No one knows why some cataracts develop rapidly and others slowly. Generally, the clouding of the lens is a slow, gradual process that may take decades. On the other hand, with some conditions, such as poorly controlled diabetes, a cataract can progress rapidly.In addition to standard Small Incision Cataract Surgery, the Wohl Eye Center now also offers Laser Cataract Surgery (sometimes referred to as “Bladeless Cataract Surgery”).
Laser Cataract Surgery is performed with the LenSx femtosecond laser which allows the surgeon to make incisions inside the eye with a computer controlled laser beam. This greatly improves accuracy and predictability of the incisions, reduces the phaco time and thus the amount of energy dispersed in the eye while removing the cloudy lens and provides additional options to correct astigmatism through computer controlled corneal relaxing incisions. Laser Cataract Surgery is a premium procedure usually requiring additional out of pocket expenses for the patient.
Frequently Asked Questions
What Causes a Cataract?
Cataracts are not caused or made worse by using or “overusing” your eyes. Most cataracts develop as part of the aging process, from a change in the chemical composition of the lens. Several major studies have shown that prolonged exposure to sunlight over many years, especially the ultraviolet-B rays, can hasten their development. Mostly they don’t become a problem until your 60s or 70s. If everyone lived long enough, we would all develop cataracts.
Cataracts can also occur at any age from an eye injury (even many years earlier), certain eye diseases (such as uveitis), medical conditions (such as diabetes), heredity, birth defect, some medications (such as steroids, diuretics, tranquilizers), excessive alcohol consumption, and smoking.
How Do You Know if You Have a Cataract?
In the early stages, a cataract may not cause any symptoms at all, or you may notice a gradual blurring or dimming of vision. Using a bright reading light may help you see better (but it may also make vision worse!). You might not notice even a dense cataract in one eye if your other eye sees well. You may see “halos” or haze around lights, especially at night, and/or have hazy or double (or multiple) vision. The symptoms may occur only in dim light or when you face bright oncoming car headlights, which makes night driving difficult.
Eye pain, headaches, and eye irritation are not symptoms of a cataract. Unless a cataract is very dense and white, it will not be visible to a casual observer.
How Are Cataracts Treated?
Once a cataract has formed, it cannot be reversed. Some studies show that antioxidants such as vitamins C and E may help slow the process or even reduce the risk of developing cataracts. Another study indicates that other nutrients may also play a role. Polyunsaturated fat and protein may also be protective. But other so-called “treatments,” such as medication or exercise, do not help at all.
The only effective treatment is surgical removal of the cloudy lens. Cataract surgery is one of the safest operations performed today. The high success rate (about 95%) is due to advances in microscope technique, high-tech precision instruments, and ultra fine needles and sutures.
If the cataract is small, surgery may be postponed for a while by changing your glasses prescription. If you have cataracts in both eyes, surgery is rarely done at the same time. You usually wait for the first eye to heal before it is safe to proceed with the second surgery — typically at least four to six weeks.
Cataracts: Surgical Procedure
Who Decides When To Remove a Cataract?
You do. You can postpone surgery until the cataract interferes with your vision so much as to make a difference in your life or livelihood. You will be advised that you are a candidate for the surgery and how much improvement in vision you can expect from a cataract removal that is free of complications. You will then have to decide if the cataract is causing you enough trouble to warrant surgery. Since everyone’s visual needs differ, this point will differ from one person to another. It is not necessary to wait until a cataract is “ripe” (totally opaque) before having it removed.
There are certain rare circumstances that require cataract removal regardless of vision: if the lens begins to break down (become “overripe”), if the lens releases chemicals (breakdown products) that might damage the eye and contribute to a type of glaucoma, or if the cataract is so dense that it prevents observation or treatment of another eye problem.
How Is a Cataract Removed?
The surgery can be done in an outpatient surgical suite or in a hospital. During surgery, your eye remains in its normal position. It is never taken out of its socket.
A small incision is made in the front of the eye and an instrument is inserted into the eye to remove the cloudy lens. There are several procedures for removing a cataract. With the “intracapsular” method (rarely used today), the lens is taken out in one piece along with the membrane enclosing it (called the capsule). With the “extracapsular” method, the front of the capsule is cut and the cloudy lens is taken out.
