What is a cataract?

The lens is a part of the eye that helps to focus light on the retina. The lens lies behind the iris and the pupil. The lens is made mostly of water and protein. The protein is arranged in a precise way that keeps the lens clear as light passes through it. Much like an old camera in which the lens focuses light onto film where the image is recorded, the lens of the eye focuses light onto the retina where it is changed to nerve signals that are sent to the brain. In either situation, if the lens is not clear it does not allow light to pass through it properly and the result is a poor image. When the lens of the eye is clear, it is simply referred to as the lens, but when it becomes cloudy it is then diagnosed as a cataract.

HOW DOES A CATARACT DEVELOP?

As we age some of the protein may clump together and start to cloud the lens. Over time the cataract may progress and cloud more of the lens making it harder to see. There are several stages of cataract development and more than one type of cataract.

An early cataract is called an incipient cataract and at this stage it does not have much effect on vision and simply needs to be monitored for progression. This is one reason that we recommend yearly dilated eye exams. As a cataract progresses, it is graded from trace to 3+ or mature.

There are several different types of cataracts including:

Congenital – some babies are born with cataracts or develop them in childhood.

Traumatic – cataracts can develop after a traumatic injury to the eye, sometimes even years later. The severity of this cataract is related to the amount of trauma to the eye.

Nuclear Sclerotic – this is the most common type of cataract caused by the aging process. This aging causes a hardening and yellowing of the nucleus in the center of the lens. This type usually changes slowly and causes changes in a person’s eyeglass prescription.

Cortical – this type forms in the outer layers of the lens. This type of cataract can look like white spokes in a wheel pointing towards the middle of the lens.

Posterior and Anterior Subcapsular – this type develops under the capsule (bag) that surrounds the lens. Steroid medication use and high myopia are risk factors for this type of cataract.

It is possible for a patient to develop more than one type of cataract.

How can cataracts affect vision?

The most common symptoms of a cataract are:

  • Blurry or cloudy vision
  • Colors seem faded
  • Glare – headlights, lamps, or sunlight may seem too bright
  • Halos – lights have a ring or starburst around them
  • Double or ghost images
  • Frequent changes in glasses or contact lens prescriptions

Be aware that these symptoms can also be a sign of other eye problems.

When is cataract surgery recommended?

In the past, it was often said that cataract surgery was not necessary until the cataract was “ripe”; however, with the advancements made in cataract surgery this is no longer true. There is no exact moment in cataract development that surgery is recommended. Due to varying tolerance levels and lifestyle differences, patients are bothered by cataract changes at different stages of development. When a cataract is interfering with daily activities and vision cannot be improved to a satisfactory level with a new glasses prescription, brighter lighting, anti-glare glasses, or magnifying lenses then it is reasonable to consider surgery. In some cases a cataract should be removed even if it doesn’t interfere with vision. For example, if it prevents examination or treatment of another eye problem, such as diabetic retinopathy or macular degeneration. Once a patient understands the risks, benefits, alternatives, and complications, they can make an informed decision about cataract surgery. Cataract surgery is not a high risk surgery, but the risk involved in any surgery is never nonexistent.

HOW IS CATARACT SURGERY PERFORMED?

Cataract surgery is performed on an outpatient basis. An anesthesiologist administers medication to provide comfort throughout the procedure. Operating time is only about ten to fifteen minutes; however, patients should plan about two hours at the surgery center for the entire process.

Upon arriving at the surgery center, patients begin the process in the pre-op area. Here, eye drops will be administered and an IV will be started for medication administration. Patients are asked to wear comfortable clothing and a shirt that buttons down the front so that EKG leads can be easily placed. Patients are not asked to change clothes but we do ask patients to leave all valuables at home.

Once in the operating room a shield will be placed over the non-operative eye for protection. A surgical drape is placed over the surgical eye to maintain sterility. Patients are positioned for comfort, oxygen is administered, and vital signs are monitored.

Additional anesthetic medication is applied to the eye. A small incision is made at the edge of the cornea. The Surgeon gains access to the cataract through the dilated pupil. The top section of the capsule is peeled away, then ultrasound is used to break up the cataract. The pieces of the cataract are irrigated and aspirated away. Now that the cataract is removed, a clear artificial intraocular lens is used to replace the lens of the eye so that light can pass through clearly and once again be focused on the retina. Because a “flap incision” is used, stitches are not necessary in the majority of cases. For this reason a shield is placed over the eye after antibiotic ointment is applied and patients are asked not to apply any pressure to the eye. The shield will be removed at the first post-op appointment in the Doctors office. If a patient has a cataract in the other eye it can be scheduled for surgery once the first eye has healed to a satisfactory level.