Cataracts

One of the most common causes for poor vision as we mature is cataract formation. The clear lens inside our eye gradually becomes harder and less transparent, eventually blocking the passage of light and reducing vision. The symptoms of a cataract vary. Common complaints include difficulty reading and seeing at distance, halos around lights at night particularly while driving, and glare or dazzle noted with bright lights, which reduce the ability to identify objects.

The decision to have the cataract removed depends on your needs and activities. Certain individuals desire high quality vision for activities such as golf or driving and feel a mild cataract is bothersome, while others are only mildly bothered by a more advanced cataract and do not feel the need to have anything done. It is essential to understand that cataract surgery is almost always an elective procedure and should be done only if you feel the decreased vision interferes with your ability to work or perform activities which you enjoy. Formerly the physician would tell the patient when the cataract was “ripe” and needed to be removed. I feel that the decision to have surgery should be shared between the patient and the physician, to be considered after we find that changing your glasses is not helpful, and following an extensive discussion of the risks and benefits of surgery.

Improvements in technology have changed cataract surgery enormously. Cataract surgery is one of the most successful and safe operations in medicine. Overall, 98% of cataract surgeries are successful. In fact, cataract surgery is so safe, that patients have a tendency to assume that it will go perfectly. Although uncommon, complications can occur either from difficulties during the operation due to the delicate manipulations required inside the eye, from abnormalities within your eye or your own individual healing response. In extremely rare situations the vision in the operative eye can be lost completely due to infection or bleeding or a second operation may be necessary to completely remove the cataract or repair the retinal tissue in the back portion of the eye. The most common serious complication, occurring in 3% (or more in diabetics) of operations, is called macular edema where fluid may collect in the central part of the retina and cause distortion and blurring. In most patients, this clears over time. Another common side effect of surgery is clouding of the clear membrane (the capsule) which holds the implant. This is called a secondary cataract and may happen weeks, months or even years after the operation. It is possible to use a laser to open the capsule and restore vision. Prior to the procedure, we require clearance from your doctor to be sure that the operation will not interfere with any other medical conditions that you may have. We also need to take a measurement of you eye to determine the power of the implant to be placed in the eye. We will provide you with the forms for your medical doctor and an appointment for the measurement of the eye.

As a result of modern technology, the procedure is straightforward. It is performed at an ambulatory surgery center (in and out the same day), the Specialty Surgery Center designed specifically for eye surgery. You arrive at the center about one hour before the surgery and are prepared by the staff. You are given medications to take the edge off the normal amount of nervousness that accompanies any surgery. The technique we use for the cataract surgery is the most advanced, requiring no sutures (stitches), so the operation only takes 10 minutes if it is uncomplicated. There are not any shots or needles necessary, just drops, so a patch is not required after the operation in most cases. After the surgery you are taken to the recovery area where you have something to eat and then you can leave in approximately one hour. The vision will probably be blurred immediately after the operation, but generally it will begin to clear the following day with best vision obtained within several days to one month. It is not uncommon to note halos around lights or a red tint to objects particularly in bright light for a day or two after the surgery. You will begin using drops the day of the operation. It is required that you be driven to and from the surgery center and probably driven to the office the next day. It is usually possible to return to work or to your normal activities within several days.

You will be seen the day after surgery, and then followed at appropriate intervals. You will use drops for approximately one month, or more if necessary. We advise all patients to wear a shield over the eye at night for the first week to prevent inadvertently rubbing your eye while asleep.

After approximately two weeks to one month, we will measure your eye to determine the change in your glasses necessary to obtain best vision. Many patients will be able to perform some activities without glasses but will still need them for driving, watching television or for fine acuity at distance. The implant is not a bifocal, so most patients require reading glasses for fine print or extended periods of reading.

If you are interested in surgery, let us know and our surgical coordinator will contact you to make arrangements at your convenience.

I hope this information has been helpful. We would like to take this opportunity to thank you for the trust and confidence you have placed in our staff. We will do everything in our power to reward that trust as we work toward solutions to present and future problems you may have with your eyes.