WHAT IS A CATARACT?
It is helpful to think of the eye as a camera. Both the eye and a camera have a lens to focus light rays into a clear image. The camera focuses the light rays on film, whereas in the eye, the lens focuses images on the retina. When the lens is clear, a sharp image is projected on the retina and a good, clear picture results. If the lens is cloudy light is blocked and the image is faint, blurred, and hazy.
A cataract, therefore, is not a growth or a tumor or a film across the surface of the eye but is a clouding of the lens within the eye.
WHAT ARE THE SYMPTOMS OF CATARACTS?
Depending on the degree of cloudiness and where in the lens the cloudiness occurs, a cataract can cause visual symptoms ranging from a slight blur to almost total blindness. Cataracts often take a number of years to develop and usually do not cause problems in their earliest stages. Sometimes glasses can help reduce this blurred vision. However, as the cataract progresses, blurring of the image becomes more severe so that even changing glasses will not help. Although cataracts usually affect both eyes, they seldom progress at the same rate and their progression is very unpredictable. A cataract may take years to develop. At other times, marked haziness can occur within a few months.
WHAT CAUSES A CATARACT?
Cataracts are a leading cause of diminished vision affecting millions of people in the United States. Occasionally babies are born with cataracts, or young people develop them as a result of injuries and certain strong medications. In the vast majority of cases, cataract formation is related to the natural aging process, in fact, more than half of the population over the age of 65 has some degree of cataract development.
Some people develop cataracts earlier than others. Unfortunately, at the present time, there is no medical, dietary or vitamin therapy which can remove cataracts. Research is currently being directed towards the non-surgical treatment of cataracts.
SHOULD MY CATARACT BE REMOVED?
The mere presence of a cataract in the eye does not require its removal. A cataract is removed when vision is reduced so that normal activities are difficult. Removal of a cataract will not alter the course of a cataract developing in the other eye or affect the other eye in any way.
Since visual needs differ, some individuals may select surgery at an earlier time than others.
In most cases, cataract removal does not require the cataract to ripen or to mature but is removed when it compromises one's lifestyle.
HOW ARE CATARACTS REMOVED?
Currently the only treatment for cataracts is to remove them through surgery. Medications do not work to reverse or to take away the cloudiness.
Laser is not currently used to remove a cataract except in experimental surgery. Most cataract surgeries are performed with a no stitch, small incision, self-sealing technique through which an ultrasound liquifies the cataract and suctions it from the eye.
HOW IS VISION CORRECTED AFTER THE CATARACT HAS BEEN REMOVED?
Once the cataract has been removed the eye will need a new lens in order to focus light rays clearly upon the retina. A replacement artificial lens, an implant, is placed inside the eye at the time of the cataract removal. The lens implants are permanent, tiny, clear acrylic lenses and require no cleaning, replacement, or other maintenance. The intraocular lens gives close to normal vision, and there is no sensation that they are in the eye. Prior to surgery, measurements are taken to determine the appropriate power of the intraocular lens for your eye.
Vision after surgery with an intraocular lens implant isn't usually at its best for several weeks. After about six weeks, when the vision has stabilized, adjustments are made in the patient's glasses to achieve the best vision. Glasses and bifocals are still often times needed after cataract surgery.
These figures illustrates different intraocular lenses with newer lens in the figure above
ARE THERE PROBLEMS WITH CATARACT SURGERY?
No surgery, including cataract surgery, is free of potential complications or problems, but cataract surgery is one of the most successful of all surgical operations performed in the United States. Over one-half million operations are done yearly. Despite the fact the eye is one of the most delicate organs, cataract surgery can improve vision about 92% to 95% of the time. Fortunately, the odds of a serious or major complication such as a hemorrhage or infection are less than one in a thousand.
In addition, because we utilize the help of fully trained anesthetists and anesthesiologists, problems associated with anesthesia are extremely rare.
Although potential problems and complications of cataract surgery or the anesthesia associated with it are present, the likelihood of a patient suffering a major complication is rare.
There is also a possibility for secondary cataracts to develop.
WHAT HAPPENS BEFORE SURGERY?
After you have been examined by the doctor and you have decided to have surgery, we will set a date for your surgery and your pre-operative exam. We require approval from your primary care physician to perform this surgery and ask that this be done prior to your pre-operative exam. Our Physician's Assistant will perform a brief physical exam and record your medical history. You should bring all of your current medications with you to the pre-operative exam. There will be time at this visit to discuss any further questions or concerns you may have about the surgery. At this time, you will be given instructions pertaining to your surgery and obtaining the pre-operative lab tests required by the surgical facility.
WHERE IS CATARACT SURGERY DONE?
Cataract surgery is done as an outpatient procedure in the ambulatory surgery facility. The procedure takes about 15 minutes to complete. In most cases the patient can go home within an hour of surgery.
WHAT HAPPENS THE DAY OF SURGERY?
You will arrive at the hospital about one hour before your surgery. A friend or relative should drive you to and from the hospital. If this cannot be arranged let our Physician's Assistant know immediately.
Shortly after you arrive, dilating drops will be placed in the affected eye that will be operated on. You usually will receive a series of four or five drops spread out over a period of time.
An i.v. will be started, your blood pressure will be checked and you will have your heart monitored. The relative or friend who accompanied you may remain with you in the holding area.
The anesthesiologists will talk with you, review your chart, and ask you some routine medical questions. You will be given some intravenous sedation to relax you and an anesthetic which will numb your eye and the area around it.
After receiving the local anesthetic, you will be taken to the operating room. We wash around the eye and a microscope is positioned over your head through which the doctor and assistant can see and work. A sterile plastic drape with a hole for the eye will be applied around your eye. The drape will then be lifted high off your face except for the area around the eye. The anesthesiologists or a nurse anesthetist will remain with you through the procedure to assure that you are safe and comfortable. Many of our patients actually sleep while we do the procedure.
WHAT ABOUT AFTER SURGERY?
When we are done with the procedure you will be taken to the recovery area and your companion can then come back to be with you. While you are waiting to be released, you will be offered light refreshment. The doctor or an assistant will come back to talk with you, go over the post-operative instructions with you, and answer any questions you may have. You will need to be seen in our office the day following the surgery. The next office visit will be approximately one week later. We stress that we are available to you 24 hours a day. If a problem or concern should arise in the 'off hours', call our answering service at 734-434-6000 and page the on call doctor.
You may feel some mild irritation or aching. Usually plain Tylenol will relieve the aching which may occur. If you should experience a great deal of pain, please call our office. When you sleep at night, if you have a shield, it will be required that you place it over the eye with tape at bedtime. Eye drops will be prescribed and you will be directed on how to place them in the eye. You may be moderately active with the only restrictions being not to rub the eye, and not being involved in heavy or strenuous activity.
During the healing period, the eye will be red and the vision somewhat blurred. There may be slight discharge from the eye, especially in the morning, and you may notice that colors will be brighter in the eye now that the cloudy cataract has been removed. It will take approximately six weeks for the eye to completely heal, and then you will receive a prescription for glasses to give the optimum vision. You may read, write, and watch TV as much as you like. You may also return to work as soon as you wish as long as it does not involve heavy, strenuous activity.
We realize that we cannot answer all of the questions and concerns that you may have but we have tried to anticipate many of the questions which have concerned our patients in the past.
We look forward to the opportunity to answer specific questions that you might have concerning your operation and your eye. Our doctors and their trained assistants are here to help you and to make your operation as free of uncertainty as possible.