Cataract Surgery

What is a cataract?
A cataract is a clouding of the normally clear, transparent lens of the eye. A cataract is not a tumor or growth of new tissue over or in the eye. Rather it is a fogging and loss of clarity of the lens itself. The lens is located in the eye just behind the iris and the pupil. Light entering the eye is focused by the lens onto the retina. When a cataract forms, the lens is no longer able to focus the light clearly. Therefore, your vision becomes cloudy. An early cataract may cause few problems with vision. If the cataract gets worse, sight may be partially or completely lost until the cataract is removed.

Although cataracts result from many conditions, the most frequent cause is the natural aging process. Other causes may include eye trauma, chronic eye disease and other medical conditions, such as diabetes.

Cataracts can take from a few months to several years to develop. Certain medications can accelerate the development of cataracts. Sometimes, the cataract stops developing in its early stages and vision is only slightly decreased. But if it continues to develop, vision is impaired and surgical treatment is required.

How are cataracts removed?
Surgery to remove the diseased lens is the only effective treatment for cataract. Neither diet nor medications have been shown to stop cataract formation. In a cataract operation, the eye’s natural lens is removed. Vision can then be obtained in the form of special eyeglasses with thick lenses or contact lenses. Most commonly, it is in the form of an intraocular lens, which when implanted, permanently replaces the old lens.
The artificial lens is made of plastic and is usually inserted at the same time the cataract is removed. Depending on the individual case, the lens is placed directly behind or, less frequently, in front of the iris, the "colored" part of the eye.

Once the surgeon has determined that intraocular lens replacement is appropriate, the patient undergoes a special preoperative evaluation. Like contact lenses and "prescription" eyeglasses, intraocular lenses differ in terms of refractive power, and the evaluation will determine the proper lens power of the implant. The length of the eye is measured and the curvature of the cornea is evaluated. Calculation of the implant power is based on this information.

The intraocular lens, which cannot change shape, is usually calculated to maximize a patient’s distance vision so that the patient can see well enough to do most things without glasses. Reading glasses must still be worn to see up close up and far away. In most cases, patients notice significant improvements in vision resulting from intraocular lens implantation.

 Are stitches (sutures) required for cataract surgery?
One of the new advances in cataract surgery is the ability to remove the cataract and implant an intraocular lens through a small incision. New techniques for making incisions have, in most instances, eliminated the need for sutures following cataract surgery. For some individuals, other types of incisions, ones that require sutures, will provide a better visual result for them. We select the type of incision that is best suited for each patient’s condition.

What results can I expect?
More than 90% of people achieve a vision better than 20/30 after cataract surgery, as long as no other eye diseases are present (for example, a retinal condition). Reading glasses are required after cataract surgery (in many cases they were also required before surgery).

The key to living with cataracts is knowing when it’s time not to live with them anymore! Usually, this happens when your normal lifestyle - reading the morning paper, driving to the grocery store or seeing the expression on the face of a child or grandchild - is jeopardized by impaired vision. Cataract surgery is just that - surgery - and we believe that the right time to have such surgery is an individual, personal choice that depends on one’s individual lifestyle requirements.

What is the best lens for implanting? Acrylic or silicone? What problems are associated with each?
There are three materials presently used for intraocular lenses: polymethylmethacrylate (PMMA), silicone, and acrylic, with other materials currently under development. Each has advantages and disadvantages.
PMMA must be implanted through a larger incision than the other materials. Silicone and acrylic can each be placed through a smaller incision than PMMA. Silicone lenses are usually avoided in diabetic patients and patients with severe retinal problems. Acrylic affords a very controlled unfolding of the lens. Today's intraocular lenses are very safe and effective.
We use the most advanced lens material available, and we tailor the choice of lens material to the needs of each patient.
I have heard a lot about topical or "no-needle, no-patch" anesthesia for cataracts. What does this really mean?
Previously, cataract surgery was performed under general anesthesia, requiring patients to stay in the hospital. Later advances used a local anesthesia injected behind the eyeball. Although this procedure allows the patients to return home the same day and is safer than general anesthesia, it is not entirely free of risk.
Today, with recent advances in cataract surgery anesthesia, topical anesthetics are often used. The eye is anesthetized using eye drops rather than through an injection of anesthetic under the eyeball with a needle. Avoiding the needle reduces the risk of bleeding, bruising and inadvertent damage from the needle itself. Even when topical anesthetics are used, patients may be given an IV sedative to help them relax and keep them comfortable during the procedure.

  • Advantages of topical anesthesia
    • Faster with greater patient comfort.
    • No patient anxiety over receiving a deep injection next to the eyeball.
    • Visual recovery begins immediately since the eye muscles are not paralyzed as with local block anesthesia.
    • Eliminates potential complications, such as perforation of the eye, hemorrhage, or damage to the optic nerve.
    • Reduces the chance for a relatively dangerous anesthesia-induced allergic reaction.
    • Eliminates the potential for postoperative headaches caused by conventional blocks.
    • Eliminates the need for an eye patch.

Is "no-stitch" cataract surgery a possibility?
"No-stitch" cataract surgery is indeed an option for many patients. The potential benefits of "no-stitch" cataract surgery include:

    • No stitches - the tiny incision seals by itself.
    • Clear vision returns almost immediately.
    • Less chance of surgically-induced astigmatism.
    • Little, if any, discomfort.

Recent advances in cataract surgery now allow many patients to have their cataract removed without the need for stitches, needles or eye patches. Overall, the vast majority of patients do well with this surgical approach to cataract excision; nevertheless, not all patients are good candidates for the procedure.




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