We offer the latest in cataract detection and treatments so our patients have the best chance of regaining vision lost to this eye disease.
What ARE CATARACTS?
Cataracts are a thickening and clouding of the lens inside the eye, affecting nearly everyone at some point during their lifetime. A cataract forms when the lens in the eye thickens and becomes cloudy. In order to see well the lens must be clear. A patient may not notice these changes as they usually develop slowly over time. Activities of daily living eventually become more difficult as the cataract progresses because of blurred vision, glare, and halos. While cataracts are the leading cause of decreased vision in the United States, this condition is completely treatable.
Cataracts are responsible for 51% of blindness around the world, affecting about 20 million people. 3.6 million cataract surgeries are preformed each year in the United States making it one of the most common procedures. It is also one of the safest and most effective surgeries. Individuals aged 40 and younger can develop cataracts. There are no scientifically proven methods to prevent cataracts from forming. Intraocular lenses that replace cataracts never wear out.
Symptoms of Cataracts
Symptoms may include:
- Glare and halos (on T.V., headlights, sunlight, streetlights)
- Blurred or cloudy vision
- Dull, faded colors
- Decreased night vision
- Difficulty seeing road signs
- Double or shadowed vision in one eye
- Frequent eyeglass or contact lens prescription changes
* Please note that these symptoms may indicate other eye problems that can result in decreased vision and even blindness if left untreated. It is very important to make an appointment for an eye exam concerning any of these ongoing issues.
TYPES OF CATARACTS
- Nuclear sclerotic
- Posterior subcapsular
Cataracts Risk Factors
Many factors can play a role in cataract development:
- High blood pressure
- Heavy alcohol use
- Genetic factors (a parent or grandparent who had cataracts)
- Long-term exposure to ultraviolet light
- Steroid use
- Exposure to radiation
- Previous eye injury
- Certain previous eye surgery
While cataracts can only be treated with surgery, cataract surgery is one of the safest and most effective of all medical procedures. Each person is unique and each cataract surgery is different, so while a good outcome from surgery is likely, it cannot be guaranteed.
The virtually painless procedure usually takes 20 minutes or less. A new crystal clear artificial lens, called an intraocular lens (IOL), replaces the patient’s cloudy lens after removal through a tiny (less than 1/10 inch) incision.
After surgery, many patients find that their vision improves quickly. For others the healing process takes longer. During the initial healing period there may be few limitations on strenuous activities, but most people can often resume normal activities within hours after surgery.
There are no medications, pills, drops, or other treatments, that can prevent or cure cataracts.
Laser-assisted cataract surgery is used to perform the initial few steps of surgery for patients who desire this method of surgery. These steps can be performed at an additional cost and insurance does not cover this portion of the surgery.
The most advanced type of cataract surgery is called phacoemulsification. This technique utilizes ultrasound to break up, or emulsify the natural cataractous lens, breaking the cataract into fine pieces and allows removal through a small, clear corneal incision.
At the time of cataract surgery, a synthetic intraocular lens (IOL) is placed in the eye in the capsule that used to surround the cataract.
Prior to a decade ago, patients undergoing cataract surgery would be given one IOL option. This option would be a monofocal lens that would correct for one distance. A patient’s target vision would typically be set for distance. If the patient had astigmatism, no point of their vision would be clear without glasses with a monofocal IOL. Today’s cataract surgery offers many options including astigmatism correcting IOLs, distance and near focusing IOLs (multifocal, crystalens) and extended depth of focus IOLs (Symfony and Symfony toric IOLs). These IOL options allow patients to choose lenses that fit their needs and active lifestyles. These advanced technology IOLs allow patients to decrease their dependence on eyeglasses or contact lenses after cataract surgery.
The standard, monofocal lens provides vision for one distance, either near or far. This traditional lens implant does not correct for astigmatism. Most patients who choose this lens desire their vision to be set for distance. This means that after cataract surgery, the vision is clearer when looking out at a distance without glasses. Up close, the vision will be blurry without glasses. If the vision is set for near, the vision will be clearer up close without glasses, but when looking out at a distance, the vision will be blurry when not wearing glasses. Most patients, regardless if they choose to be set for distance or near, will need glasses for their sharpest vision with a traditional, standard IOL.
