What Is a Cataract?
A cataract is a clouding of the eye's naturally clear lens. The lens focuses light rays on the retina at the back of the eye to produce a sharp image of what we see. When the lens becomes cloudy, the light rays cannot pass easily through it, and the image becomes blurry.
Cataracts usually develop as part of the normal aging process, but they can also result from eye injuries, certain disease or medications. Genetic factors may also play a role in cataract development.
How Can a Cataract Be Treated?
The cataract may not need to be treated if your vision is only slightly blurry. Changing your eyeglass prescription may help to improve vision for a while.
There are no medications, eye drops, exercises or glasses that will cause cataracts to disappear once they have formed. Surgery is the only way to remove a cataract. When you are not able to see well enough to do the things you like to do, cataract surgery should be considered.
In cataract surgery, the cloudy lens is removed from the eye through a surgical incision (not with a laser). In most cases, the focusing power of the natural lens is restored by replacing it with a permanent intraocular lens implant.
What Techniques are There?
Using the extracapsular cataract extraction technique, the surgeon makes an incision where the cornea and sclera meet. Carefully entering the eye through the incision, the surgeon gently opens the front of the capsule and removes the hard center, or nucleus, of the lens. Using a microscopic instrument, the surgeon then suctions out the soft lens cortex, leaving the capsule in place.
Phacoemulsification is a modification of the extracapsular cataract extraction. In phacoemulsification, the nucleus is fragmented by an ultrasonic oscillating probe.
The nuclear fragments are simultaneously suctioned from the eye. The size of the incision is smaller than the incision needed to remove the capsule in the extracapsular technique.
An intraocular lens (IOL) is a clear plastic lens that is implanted in the eye during the cataract operation. Lens implants have certain advantages. They usually eliminate or minimize the problems with image size, side vision and depth perception noted by people who wear cataract eyeglasses.
They are also more convenient than contact lenses because they remain in the eye and do not have to be removed, cleaned, and reinserted.
What Can I Expect if I Decide to Have Surgery?
Once you and your ophthalmologis (Eye M.D.) have decided that you will have your cataract removed, he or she will complete an eye examination. Ask your ophthalmologist if you should continue your usual medications.
Your eye will be measured to determine the proper power of the intraocular lens that will be placed in your eye during surgery.
Finally, you should make arrangements to have someone drive you home after the surgery.
The Day of Surgery
Surgery is usually done on an outpatient basis. You may be asked to skip breakfast, depending on the time of your surgery.
When you arrive for surgery, you will be given eye-drops and perhaps a sedative to help you relax. You will also be given a local anesthetic to numb the eye area. You may see light and movement, but you will not be able to see the surgery while it is happening.
You eye will be kept open by a lid speculum or other method. The skin around your eye will be thoroughly cleansed, and sterile coverings will be placed around your head.
Under an operating microscope, a small incision is made in your eye. Microsurgical instruments are used to break apart and suction the cloudy lens from your eye. The back membrane of the lens (called the posterior capsule) is left in place.
A plastic intraocular lens implant will be placed inside your eye to replace the natural lens that was removed. The incision is then closed. When stitches are used, they usually do not need to be removed.
When the operation is over, the surgeon will usually place a shield over your eye.
After a short stay in the outpatient recovery area, you will be ready to go home.
You will need to:
Use the eye drops as prescribed;
Be careful not to rub or press on your eye;
Use over-the-counter pain medicine if necessary;
Avoid very strenuous activities until the eye has healed;
Continue normal daily activities and moderate exercise;
Ask your doctor when you can begin driving;
Wear eyeglasses or shield as advised by your doctor.
When is the Laser Used?
Laser surgery is never a part of the original cataract operation. However, the posterior capsule sometimes turns cloudy several months or years after the original cataract operation.
If cloudiness blurs your vision, a subsequent surgery using a laser can be done by your ophthalmologist.
Will Cataract Surgery Improve my Vision?
The success rate of cataract surgery is excellent, resulting in improved vision in the majority of cases. A small number of patients may have problems.
Some of the more serious complications that may affect your vision are:
detachment of the retina
Call your ophthalmologist immediately if you have any of the following symptoms after surgery:
Pain not relieved by non-prescription pain medication;
Loss of vision;
Nausea, vomiting or excessive coughing;
Injury to the eye.
Even if the surgery is successful, you still may not see as well as you would like to.
Other problems with your eyes, such as macular degeneration (aging of the retina), glaucoma and diabetic retinopathy, may limit your vision after surgery. Even with such problems, cataract surgery may still be worthwhile.