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Cataracts and Cataract Surgery
Causes
of cataracts
Timing of cataract surgery
Benefits of cataract surgery
Driving
and cataract surgery
Treatment
FAQ’s
Cataracts and
Cataract Surgery
A cataract is the clouding of the normally clear, natural crystalline lens of the eye. The lens is composed of water and protein. The protein is arranged in a highly organized pattern that allows light to pass through it with minimal distortion. As a result, the lens appears virtually clear. The lens can become cloudy (see Causes of Cataracts), blocking or scattering some light and preventing it from reaching the retina in sharp focus. This causes blurred vision and glare. Most cataracts progress slowly over a period of years, but their rate of progression is unpredictable. They can affect one eye or both eyes.
As cataracts become more dense, they produce visual symptoms; these typically include blur, glare, halos around lights, and double vision. Colors can become dull, a brown-yellow tint is common, and driving can become dangerous. Untreated, cataracts can cause blindness. In the U.S., however, cataracts are usually treated when they begin to interfere with activities of daily living such as reading and driving.
There have been remarkable advances in cataract surgery in the past several
years. People used to be required to lie still in bed for weeks and have many
restrictions. Today cataract surgery can be safely performed as an painless
outpatient procedure; excellent vision is usually restored within a week or
two.
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Causes of cataracts
Researchers continue to study
cataracts, but their cause remains uncertain. However, there are certain risk
factors associated with cataracts, they include:
Timing of cataract surgery
The decision to proceed with
cataract surgery should be made with your doctor after he/she measures your
vision, examines your eye(s), and listens to your description of the visual
problems you are experiencing. With modern medical technology, cataracts are
routinely treated safely and effectively using microsurgical techniques. Today,
cataract extraction is one of the most successful surgical procedures-about 98
percent of all cataract surgical procedures result in improved vision.
During the early stages of cataract development, more frequent changes in your eyeglass prescription may be sufficient to restore adequate vision. Surgery should be considered when the reduced vision caused by cataracts begins to interfere with normal daily activities such as reading and driving, even when corrective glasses are used. Although the potential risks of surgery must be weighed against its potential benefits, delaying surgery can lead to accidents when driving as well as personal injury such as falls. In addition, the surgical removal of advanced cataracts is more difficult than the removal of less dense cataracts.
You may have other specific visual problems you want to
discuss with your eye doctor.
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Benefits of cataract surgery
In the mid- and late 1990s, numerous medical studies were
conducted to help us understand how cataract surgery affects the quality of life
of older people. One study, conducted by the Johns Hopkins University School of
Hygiene and Public Health, found that patients who had cataract surgery enjoyed
an improvement in their quality of life, reflected in their driving skills,
community activities, home activities, and mental health.
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Driving and cataract surgery
More recent studies continue
to document cataract surgery's benefits. A study published in the Journal of the
American Medical Association found that older people who have cataract surgery
reduce their chances of having a car accident by more than 50 percent.
In addition to greater safety, those who had cataract surgery enjoyed other benefits. People who didn't have the surgery drove much less than those who did, logging only half the number of passenger miles. This could be an indication that cataracts cause patients to limit their mobility. The study's authors note that the limitations on driving, an ability that may be needed to commute to work or an activity site, could have a significant impact on the quality of life for someone who wants to remain active.
Despite the proven benefits, many patients are reluctant to have cataract surgery. They may delay it because of a lack of family support, the need to address other chronic conditions, or the mistaken perception that cataract surgery requires a significant amount of time for recovery.
Today, most cataract operations are performed in an
outpatient setting and do not require admission to a hospital. Twenty years ago,
thick glasses were prescribed so that people who had cataract surgery could see.
In the past two decades, however, small artificial lenses that can be implanted
in the eye have been developed. These intraocular lenses (IOLs) can provide good
distance vision with thin glasses or, sometimes, without glasses at all.
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Treatment
At present the only treatment for a cataract is
surgical removal. Fortunately, there have been tremendous advances in cataract
surgery in the past several years. The chance of recovering good vision after
surgery is now excellent, although complications can occur in one to three
percent of patients. There is remarkably very little discomfort after
cataract surgery.
The most common method of cataract removal is Phacoemulsification. In this technique a tiny vibrating ultrasonic probe creates high energy sound waves that break the cataract into smaller particles. These particles are gently suctioned out of the eye. Using a small incision speeds up healing after surgery.
The preferred method to restore vision for nearly all of our patients after cataract removal is to implant an intraocular lens implant into the eye at the time of surgery. This clear artificial implant is placed in the eye behind the iris and pupil in the same position as the natural lens, and it stays in the eye permanently.
