Cataract Surgery

How are cataracts treated?

When cataracts are deemed clinically significant the faulty lens is replaced with a synthetic, permanent lens.

Cataract surgery is performed as an outpatient in a hospital or at an ambulatory surgery center. Only one eye is operated on in a given day. The older concept of a 'mature' or 'ripe' cataract is no longer as desirable. In fact, a lens that is too 'ripe' poses a greater surgical risk. Since no stitches are used and the eye usually recovers quickly, there are fewer restrictions after surgery, but this depends on variables like the degree of surgical difficulty, the age of the patient and the severity of the cataract.

The lens is pulverized and removed as a semi-liquid (phacoemulsification). Usually, to facilitate this procedure, a laser - the femtosecond laser - is used to prepare the eye for easier and safe removal of the cataract. This allows for faster, safer surgery that requires no stitches. Topical anesthetic (drops applied to the eye) is all that is needed, but the surgery is always performed in a proper operating room with an anesthesiologist present. To reduce a person's anxiety, anesthesia is usually administered by the anesthesiologist.

How is the cataract lens replaced?

Once the cataract lens is removed a synthetic lens is inserted in its place. The lens is self-retaining (requires no stitches) and will last the duration of a person's life time. The Intraocular lens (IOL) can have several different (refractive) qualities that can help to reduce or eliminate a person's dependency on glasses.

Is a laser used in cataract surgery?

Femtosecond laser has been introduced into cataract surgery as an elective adjunct to the conventional procedure. The Femtosecond Laser allows for 'bladeless' incisions, a more refined capsulotomy (incision into the front surface of the lens) and softening of the cataract before its removal. The application of this technology reduces the trauma of surgery, thereby reducing the surgical risk and speeding visual recovery. Of course, this technology also requires an out-of-pocket investment by the patient.

Intraocular Lens Implants (IOL's)

There are essentially two categories of intraocular lens implants: Monofocal or standard IOL's and Premium IOL's.

1. MONOFOCAL IOL's correct vision at only one distance (far or near) and do not compensate astigmatism. Typically, a person who has a monofocal lens implanted will require glasses for some or all visual tasks

2. PREMIUM IOL's enjoy the name 'premium' for two very different reasons:

(1) They reduce the person's need for glasses after surgery.

(2) They require that the patient pay a 'premium' over the usual cost of cataract surgery.

The choice of which type of IOL is correct for a given person should be based on that person's personal needs and preferences and the judgment of the surgeon.

(a) TORIC INTRAOCULAR LENS IMPLANTS (IOL's)

These lenses are not multifocal and do not compensate near vision. They DO correct astigmatism. So, reading glasses are still needed after surgery. When an astigmatic lens is used I measure the eye again at the time of surgery with a measuring device that is incorporated into the microscope. In this way, the artifacts imposed by the cataract are eliminated and a maximally accurate reading of the eye's native prescription can be made. This technology also insures that the placement of the lens is ideal.

(b) MULTIFOCAL IOL's:

Multifocal lenses come in many varieties. When applied properly these lenses can supplant the need for glasses at all distances: far, intermediate (the computer) and near. A patient's candidacy for these implants depends on the pre-surgical refraction, history of prior ophthalmic procedures, binocularity (whether both eyes work well together), and whether one or both eyes will be having cataract surgery. Other ophthalmic conditions may also override a person's eligibility for these lenses.

Multifocal lenses are NOT like progressive spectacles. There is no need to move your head to see far vs. near. Some patients will see halos around lights, especially at night. This diminishes over time for some, but not all patients. Multifocal lenses can also correct astigmatism.

These lenses are somewhat flexible and allow the person to bring near images into relative focus without glasses. The range of near vision with these lenses is not as extensive as with multifocal implants, but there is far less likelihood of halos or adverse visual effects. A patient's candidacy for these implants depends on the amount of astigmatism, the pre-surgical refraction, history of prior ophthalmic procedures, binocularity (whether both eyes work well together), and if both eyes will be receiving the same lenses in near proximity. Other ophthalmic conditions may also override a person's eligibility for these lenses.

Simulated Vision with Cataract

Simulated Vision after Cataract Surgery

Do cataracts come back?

No. A cataract is the lens of the eye, so once removed, it cannot recur. However, in cataract surgery the capsule (outer peel) of the lens is preserved. Because this tissue is organic, it can become hazy much like the cataract itself. This is often referred to as a secondary cataract. The hazy capsule, also called a capsular opacification, can interfere with vision, since light that passes through the lens must then pass through the posterior capsule.

Symptoms may include: reduced clarity, haze, glare, double vision in one eye, ghosting around images, and less commonly, distortion.

While a capsular opacity, or secondary cataract, is not of great concern and is easily treated in the office, it is important to contact your ophthalmologist as soon as you note these symptoms to make sure that another, more serious ophthalmic condition is not responsible for these symptoms.

Does a hazy capsule require additional surgery? No. This development can be treated in the office with a laser. The process is called photo-disruption and is performed with a YAG laser. When the laser is focused on the hazy capsule, it creates a series of holes in the capsule that eventually coalesce (come together) and create a clear opening. The process is painless and performed in the office.

Are there risks to YAG Laser Photocoagulation?

There are risks to any procedure, but they are relatively limited. Cases of post-treatment edema (swelling) in the macula have been reported, as well as temporary elevations in the intraocular pressure. Torn and detached retinas have been observed in rare cases after treatment. There are, however, predictable side effects that most patients should expect to see. These include floaters that dissipate days to weeks after treatment.

Robert Friedman M.D