Cataracts and Cataract Surgery

Article from The Second Wind

Dear Doctor Weaver,

Recently, I was told by my eye doctor that I have cataracts. It was recommended that I get cataract surgery, but I am very nervous about any form of eye surgery. What exactly is a cataract and can you share any information to help relieve my apprehensions about surgery?

Thanks,
Marion

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Dear Marion,

Everyone is born with a natural lens inside each eye. Like a camera lens, this natural lens focuses light and images that allows you to see. During childhood, this natural lens is very clear. As a person ages, the lens can change in shape, size, and color.

There are many different types of cataracts that affect different parts of the lens. Cataracts can be a darkening/clouding of the color of the lens or a physical change of its surface. Either of these changes affects the quality of vision by scattering light or letting less light into the eye.

Cataracts develop for many reasons. Some studies believe that long-term UV exposure contributes to the progression of cataract development. Systemic conditions, such as diabetes, also affect metabolic processes that cause cataracts to form more quickly. Injuries, such as blunt trauma to the eye, can also cause cataracts to develop. Typically, cataracts are an age-related condition, which means that the longer a person lives, the more likely he/she will develop cataracts.

When cataracts form, vision that was once clear now becomes hazy or blurry. Some people notice this especially when driving at night. During dark light conditions, the pupils dilate. This occurs to allow more light to enter the eye in order to see better at night. However, a cataract scatters light and reduces the amount of light entering the eye, which leads to the night-driving complaint or halos and glare. Cataracts also cause problems with vision during the day as well. Bright sunny days (especially with snow-covered ground) can cause a high amount of glare that makes it difficult to see comfortably.

Initially, when a cataract develops, this can cause a change in the shape of the lens. This, in turn, causes a change in a person’s eyeglass or contact lens prescription. So, if a patient comes in for an eye examination with a blurry vision complaint and early cataracts are present, the patient may only require a change in his/her eyeglasses to make things clearer. But when cataracts advance and cause an increase in the darkening/clouding of the natural lens, the vision is blurred because less light is entering the eye, not because the prescription has changed. At this point, cataract surgery is typically recommended.

Cataract surgery involves the removal of the natural lens (containing the cataract) and replacing that with an artificial lens implant, called an intraocular lens. The power of this lens is carefully calculated based on non-invasive measurements that are performed at the surgeon’s office. There are two types of intraocular lenses: monofocal and multifocal. Monofocal lenses allow you to see at distance, requiring the use of bifocals or reading glasses to allow you to read up close. The advancement of new technology has allowed multifocal lens implants to provide both distance and near vision, possibly eliminating the need for eyeglasses completely.

During the surgery, a very small incision is made and typically no stitches are required. Cataract surgery used to require an overnight stay in a hospital, but now, it is an out-patient procedure performed at a surgical center. The actual surgery takes only about 10-15 minutes. The patient returns for regularly scheduled follow-up visits to ensure that the vision is acceptable and to monitor for any ocular complications. All patients are given drops to use routinely before and after the procedure to help minimize infection and inflammation. Typically, a new eyeglass prescription is determined one month after cataract surgery if needed.

To conclude, cataract surgery is an elective procedure. Your eye doctor may make a recommendation for surgery based on his/her findings, but the ultimate decision is up to you. Cataracts definitely affect the quality of vision as well as quality of life. So if you have cataracts and you are not seeing well with your current eyeglasses, I would recommend that you make an appointment with your eye doctor to review his findings with you and go from there.