Cataracts and Cataract Surgery

What is a cataract?

A cataract is a gradual clouding of the natural lens of the eye, which is behind the iris, or colored part of the eye. It is usually a result of normal aging changes, but may be affected by certain diseases or medications or prior retinal surgery.

What causes cataracts?

Cataract development is generally related to aging. Other potential causes of cataracts include genetic disorders or medical problems (such as diabetes), injury to the eye (recent or in the past), medications, long-term unprotected exposure to sunlight and previous surgery.

What are the symptoms of a cataract?

The first symptom is usually glare when light is shining towards the eyes, such as with oncoming traffic during night driving. This symptom gradually worsens, so that vision is blurred even with good lighting conditions. Sometimes near (reading) vision is the most affected, sometimes distance, and sometimes both. Occasionally double vision occurs in an eye with cataract. The following can all be signs of cataracts:

• Painless blurring of vision
• Glare or light sensitivity
• Prescription changes
• Double vision in one eye
• Needing brighter light to read
• Poor night vision
• Fading or yellowing of colors

How are cataracts detected?

A complete eye examination by your ophthalmologist can detect the presence and degree of a cataract, as well as any other ocular conditions that may be causing blurred or decreased vision. There may be other reasons for visual loss in addition to a cataract, such as problems involving the retina or optic nerve. If any of these additional problems are present, perfect vision after cataract surgery may not be a reasonable expectation. Such conditions may limit the visual potential for an eye. It is very important to identify these problems, if present, prior to cataract surgery because depending on their extent, cataract extraction may not result in an improvement in vision. Your ophthalmologist may be able to tell you how much visual improvement is likely following cataract surgery.

What is the treatment for a cataract?

The only way to remove a cataract is with surgery. However, if symptoms from the cataract are mild, a change in your glasses prescription may be all that is needed for you to function comfortably. When surgery is necessary to improve vision, the majority of patients receive phacoemulsification with lens implantation. The patient is given pain control medication in the form of drops in the operative eye, and typically some light sedation via an IV. They are able to leave the day of surgery (outpatient surgery).

When is surgery necessary?

Cataract surgery should be performed when cataracts cause enough vision loss to interfere with daily activities. Cataracts are a normal change that comes with aging and are typically not damaging to the eye. The patient can generally expect the same results from surgery regardless of when the surgery is performed. For this reason, the surgery is considered elective and the patient can decide if and when he or she wants to have. This decision is based on how the cataract affects the patient’s daily activities and the patients overall health. For most people, the important issues are driving or reading, but the need for surgery may also be based on recreational activities (golfing, hunting, sewing) or work.

Occasionally, the surgeon will advise his or her patient to have cataract surgery because of a need to treat or better diagnose retinal pathology or because of inflammation or glaucoma in the eye. Your ophthalmologist can help you with the decision about surgery under these circumstances.

How is cataract surgery performed?

Cataract surgery is performed on an outpatient basis with local anesthesia. The patient is awake, though lightly sedated, and does not feel the surgery. The procedure itself generally takes 15 to 20 minutes, but there is additional preoperative and postoperative time. During the surgery the natural lens of the eye is broken up into smaller fragments using ultrasound power, and suctioned from the eye. This process called phacoemulsification. The clouded lens is then replaced with an artificial intraocular lens (implant) in order to restore vision. There is typically no pain following surgery and the patient can be active as soon as the sedation wears off.

How successful is the surgery?

If an eye is otherwise normal and healthy, the chance for a good result with improvement in vision approaches 98 percent. The risk of serious complications is extremely low.

How soon will I see from the operated eye?

Most patients have improved vision as soon as the bandage is removed, which is generally the day after surgery.

Will I need glasses after cataract surgery?

This depends. Most patients achieve good vision without glasses but maximum vision may require some glasses. Individual variations in each patient’s eye determine how well he/she sees after surgery. Each patient should discuss their unique situation and the choices available to them with his or her surgeon. These options currently include monofocal, toric, and multifocal or accommodating lens implants, which are available to correct both distance and near vision and astigmatism when the patient’s eye meets selection criteria.

How fast is the recovery from cataract surgery?

Most patients will have improved vision in the operated eye the day after surgery. Strenuous activity, such as heavy lifting, or activities which might lead to risk of a blow to the eye or foreign material entering the eye, should be avoided for several weeks. On the other hand, normal non-strenuous activities including bending, lifting, walking, reading and driving can be resumed as soon as the day after surgery.