CATARACT SURGERY & LENS IMPLANT


THE EYE HEALTH CATARACT SURGEONS

Stephen Sullivan
M.D.
Kenneth Kenyon
M.D.
Leonardo Velazquez
M.D.

Each year the cataract surgeons at Eye Health analyze the newest technology and techniques in an attempt to deliver to their patients the most up-to-date advances in cataract surgery. This year, as always, they have continued to incorporate new instrumentation capable of providing both quicker and even less invasive cataract removal.

Cataract surgery is principally performed to remove a clouded (aging) lens which is causing both glare and blurring. A remarkable and fortunate reality however is that cataract surgery can also eliminate most of a patients pre-existing glasses prescription. Because the natural lens (the cataract) is removed and replaced with a new plastic intraocular lens during cataract surgery, the prescription of this implanted lens can be customized to the patient's eye to correct for pre-existing nearsightedness or farsightedness. The intraocular lens however cannot correct for their astigmatism. As such most patients will still need some spectacle "fine-tuning" of their astigmatism and some glasses assistance for reading. Anyone who is apparently seeing both at a distance and near without glasses is doing so because they are (consciously or unconsciously) using one eye for distance and one eye for near.

Recently lens implants have been developed to provide for greater depth of focus and to try to simulate intraocular "bifocals". The current limitations of these "presbyopic" lens implants however are that they still do not correct for astigmatism and the ability to predict the exact lens power required is still not perfect. The additional out-of-pocket cost to the patient is $2,000 per eye and is not covered by insurance.

eye diagram - cataractWhat is a cataract?
A cataract is the clouding of the normally clear lens, the part of the eye responsible for focusing light and producing clear, sharp images. It is analogous to a window that is frosted or "fogged" with steam. Although aging is the main culprit, cataracts can happen at any age due to sunlight, smoking, diabetes, steroids, eye injury, and family history. Its symptoms include a gradual blurring of vision, fading or yellowing of colors, poor night vision, and increased sensitivity to light and glare. It is neither a film over the eye nor a growth/tumor. Cataracts are not spread from one eye to the other, and are not caused by "overusing" the eyes. It is, however, the leading cause of reversible blindness in the world.

Is my cataract ripe?
Historically, cataract surgery had been thought of as an operation for the "elderly" or those who were severely visually disabled. With dramatic improvements in surgical techniques and lens implant design, cataract surgery is now being performed much earlier and in much younger patients.

The concept of a "ripe" cataract is not a function of the nature of the cataract, but rather the degree of visual disability. Basically when someone is unable to perform those visual functions that are vital to their happiness or employment, then cataract surgery may be indicated. Because we are far more active today at any given age than the previous generation was at that same age, we are more likely to experience visual limitations earlier. What is visual disabling to an individual depends upon their visual activity and their ability to perform that task. For example, if a truck driver at age 60 is unable to drive at night because of glare caused by a cataract, surgery may be indicated. Another individual with exactly the same vision and the same degree of cataract however may not be disabled because they do not depend upon night driving. The need for cataract surgery is therefore a matter of functional disability and not a function of a particular level of cataract development.

How Cataracts Are Removed?
Cataracts, the aging lens of the eye, are removed by a process called phaco-emulsification. Phaco-emulsification has been the technique of cataract removal for the past 20 years. During cataract surgery a very small instrument, about the size of the laminated tip of a shoelace, is used to both dissolve the lens and then to suck it out of the eye. This small instrument, which is able to dissolve the cataract by using ultrasonic energy, can fit through an opening about 1/8" diameter. Extremely rapid sound waves (ultrasound) are used to break (emulsify) the lens into very tiny pieces which can then be easily sucked out of the eye.

Are lasers used to remove cataracts?
No. The current technology for cataract surgery is removal with ultrasound fragmentation. Lasers are used for many other purposes in eye care, but not to remove cataracts. Lasers, however, are easily used to remove a 'secondary membrane' following cataract surgery which occurs in a minority of cases.

How long does cataract surgery take?
The surgery itself usually takes approximately 10 to 20 minutes. The entire experience in the SurgiCenter, including preparation time and post-op recovery, is generally less than an hour and a half.

Can cataracts grow back?
No. However, many people develop a film in their eye called a cloudy capsule which can blur the vision months to years following cataract surgery. This is a normal health process whereby the capsule that surrounds the lens becomes cloudy. This fine film of scar tissue can blur the vision and simulate the original cataract. This is why patients should be followed on a regular basis following cataract surgery. The cloudy capsule is easily removed with a 20 second laser procedure done in the office.

Cataract Surgery and Refractive Surgery (LASIK)
Cataract surgery is not LASIK surgery. LASIK is a laser procedure and cataract surgery is a surgical procedure. Both have the potential of reducing or eliminating dependence upon glasses. LASIK reshapes the cornea of the eye. Cataract surgery replaces the lens of the eye with an intraocular lens implant. LASIK is performed on a younger population; patients who do not have cataracts. Generally over age 60, cataract surgery is the procedure of choice.

Does cataract surgery eliminate the need for glasses?
The short answer is: No! Since most cataracts occur after age 50, people are already in the "bifocal" age group. By 50 years old anyone who has been wearing glasses since their 20's will transition into bifocals, and those who have never worn glasses will be wearing reading glasses. The human eye is incapable of focusing both far and near simultaneously after age 50 (presbyopia). Therefore virtually everyone in this age group will be wearing some sort of glasses prescription: with or without cataract surgery or LASIK.