Cataracts & Cataract Surgery

What is a Cataract?

The eye functions like a camera. There is a lens inside the eye. When we are young, the lens is clear and works to focus light on the retina. A clear lens lets light pass without degrading the image. This allows for clear, sharp vision.

As we get older, the lens slowly becomes cloudy. A cloudy lens is called a cataract. When images pass through this cloudy lens, the images are degraded and cause blurry vision.

In the clinic, we use the example of the headlights on a new car being clear, whereas the headlights on an older car becomes cloudy over time. Many patients ask if a cataract is a film over the eye. It is not a film over the eye

What are the symptoms of Cataracts?

Blurry or Foggy Vision
Muted or Dull Color Perception
Glare from Sunlight or other sources of Light
Decreased Night Vision
Halos around Lights
Glasses no longer Work

Who do Cataracts affect?

The process a cataract formation begins in our 40’s, but doesn’t significantly affect our vision until our 50’s, 60’s, or 70’s.

Cataracts are the leading cause visual disability in individuals 55 years of age and over. Those with cataracts may have difficulty with:

Driving
Seeing at night
Reading
Viewing a computer screen, phone, or tablet
Seeing captions on TV

Unlike diseases like glaucoma or macular degeneration, cataracts are a degeneration which means that 100% of us will develop cataracts if we live long enough.

Can I prevent Cataracts?

There are no known ways to prevent cataracts at this time. Neither dietary changes, supplements, eye drops, or sunglasses will prevent the formation of cataracts.

A ophthalmologist at the University of California – San Diego, Dr. Kang Zhang, discovered an enzyme called lanosterol. This enzyme appears to clear cloudy lens cells in Petri dish studies, but is yet to be studied in humans. This research could lead to the development of an eye drop to slow or reverse the development of cataracts. These studies are currently in their infancy.

Is it Presbyopia or Cataract?

In the early stages of cataract formation, the lens begins to stiffen. It is not yet cloudy. Stiffening of the lens can cause the loss of good near vision. This begins right around age 44-45. Similar to fully developed cataracts, an individual may have difficulty with near activities. Presbyopia does not require surgery as it can be corrected with glasses or contact lenses.

What speeds up the formation of Cataracts?

Injuries to the eye, certain diseases, and some medications can speed up the formation of cataracts. A good example is the chronic use of corticosteroids, even as a nasal spray, can cause cataracts to form much quicker.

However, the vast majority of cataracts are a consequence of the aging process.

What is Presbyopia?

How are cataracts treated?

Cataracts are treated with surgery. Cataract surgery is one of the safest surgeries in all of medicine. It can, in many cases, improve one’s quality of life in a short period of time. More than 3 million cataract surgeries are performed each year in the United States.

The operation involves putting the eye to sleep with local anesthesia. A small incision, approximately 2 1/2 mm in length, is made at the edge of the cornea. An instrument about the size of a small pencil is used to break up the cataract and remove the resultant fragments from the eye. A replacement lens, also called an intraocular lens or IOL, is placed in the same location at the original lens through the same incision.

In most cases, stitches are not required to close the incision. A technique using sterile water injected into the edges of the incision causes it to self-seal.

How do I know if I need Cataract Surgery?

A refraction needs to be performed. A refraction is a special testing using a device called a phoropter. A phoropter has lenses to check your vision. If your vision improves with the refraction test, you may only need glasses or and updated prescription to change your glasses.

If your vision cannot be improved with the refraction test, then you may be a candidate for cataract surgery. You must be having difficulty with your activities of daily living to qualify for cataract surgery. This will be documented with a form at your final pre-surgical appointment.

How long does Cataract Surgery take?

Like any surgery, the length of a cataract surgery can vary. Most cataract surgeries take 15-20 minutes. A denser cataract can take 30-40 minutes, especially if the pupil does not dilate fully an other techniques are required to mechanically open the pupil.

Even though surgery may be less than 30 minutes, you should be prepared to be at the surgery center for 2-3 hours as the entire process from start to finish takes longer.

Can you walk me through Cataract Surgery?