Premium/Advanced Technology IOLs
Patients who desire less dependence on their glasses after cataract surgery may choose to have an advanced technology lens implant if their surgeon feels he/she is a candidate for these lenses. These lenses can correct astigmatism, can set the vision for both distance and near, or set the vision for intermediate and distance vision. There is no lens available to correct for distance, intermediate, and near vision perfectly. However, these lenses can greatly reduce the need for glasses following cataract surgery for most activities.
Premium lenses are not covered by any insurance company, including Medicare. These advanced technology lenses are always an out-of-pocket expense. Insurance covers the cost of the actual cataract surgery minus deductibles and co-pays as usual, but insurance companies always view these lenses as not medically necessary and will not pay for them.
Many patients view the cost of premium lenses worth the additional expense because they no longer need to wear glasses for most activities. The office offers financing options to assist in covering the cost of these lenses to help make the lenses more affordable.
Toric IOLs correct for astigmatism. They are designed to offset the imbalance created by the cornea’s irregular shape. These lenses correct the astigmatism and give a much clearer distance vision, without having to rely on glasses as much for distance. This IOL will typically require glasses for intermediate and near vision. Without this lens, all vision points are blurry until glasses are worn.
The Tecnis multifocal IOL is engineered to provide clear distant and near vision using focusing rings built into the lens. This lens offers improved near vision over other choices however intermediate vision may require glasses. It is typical to experience some glare and rings around lights with night driving, but this usually improves over time.
(Extended depth of focus IOL) with astigmatism correction
The Tecnis Symfony IOL is engineered to provide clear vision at distance and intermediate using focusing rings built into the lens. The shape of this IOL corrects astigmatism as it offsets the imbalance created by the irregular shape of the cornea, similar to the way astigmatism correction contact lenses do. This lens provides an extended depth of focus to include intermediate and distance vision, however reading glasses are required to see objects and to read books up close. It is typical to experience some glare and rings around lights with night driving that usually improves with time.
The accommodating intraocular lens is called the Crystalens. This lens provides excellent distance and intermediate vision. It is engineered with a hinge to allow movement of the IOL to focus on images at different distances. Reading glasses are required to see objects, including books, up close.
Accommodating IOL with astigmatism correction
The accommodating intraocular lens with astigmatism correction is called the Trulign. This lens provides distance and intermediate vision. It is engineered with a hinge to allow movement of the IOL to focus on images at different distances and the shape of this IOL corrects astigmatism as well. Reading glasses are required to see objects, including books, up close.
Many large studies have shown that despite advances in pre-operative measurements and calculations for the IOL, only 60% of patients end up with vision requiring less than 1 diopter of correction to have their best vision. Our office, using the latest in testing and calculations to determine the IOL power for each patient, has a much better outcome than that. Still, there are patients who require more spectacle correction than anticipated after cataract surgery due to where the lens settles in the capsule in which it is placed. Where the lens settles in the eye during the healing process and modulation of this is an area of continued research.
There are some lifestyle changes that doctors believe can help slow the development and progression of cataracts. Once a cataract has begun to form, these measures may slow progression.
Wearing ultraviolet (UV) eye protection
Eating a healthy diet on a regular basis, including limiting or excluding refined carbohydrates
Maintaining a healthy weight
Optimizing control of medical conditions such as diabetes
Not drinking in excess
Regular eye exams as some symptoms attributed to cataracts may be due to other eye problems, including ones that can result in decreased vision and even blindness if left untreated.
What Can a Patient Do
Achieving an optimal outcome with cataract surgery requires teamwork between the patient, eye doctor, office staff, and surgery staff.
Office visits for cataract surgery include:
Initial visit for complete eye evaluation;
A visit for special measurements of the eye to determine an IOL power exclusively for the patient, and discussion of the IOL choice that best fits the patient’s lifestyle, eye health, and expectations;
The surgery day; and
Two post-operative visits.
Our office will do its best to communicate with patients. We welcome any questions and clarifications about the procedures our patients undergo. As with all surgery, the patient plays an important role in following up for pre-op and post-op visits and in following eye care instructions, which are an essential part of the surgical procedure.