Cataracts

Understanding Cataracts
When the natural lens which focuses the eye becomes unclear, the condition is called a cataract. It prevents the formation of clear images on the retina, the nervous tissue lining the back of the eye, and therefore, the retina must send signals of an obscured image to the brain. The end result is that the patient does not see well. Cataracts are the leading cause of poor vision in adults, and they grow with age. Cataract formation can be accelerated in patients with illnesses (such as diabetes), the use of certain medications (such as corticosteroids), or in the event of ocular trauma. Each year, over a million people in the United States undergo surgery to remove a cataract, attesting to the safety, efficiency and need of this procedure.

How Can Someone Know Whether They Have a Cataract?
Visual problems are often the first symptom of cataract, although early cataracts are often free of symptoms. Patients with cataract will often complain of hazy, blurred or dim vision. They may feel that colors appear weak or washed out. They may notice that reading or watching television is difficult because the image is not clear. They may find that driving at night becomes difficult because of glare and that bright sun seems extraordinarily annoying. These patients often see a local eyecare specialist such as an optometrist who discovers that the patient's vision cannot be improved with spectacles and will usually diagnose the cataract.

When Should Cataracts Be Removed?
A complete eye examination including several sophisticated diagnostic tests is necessary to determine if the visual complaints are due to cataract or whether cataract is the only problem a patient might be suffering. Notably, cataracts are more common in the elderly, and this population more often suffers other vision threatening diseases such as glaucoma. If a cataract is determined to be visually significant in that it interferes with the patient's abilities to enjoy his normal activities, cataract removal is offered to the patient. An ophthalmologist should reassure the patient that a cataract will not usually cause problems with the eye and can often be left alone for years or even decades if the patient so chooses. In addition, the ophthalmologist should advise patients that cataract extraction is one of the safest operations performed today.

ReSTOR Interocular Lenses (IOL's)
Multifocal lenses, such as the ReSTOR® lens, potentially enable one to see clearly both at distance and at near without glasses. This lens can be implanted after cataract surgery or in someone who would like to have laser refractive surgery, but is not a candidate. Generally, however, there may be additional costs associated with the implantation of this lens.

Toric Lenses
Toric lenses are intraocular lenses (IOL's) that are implanted into the eye after cataract surgery and can help to reduce or eliminate the need for astigmatism correction in glasses or contact lenses.

How are Cataracts Removed and Vision Restored?
Cataract extraction involves removing the clouded lens from the eye. It can now be performed with topical (no injection!) anesthesia or local anesthesia in the outpatient setting. Essentially, a tiny cut is made into the front of the eye so that microsurgical instruments can liquefy and then vacuum out the cataract. Then, an artificial, clear, replacement lens is inserted in place of the cloudy lens. The operation usually is complete within a half hour and the patient enjoys good vision often within 24 hours, without much pain or even discomfort. Furthermore, the power of the artificial lens can be calculated so that the patient might not even need glasses for distance vision or reading despite requiring them pre-operatively.

How are Lasers Used?
The artificial lens inserted into the eye of patients undergoing cataract extraction is completely clear. It is placed into the natural pouch, called the capsule, that housed the original cataract. This pouch, being a natural material, often clouds over after cataract surgery. However, this "after-cataract" is easily vaporized using the YAG laser during a procedure requiring no injections nor incisions. A patient with an after-cataract simply goes to his ophthalmologist's office and sits at a machine much like the slit-lamp that is used for general examinations. A special lens is put over the eye after an anesthetic eyedrop is instilled, and the YAG laser is then aimed by the ophthalmologist so that the laser beam disrupts only the after-cataract and clears it away. The patient's vision usually improves markedly within minutes to hours after the procedure without pain, bleeding or other surgery.