Cataract

What is a cataract?

Above: a clear lens; Below: a lens clouded by a cataract

A cataract is a clouding of the natural lens of the eye.  A normal lens allows the light to focus an image clearly on the back of the eye.  As a cataract develops, the lens scatters light, which prevents light from passing through the eye and makes it harder for a person to see.

Cataracts are a normal part of aging.  Approximately half of adults aged 65–74 have cataracts, and about 70% of those over 75 have this condition.  Other causes are eye injuries, smoking, certain diseases, medications, and genetic inheritance.

Symptoms of cataract:

• Cloudy, fuzzy, foggy, or filmy vision
• Changes in the way you see colors
• Difficulty driving at night
• Glare from lights, lamps, or the sun
• Frequent changes in your eyeglasses prescription
• Double vision

How is a cataract diagnosed?
A regular eye exam is all that is needed to find a cataract.  Your ophthalmologist will ask you to read a letter chart to see how sharp your vision is.  Using a slit lamp with microscope, your surgeon can examine the structures of the eye, including the lens, to determine the clarity, or degree of cataract of the lens.  A complete exam including a glaucoma check and a dilated exam to look at the inside of the eye will check the overall health of the eye and rule out any abnormalities in the retina.

How is a cataract treated?
Surgery is the only effective treatment. The surgery involves removing the cloudy lens and replacing it with a lens implant. A small cataract does not need to be removed immediately.  To help you decide how your cataract is affecting your vision, you may want to ask yourself some of these questions:

• Am I experiencing glare from sunlight or headlights?
• Is it difficult to see while driving?
• Can I see well enough to do the things I want to do at work or at home?
• Am I able to read, play cards, watch TV, sew etc. without difficulty?
• Do I feel like my eyeglasses help me to see as well as I’d like?
• Does my eyesight bother me frequently?

You may also have other specific problems that you may want to discuss with your ophthalmologist.

When a cataract becomes visually significant and affects your activities, your ophthalmologist will recommend cataract surgery.  Cataract removal is one of the most common operations performed in the U.S. today, and it is also one of the safest and most effective. In over 95% of cases, people who have cataract surgery have better vision afterwards.

How is a cataract removed?
There are two popular ways to remove lenses with cataracts:

• 

  An illustration of phacoemulsification during cataract surgery

  Phacoemulsification (“phaco”): Dr. Lee makes a small incision (2.2-2.4 mm) on the side of the cornea and then inserts a tiny probe into the eye. The probe emits ultrasound waves that will break up the cloudy center of the lens so that it can be removed by suction. This avoids any tissue that may cause bleeding so you may continue taking blood-thinning medications.

• Extracapsular surgery: In this type of surgery, a slightly longer incision is made on the side of the cornea to remove the hard center of the lens. The remainder of the lens is then removed by suction.

Both procedures involve placing a lens implant of customized power to achieve the best vision possible.

Your ophthalmologist will discuss options with you before choosing the best kind of cataract removal and lens replacement for you.   Our doctors prefer the phacoemulsification technique because patients recover more quickly and with less change in lifestyle.

What Should I Know About Surgery?
The surgery is performed under IV sedation, NOT general anesthesia.  Numbing eye drops are  inside your eye.  There are no injections near your eyes.   The surgery takes about 20-30 minutes to perform while you are lying on your back.  You will need to have a friend or family member accompany you on the day of surgery to drive you home.  You may also want to have someone stay with you for at least a day to help you follow your doctor’s instructions following surgery.  You will be using eye medications following surgery.

Your ophthalmologist will need to check your eyes the next day, about 1 week later, and a month later with a final prescription for glasses, if needed.  They will check your progress and make sure you have the care that you need until your eye fully recovers.  If you have cataracts in both eyes, your doctor will discuss with you the best time to schedule surgery on the second eye.

Can a Cataract Return?
A cataract cannot return because all or part of the lens has been removed.  However, in about half of all people who have extracapsular surgery or phacoemulsification, the lens capsule can become cloudy.  This causes visual problems similar to those caused by a cataract.

The treatment for this condition is a procedure called YAG capsulotomy.  Your ophthalmologist uses a laser (light) beam to make a tiny hole in the capsule to let light pass.  This surgery is painless and is performed in our office.  Most people see better after a YAG capsulotomy.

What is an intraocular lens (IOL)?

A typical IOL

An intraocular lens (IOL) is an artificial, replacement lens with optical powers, which gets surgically implanted in the eye to replace the existing clouded lens during cataract surgery.

What are my different options for IOLs?

• The Monofocal IOL is the traditional replacement lens used for cataract surgery. This type of lens restores good functional distance vision, but does not correct astigmatism or presbyopia. Therefore, individuals with significant amounts of astigmatism may still require glasses and glasses will most likely be required for reading. However, IOL technology continues to progress, and there are several other options for those who wish to have less reliance on glasses.
• The Acrysof Multifocal ReSTOR IOL, the first apodized diffractive IOL for cataract patients, allows patients to have a full range of quality vision (near, intermediate, and distance) and greatly reduces the patient’s reliance on glasses. In clinical trials, 80% of patients reported “never” wearing reading or bifocal glasses after cataract surgery with the AcrySof ReSTOR IOL in both eyes.
• The Acrysof Toric IOL provides high-quality distance vision in those who have both a cataract and corneal astigmatism. In these patients, the customized toric lens implant significantly decreases the dependence on glasses for distance vision.
• 

  Crystalens

  The Crystalens AO is an accommodative IOL that flexes like the eye’s natural lens so that you can see near, far, and everywhere in between. This lens also enhances contrasts so that the patient may see better in dim lighting and at night.

Our cataract surgeries are performed at:
Davis Ambulatory Surgical Center
120 Carver Street
Durham, NC 27704
Phone: 919-470-1000