Implanting an intraocular lens adds little additional
risk to the surgery. Recent developments in the intraocular lens industry
have now provided us with multifocal lenses that allow patients to see distance
as well as near vision without glasses. Patients now have a number of lens
options to choose from.Patients who have certain unusual eye conditions might
not be good candidates for intraocular lens implantation. We will discuss this
with you when planning your surgery.
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What are cataracts?
A cataract is an opacification (clouding) of
the natural lens inside of the eye. The lens helps us focus on objects at
different distances. As a part of the normal aging process, changes in the lens
can cause it to become cloudy. Left untreated, a cataract can become so dense
that it causes blindness. In fact, cataracts are the leading cause of blindness
in the world. The original meaning of "cataract" is "waterfall," and the name
was chosen because distorted vision caused by a cataract reminded people of the
distorted view that is obtained when looking through a waterfall.
Who gets cataracts?
Most people who develop cataracts are older
than 60 years. Cataracts in older people are so common they can be regarded as
normal part of the aging process. Among the major conditions related to
cataracts are diabetes or injury to the eye. Medications such as steroids can
also cause cataract formation. In rare cases, congenital cataracts are present
at birth. These cataracts are usually related to the mother having German
measles, chickenpox, or other infectious diseases during pregnancy or to the
child having certain syndromes (e.g. Marfan's). Some cataracts are inherited.
What are the symptoms of a cataract?
Typical symptoms include:
These symptoms can also be signs of other eye problems. If you have any of them, consult an ophthalmologist for an eye examination.
How do I decide to have surgery?
Most people have plenty of time
to decide about cataract surgery. Your doctor cannot make the decision for you,
but talking with your doctor can help you decide.
How can cataracts be treated?
The natural lens of the eye that
has been damaged by a cataract is surgically removed and then replaced with a
clear artificial lens. During the surgery, usually done on an outpatient basis,
a tiny incision is made in the eye and the cataract-damaged natural lens is
removed through the incision. An artificial lens is then inserted through the
same incision. Most patients have significantly improved vision after the
procedure.
Can a cataract return?
A cataract cannot return because the
entire lens has been removed. However, in as many as half of all people who have
extracapsular surgery or phacoemulsification, the lens capsule (the tissue bag
that supports the replacement lens) becomes cloudy. This cloudiness can develop
months or years after surgery. It can cause the same vision problems as the
original cataract.
The treatment for this condition is a procedure called a YAG laser capsulotomy, which is named for the material used to generate the laser energy (yttrium-aluminum-garnet). The doctor uses a laser (light) beam to make a small opening in the capsule through which light can pass unimpeded. This surgery is painless and does not require a hospital stay. Most people see well after a YAG capsulotomy. Your doctor will discuss the risks with you.
What are the benefits of cataract surgery?
Cataract surgery
restores quality vision for millions of patients each year. Good vision is vital
to an enjoyable lifestyle. Numerous research studies show that cataract surgery
restores quality-of-life functions including reading, working, moving around,
hobbies, safety, self-confidence, independence, daytime and nighttime driving,
community and social activities, mental health, and overall life
satisfaction.
What are the risks of cataract surgery?
Cataract surgery is
performed millions of times every year in the United States. In fact, it is the
most commonly performed surgery in the U.S. About 98 percent of patients have a
complication-free experience that results in improved vision. Nevertheless,
cataract surgery has risks and complications. Most complications resolve in a
matter of days to months. In rare cases, patients lose some degree of vision
permanently as a result of the surgery.
Is it still necessary to wear thick glasses after cataract
surgery?
No. Today, cataract patients who have artificial or intraocular
lenses (IOLs) implanted during surgery may only need reading glasses for close
vision. Patients who do not receive IOLs wear contact lenses for distance vision
and reading glasses for close vision. Some patients choose to wear multifocal
contact lenses for all distances.
How successful is cataract surgery?
Cataract surgery has an
overall success rate of 98 percent. Continuous innovations in techniques and
instruments allow cataract surgeons to treat more patients while keeping costs
down and improving quality of patient care.
Are lasers used to treat cataracts?
In general, no. In some
cases, the bag-like capsule membrane that supports the artificial lens that
replaces the damaged cataractous natural lens may become clouded several months
after cataract surgery. In that case, a YAG laser may be used to make a clear
opening in the lens-containing membrane.
What kind of doctor performs cataract surgery?
Medical doctors,
MDs, who, after completing medical school and an internship, have had 3 or more
years of special training in eye diseases and surgery, are called
"ophthalmologists." Only ophthalmologists who have had special training in eye
surgery are allowed to perform cataract surgery.