The newest extracapsular techniques combine small incision surgery with phacoemulsification. With “phaco,” a needle-like instrument that vibrates at high speed is inserted into the cataract to break it up. Then the tiny fragments are gently suctioned out, and an IOL is inserted. The eye incision is closed, sometimes with sutures, sometimes without (“no-stitch” technique).
The latest improvement in Cataract surgery is called “Laser Cataract Surgery”. This technology allows the surgeon to replace the manual incisions with computer controlled laser cut incisions inside the eye. This is a premium procedure available at an additional cost to the patient.
Will You Be Awake During the Operation?
Most people choose to stay awake (though drowsy) with a local anesthetic to numb the nerves for pain. You will probably be given a sedative to calm you, then the anesthetic, either as eye drops or by injection under the eye. The injection also paralyzes the eye muscles, to keep the eye still during surgery. The lids may be separately injected with a local anesthetic to keep you from squeezing them during surgery. (The injections sting for only a few seconds.)
Sometimes general anesthesia is recommended: if you are especially frightened and don’t wish to stay awake during the procedure; if there is a chance you might not be able to hold still; or if you have claustrophobia and cannot tolerate having your face covered during surgery. Children always need to have general anesthesia.
When Can Normal Activity Be Resumed?
You will probably be up and around on the day of surgery. In a day or so, it will be safe to use your eyes for reading or watching TV. Depending on the procedure used and the size of the incision, you should be able to resume full, normal activity in a few days, but you may be urged to wait for a month or so if your usual activities are strenuous.
What Will Vision Be Like After Surgery?
Your vision after surgery will depend on many factors, such as your vision before the cataract developed and the eye’s overall condition. Because the surgery removes the natural lens from your eye, it also depends on how your eye will be optically corrected.
If you have an intraocular lens (IOL) implanted during surgery, normal vision should be fully restored within a few weeks or even sooner. An IOL is a permanent replacement for your natural lens. After it has been placed inside your eye, it requires no care. You cannot feel or see it, and others do not notice it. Today, almost all patients having cataract surgery choose to have an IOL.
Even though vision can be good with a traditional IOL, you may require some correction for reading and probably a correction to fine-tune your distance vision. (A multifocal IOL is now available will reduce the odds that you will be dependant on reading glasses. Please visit our section on ReSTOR to find out more about this new and exciting IOL option.
If you are not having an IOL (they are not appropriate for everyone) your vision can be restored with contact lenses or special cataract glasses. Contacts are better optically but not everyone can wear them. Cataract glasses work well but they are not easy to get used to — they are heavy, and they magnify and distort vision. But once you adapt to them, you’ll find the improved vision well worth the effort.
Some patients, even with optical correction, do not obtain clear eyesight after surgery. Some have pre-existing disease affecting the retina (such as macular degeneration) or optic nerve (such as advanced glaucoma). Others develop one of the rare complications of cataract surgery.
What Complications Are Possible?
Any eye surgery, no matter how safe, presents some risk of infection, bleeding, glaucoma, corneal problems, chronic intraocular inflammation, or retinal swelling and detachment. Fortunately, these are usually temporary and/or can be treated with medications or surgery. Rarely, the IOL may be pulled off-center during the healing process, and a second surgical procedure will be needed to reposition or remove it.
Surgical results can never be guaranteed, but the odds are excellent that everything will be fine, and you will see just as well after the operation as you did before the cataract developed, and perhaps even better.
Know your options
When you have cataract surgery you have choices for the kind of replacement lens (IOL) your doctor uses:
Know your Options: Monofocal Lens:
Know your options: Multifocal Lens:
Know your options: Toric Lens:
LenSx Laser Cataract Surgery
AcrySof® IQ ReSTOR® IOL
The ReStor Lens is a multifocal Intraocular Implant Lens.
Patients with both cataracts and presbyopia can have both conditions corrected at the same time, eliminating the need for spectacles after surgery in most patients.
AcrySof® IQ Toric® IOL
Toric lenses are used to correct for astigmatism (irregular shape of the cornea or the lens).
Watch these videos to learn about astigmatism and presbyopia:Understanding Astigmatism