Cataracts

In a normal eye (left) the lens is clear, allowing light to focus on the retina. When a cataract occurs (right), the lens becomes clouded, causing light rays to scatter.

Cataracts are like gray hair, everyone gets them if they get old enough. A cataract is a clouding of the natural lens inside of your eye. It would make more sense to call it a clouded natural lens, but over the years cataract (which means waterfall) has become part of the medical vernacular.

The only way to cure a cataract is to remove it from the eye. Neither exercise, medications, diet nor metaphysics can make a cataract better. Removal of the cataract means removal of the natural lens inside of the eye. For the past 20 years, safe and reliable plastic lenses have been used to replace the natural lens. You can think of these like a permanent contact lens INSIDE of your eye. We call them intraocular lens implants or IOLs. The IOL is placed at the same time that the cataract is removed.

In cataract surgery, an artificial lens replaces the natural lens of the eye.

The lens implant can be chosen to make the eye less dependent on glasses. Cataract patients who were very nearsighted may only need glasses to read the newspaper after surgery, and people who were farsighted might be able to read the newspaper without glasses for the first time in decades. There are even bifocal (multifocal) lens implants. It's a miracle, but if just one eye has the cataract surgery there are limitations because the two eyes must be balanced.

The fact that you have a cataract does not mean that you need surgery. In fact, early cataracts should be observed until they interfere with a person's daily activities. Many times, they never need surgery, and with very rare exceptions, they should be removed only when it is convenient for the patient. Cataract surgery is among the safest and most successful surgeries done in the United States, but it is still surgery, so there can be complications.

If you are over 60 years old, your vision is blurry and it cannot be corrected with glasses, then you probably have cataracts. Often there is glare around lights, and an almost imperceptible muting of color perception.

Modern Cataract Microsurgery

Cataracts are removed using a high tech ultrasonic method called Phacoemulsification. It is a myth that cataracts are removed with lasers. Laser devises have recently become available for cataract removal, but they have no advantage over the ultra sonic machines. Millions of cataracts have been safely removed by ultra sound, but only a handful have been removed by laser.

Phacoemulsification allows the cataract to be removed through a tiny incision that seals itself, so sutures are generally not used. We call this "no stitch" cataract surgery.

The surgery is almost always painless. It takes about half an hour. During that time, the patient lies comfortably on his/her back. The eye is put to sleep, but the patient is awake. If there is any anxiety, sedation can easily be administered directly into the vein. The heart and blood pressure are monitored though out the procedure.

Follow-Up Care

A protective cover is placed over the eye for about 24 hours. The only limitations on activity are swimming, vigorous exercise and driving. Driving can usually be resumed after one day. Office visits are required on the day after the microsurgery, and once a week after that until the eye is healed. Antibiotic drops are used four times a day for the first week, then twice a day for two more weeks.

Cataracts and Laser Vision Correction

Laser vision correction has no effect on the development of cataracts, but it does affect the calculations required for cataract surgery with lens implantation.

Most people, whether they had laser surgery or not, require cataract surgery as they mature. The data regarding the status of the eyes before the laser surgery has been helpful to me in the calculations required for cataract surgery with lens implantation. These data are available to all of my patients upon their request.