night vision may also be a symptom of cataract.  A cataract is diagnosed by examining the inside of the eye with a slit-lamp microscope.

HOW DO CATARACTS AFFECT US?
Cataracts are the number one cause of poor vision among older adults.  Over two-thirds of the population over age 60 have a vision problem from cataracts. Cataracts are actually formed as a normal result of aging and can be aggravated by injury, ultraviolet light, drugs, systemic and ocular disease. People with blurred vision from cataracts often find that daily activities such as driving, reading, watching TV and even walking have become increasingly difficult.  Besides blurry vision, glare, rings around lights, and increasing near-sightedness are common symptoms of cataracts.

WHAT TREATMENTS ARE AVAILABLE?

There are no known drops, eye exercises, or medications which will significantly slow the growth of, or eliminate, a cataract. A new eyeglass prescription can sometimes offer some compensation, but it is often only a temporary measure.  Rarely, with a very localized, central opacity, dilating drops can be used to delay the inevitable need for surgery.  Eventually, as a cataract progresses, new glasses or drops will not improve vision, and cataract surgery is the only effective treatment.  Contrary to a common misconception, laser treatments alone cannot be used to remove primary cataracts, but can be used to treat several other eye problems, including clouding of the lens capsule following cataract surgery.  Once the cataract impacts an individual's quality of life, surgery may be needed to improve vision. This treatment involves removing the cloudy lens and replacing it with an artificial lens, either a fixed or a "multifocal implant".

HOW IS THE CATARACT REMOVED?
There are several different surgical methods available to remove cataracts.  All modern techniques include the use of an operating microscope and microsurgical instruments. In standard extracapsular cataract extraction, a small incision is made in the front outer surface (capsule) of the cataract (natural lens), and the cataract (nucleus) is mechanically extracted; residual fragments are then aspirated through a 1/8 inch opening leaving the posterior capsule intact.
The most common extracapsular technique is called "phacoemulsification". This technique utilizes an ultrasound probe introduced through a very small incision to break up the cataract and aspirate the fragments.  Then, an intraocular lens implant (IOL), a small, precision man-made lens, can be inserted into the capsular bag. Implants are more natural than contact lenses because they remain in the eye exactly where the cataract had been and do not have to be removed, cleaned or reinserted.  The surgical incision is meticulously designed so that it can seal without sutures. The benefits of the small-incision, sutureless, cataract procedures include a faster recovery of vision. In some cases, a buried suture may be used for increased safety.  New foldable implant designs have been introduced to allow the insertion of the implant without enlarging the small incision.

We prefer extracapsular cataract surgery utilizing phacoemulsification.  The rate of complications is reduced because the posterior capsule acts as a natural barrier in the eye. This reduces the risk of compromised vision from swelling of the retina in the back of the eye.  There is also a reduced incidence of retinal detachment. Diabetics also have less complications with this approach.  Laser probes are becoming available as an alternative to ultrasound probes, but offer little advantage over current phacoemulsification instruments.

In summary, the specific technique of planned surgery is based on a patient's age, cataract type and other factors.  Our ability to modify techniques allows us to also improve such co-existing conditions as astigmatism. Investigational lasers are being used as an alternative to ultrasound to break up and remove a cataract. Lasers may be used for better glaucoma control prior to cataract surgery and other lasers can be used to open the capsule of a cataract, but surgery is still required to remove the cloudy cataract and implant an intraocular lens.

ARE THERE RISKS WITH SURGERY?

To restore quality of life, cataract surgery can improve one's ability to perform normal activities. Even with successful cataract surgery, your eye may not see as well as you would like.  Other problems such as retinal swelling, macular degeneration, glaucoma or diabetes may limit vision after surgery. Despite the small risk of such problems, cataract surgery is almost always beneficial.  The surgery is performed on an outpatient basis and normally takes less than 30 minutes to complete.  If your eyes are otherwise healthy, the chances of restoring good vision following cataract surgery are excellent. 

CAN A CATARACT COME BACK?

In modern surgery, the clear posterior capsule surrounding the cataract is left in place to provide support for the implant and to reduce the risk of retinal swelling, retinal detachment, and vitreous loss. This capsule, due to normal healing, can gradually become less clear.  This is known as a cloudy capsule or 'secondary cataract'.  The cloudy posterior capsule can be cleared centrally with a YAG laser. This is a quick, relatively simple, painless office procedure, requiring only eyedrops for anesthesia.  Visual return is virtually instantaneous.  

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