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What is a Cataract?
A cataract is a clouding of the normally clear, transparent lens of the eye. A cataract is not a tumor or growth of new tissue over or in the eye. Rather it is a fogging and loss of clarity of the lens itself. The lens is located in the eye just behind the iris and the pupil.
Light entering the eye is focused by the lens onto the retina. When a cataract forms, the lens is no longer able to focus the light clearly. Therefore, your vision becomes cloudy. An early cataract may cause few problems with vision. If the cataract gets worse, sight can be partially or completely lost until the cataract is removed.
How Fast Does A Cataract Grow?
Certain types of cataracts progress quite rapidly and cause cloudy vision within a few months. Fortunately, these are relatively uncommon. Most cataracts develop gradually and do not require surgery for many months or years. In some instances, surgery is not required.
What Are the Causes of Cataracts?
There are many types of cataracts. Most are caused by chemical changes in the lens that partially result from the normal process of aging. These cataracts can rarely occur as early as age 30.
There is now evidence that prolonged exposure to ultraviolet light can contribute to cataract formation. Ultraviolet light is a normal, invisible component of sunlight. Most exposure to ultraviolet light occurs when outdoors between 10:00 a.m. and 2:00 p.m., particularly in the summer season. Exposure to ultraviolet light can be reduced by wearing a hat with a brim and glasses that filter out ultraviolet light.
Other causes of cataracts include eye injuries and certain infections or diseases, such as diabetes. There is new preliminary information that suggests that mild forms of vitamin deficiencies can contribute to cataract formation. For this reason, it may be prudent to take one multivitamin per day. There is no evidence that taking large doses of vitamins provides any benefit. In rare instances, children can develop cataracts. If these are present at birth, they are called congenital cataracts.
What Are the Symptoms Of Cataracts?
The most common symptom of a cataract is cloudy or blurred vision. Some people notice a haziness or cloudiness of their vision, as if their glasses are constantly in need of cleaning. Double vision can occur as the cataract is forming. Glare or sensitivity to bright lights is another common complaint; at night, there may be haloes around lights or scattering of the light from the headlights of oncoming cars.
Some cataracts first affect reading or other types of close work. Other types of cataracts initially interfere with driving or seeing at a distance. Sometimes changing the glasses is helpful in restoring good vision. However, as the cataract worsens, stronger glasses may no longer improve sight.
When Should A Cataract Be Removed?
The appropriate time for cataract surgery depends upon the severity of your cataract and the degree to which it interferes with your normal daily activities. Selecting the right time for cataract surgery is a personal decision. If you are very active and use your eyes extensively for detailed work, you might benefit from cataract removal at an earlier stage than someone with less critical visual needs.
How Are Cataracts Treated?
At present the only treatment for a cataract is surgery to remove it. Many other remedies for cataracts have been attempted. These have included medications, eye drops, vitamins, changes in diet, and resting the eyes. Unfortunately, none of these has proven successful in dissolving or clearing cataracts.
Fortunately, there have been tremendous advances in cataract surgery in the past several years. The chances for recovering good vision after surgery are now excellent, although severe complications can occur in 1-3% of patients. Due to recent advances, cataract surgery now causes remarkably little discomfort and inconvenience.
How Are Cataracts Removed?
Are Stitches (Sutures) Required For Cataract Surgery?
One of the most exciting advances in cataract surgery is the ability to remove the cataract and implant an intraocular lens through a small incision. New techniques for making incisions have, in many instances, eliminated the need for sutures following cataract surgery. For some individuals, this type of incision is preferable. However, for other individuals, other types of incisions, ones that require sutures, will provide a better result for them. We, therefore, select the type of incision that is best suited for each patient's condition.
What Is A Secondary Cataract?
Following cataract surgery, we deliberately leave the back membrane of the lens in place to support the intraocular lens and protect against complications. In over 50% of eyes, this membrane eventually becomes cloudy. This cloudiness usually develops 1-5 years after surgery. This clouding of the membrane is called a "secondary cataract." The symptoms of this are often similar to those that occurred with the original cataract.
If a secondary cataract develops, we can make a small opening in the middle of this membrane using the YAG laser. This can be done quickly and painlessly without requiring an incision in the eye. The membrane almost never grows back after laser treatment. The only exception is in children, in whom the membrane often regrows one or more times. This laser procedure is also what many people confuse with laser cataract surgery.
Will I Have An Intraocular Lens Inserted During My Operation?
Removing the cataract is only the first step in recovering good vision. Since the cataractous lens has now been removed, we must provide an additional lens in order to help the eye focus light clearly. Following cataract surgery, there are three methods by which clear vision can be restored.
Intraocular Lens Implant (IOL): Our preferred way to restore vision for nearly all of our patients after cataract removal is to insert an intraocular lens implant into the eye at the time of surgery. This clear 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. 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.
It is possible to implant an intraocular lens in an eye that has had previous cataract surgery. This can be especially beneficial to those who are having difficulty using cataract glasses or contact lenses. Not all patients are good candidates for this surgery. However, secondary lens implantation can be a very rewarding operation for those who have become frustrated with cataract glasses or contact lenses.
Contact Lenses: A contact lens can restore good vision following cataract surgery, and there have been many advances in lens design and materials in recent years. Contact lenses do not cause the visual distortions that occur with cataract glasses. Unfortunately, there are several disadvantages with contact lenses. The major one is that one must learn to insert and remove the contact lens every day. In addition, some people are not able to adapt to wearing a contact lens on the eye. Another disadvantage is that a contact lens can be easily damaged or lost, and improper care or use may cause eye infections. Only rarely do we recommend the use of contact lenses to correct vision after cataract surgery.
Cataract Glasses: These are thick, heavy glasses that cause a number of significant visual distortions, although the central vision is generally excellent. Only rarely do we recommend the use of cataract glasses to correct vision after cataract surgery.
Are There Different Types Of Intraocular Lenses?
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There are countless varieties of intraocular lenses. All lenses contain a clear central portion for focusing the light (called the "optic") and some type of flexible arms for supporting the lens inside the eye. The optic of the lens acts just as your natural lens once did, except that it cannot adjust its focus. As a result, you may need to wear regular bifocal glasses following surgery in order to get the best possible vision, especially for reading.
Recent advances in intraocular lens designs and surgical techniques have permitted us to implant lenses through small incisions. These incisions are so small that almost no astigmatism is created, and depending on the particular circumstances, sutures may not even be required to close the incision. Depending upon the condition of your eye, you may or may not be a candidate for one of these types of implants.
In the past, lens implants were monofocal or “one size fits all”. Monofocal lenses provide only one focal point: either near vision for reading, or far vision for seeing distance. Monofocal lens patients will need to wear glasses following cataract surgery either for distance or near or both.
Multifocal premium lifestyle lenses are now available. Multifocal lenses provide a full range of vision and greatly reduce your dependency on glasses. Premium lifestyle lens implants currently available at Associated Ophthalmologists include: Acrysof Restor (multifocal) and Acrysof Toric (astigmatism correcting).
Please feel free to ask us any questions you might have about these various lenses.
There have been remarkable advances in cataract surgery in the past several years. We have gone from the time when people needed to lie still in bed for six weeks to an era in which outstanding vision is usually restored, often within a week or two. We look forward to discussing any of these matters further with you.