In the beginning, you’ll register at the reception desk and wait to be called to the pre-operative area. Once in the pre-operative area, you’ll meet members of the nursing staff who will start preparing you for surgery. They’ll ask you a number of standard medical questions, place an IV in your arm for the anesthesiologist, and dilate your pupil for your surgeon. You’ll also meet the anesthesiologist in the pre-operative area.

Your pupil needs to be very dilated for cataract surgery, so you will receive 3 rounds of the dilating drops. You’ll then wait until the pupil is maximally dilated. From the pre-operative area you go the operating suite in the rear of the surgery center. In the operating suite, you’ll meet another nurse and a surgical technician who will sterilely prepare your eye for surgery and place a drape over your face, exposing only the eye undergoing surgery.

Don’t worry, there is a rod that keeps the drape from sitting directly on your face so that you can easily breath. A nasal cannula will be in your nostrils providing you with fresh oxygen throughout the surgery.

You may hear your surgeon talking to the surgical assistant. The assistant is there to hand instruments, medications, etc. to the surgeon throughout the case. The surgeon is the only individual that will be operating on your eye. The anesthesiologist will be present throughout your surgery, in case you need additional pain control, sedation, or have any emergencies.

You will not be asleep during the surgery. You will be relaxed by the IV sedative. Your eye will be asleep. You will not be able to see details while undergoing surgery. You may feel water dripping on your eye and mild pressure at times. You may see a kaleidoscope of colored lights during the surgery. Many patients report that the experience of undergoing cataract surgery is psychedelic.

After surgery, the drape will be removed and your eyelids will be cleaned. Drops will be placed on the eye and a shield will be taped in place to cover the eye. You’ll then be taken to the post-operative area.

In the post-operative area, you’ll meet another nurse who will review the post-operative instructions which in general include:

You should not bend, lift, or strain (do lift anything heavier than 7 lbs. or a gallon of milk)
Keep your eye shield in place (you will remove it briefly to instill your eyedrops in the evening)
If you have any pain or discomfort , use Tylenol (if you are not allergic or have other issues)
You can continue your glaucoma drops (if you use glaucoma drops)
In the morning, you can remove your shield (don’t lose it, you’ll need it for 1 week)
Use your drops in the morning before arriving for your post-operarative visit

The nurse will give you written directions. At the top of the paper, the time of your next day visit will be written. You will be given something to drink and a small snack like crackers. Your family member will then be called to the post-operative area to assist in getting you checked out.

Can I drive home after Cataract Surgery?

No, you cannot drive yourself home after cataract surgery. You must have a friend or family member pick you up and drive you home. The surgery center will not release you to a Uber or Lyft driver for safety reasons.

Will my vision be clear after Cataract Surgery?

Cataract surgery is a minimally-invasive surgery. The first day after surgery, your eye may still have some affects from anesthesia. Your pupil may still be dilated. Your eye may be minimally inflamed. For these reasons, we expect that your vision may still be blurry at the first post-operative visit.

We do not want to create the expectation that results are instantaneous after cataract surgery. The vision typically improves little by little, each passing day. It can take 1-2 weeks to see significant improvement. Patience if important during this time period. Continue your drops as directed by your surgeon. You will be seen again to monitor your progress in approximately one week.

Some patients vision may be limited by more than one condition. For example, there may be other pre-existing conditions that will continue hinder the vision. In this situation, cataract surgery alone may not significantly improve the vision.

What are the Risks of Cataract Surgery?

Cataract surgery is completed without complication in greater than 98% of cases. Innovation in techniques and equipment continue to make cataract surgery safer. That does not mean that cataract surgery is without risks. 2% or less of patients may experience a complication. The most common complications will be listed below, but it is impossible to list every possible complication:

Pain
Infection
Bleeding
Loss of Vision
Loss of the Eye
Need for further Surgery
Need for Glasses or Contacts
Droopy Eyelid
Death

We take precautions to avoid complications. If a complication occurred, we would take steps to manage the complication to achieve the best case scenario. Like any medical procedure, no guarantee can ever be made.

If you have any questions regarding your surgery, do not hesitate asking your questions. We are here to answer your questions and to provide you with the highest level of care available.