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The most impactful research and technology that is being done for cataract surgery revolves around the lens implants that we use during the process. For example, rather recently, we just had FDA approval of multifocal lenses. These are the lenses that allow people to see both far and near without glasses, but these lenses that will also correct for patients astigmatism. About 10% of patients undergoing cataract surgery have coexisting glaucoma. In the past, surgical treatments for Glaucoma have been rather invasive. One of the exciting new advances is the development of small drainage devices that can be implanted in the patient’s eye at the time of cataract surgery. These don’t take long to do, and they don’t add to the discomfort during the procedure or to any recovery time. The good news is that with modern technology and under the care of an experienced and qualified surgeon, patients can anticipate a relatively easy process, a short surgery time, a quick recovery time, and a really good benefit to your quality of life.
The starting point to treating cataracts is to get your eyes examined. Now there’s no diet, exercise or eyedrops to take that are going to make a cataract go away. Ultimately, once the symptoms become significant enough, the treatment is a surgical one and it involves taking the cataract out and putting a lens implant (that’s clear) in place of that natural cloudy lens.
Fortunately, there are so many different things that we can do to help our dry eye patients. It may range from just taking breaks in front of the computer to tear supplements (medications that stimulate tear production) or minor in-office procedures – all designed to really help make patients’ eyes feel more comfortable and see better.
The single biggest risk factor for cataract development is age. In fact, half of the people over the age of 55 have some degree of cataract. Now, there are other risk factors such as debilitating chronic disease, diabetes, trauma, and in fact, certain medications can predispose someone to developing cataracts.
Cataracts are treated by cataract surgery and what that is is a lens exchange, so we’re taking the cloudy lens out of the eye and putting in a clear lens implant in its place. It sounds really involved (and it technically is) but it’s a quick procedure. Within 10-15 minutes, patients can undergo cataract surgery. It’s done as an outpatient, usually using just eyedrop anesthesia. The patient doesn’t feel any pain and although it is kind of scary to think about, the recovery is really fast and most patients will notice an improvement in their vision within a few days. There are risks of cataract surgery like any procedure, so despite the full intention and expectation of a good outcome, obviously things can happen. It’s important for patients to have a thorough discussion with their ophthalmologist prior to proceeding so they can understand if there are any special circumstances relating to their case.
Cataract surgery is done on an outpatient basis using just eyedrop anesthesia. The procedure (usually taking about 10 minutes or so) involves taking the natural lens out of the eye and putting in a clear plastic lens in its place. The patient isn’t in any pain during the procedure. They’re alert, but they’re relaxed. There’s an anesthesiologist there that gives the patient some relaxing medicine through an I.V. The recovery is usually quite quick too, so that within a few days, most patients are noticing a nice improvement in their eyesight. Now, there are risks. Any surgery does carry the possibility of problems occurring, so despite the full intention and expectation of the ophthalmologist of a good outcome, obviously problems can occur. It’s important for patients to have a thorough discussion with their ophthalmologist prior to proceeding so they can understand if there’s any special circumstances relating to their case.
The recovery from cataract surgery is usually pretty quick. Patients may feel a little soreness or grittiness. The eyes may look a little red and patients may see things like halos around lights and certain other types of distortions, but within a few days to a few weeks, the eyes typically return to normal.
While there’s really no way to fully prevent cataracts, certain lifestyle changes might be able to help. People who smoke tend to get cataracts at a younger age. People who do kind of dangerous recreational activities and experience trauma to their eyes, they are going to get cataracts sooner. Patients who have chronic diseases that are rather debilitating and are taking some pretty strong medications may get cataracts at a younger age, Asthmatics who are using steroid inhalers have been shown to get cataracts at a younger age as well. Some of these things might be unavoidable, but if you can try to keep yourself overall healthy and try to protect your eyes and your body, that might serve you best from developing a cataract at a younger age.
Because most cataracts develop simply because of age, it’s very common for patients to come in with cataracts in both eyes. They often ask if we do the procedure on both eyes the same day like we do with LASIK surgery, for example, but with cataract surgery we usually do one eye in one day and the other eye a week or two later. People also wonder if their cataracts can grow back and the answer is: no. Cataracts themselves do not grow back. However, behind the lens implant, patients can develop a cloudy membrane that forms and that can happen anywhere from 3 months to 30 years after their cataract surgery. It may seem to the patient like they’re getting their cataract back, but that’s really not what’s happening. That membrane can be treated with an in-office laser procedure which is really easy for the patient to go through and the visual recovery is rather quick.
A cataract occurs when the natural lens of the eye gets cloudy. At first, it gets kind of yellow in color or brown in color, but it can actually become milky white. If you think of the human eye like a traditional camera, the cataract occurs in the lens, so a the light is passing from the object of regard through the lens and ultimately onto the retina (which is similar to the film in a camera) – the image quality is poor if the lens is cloudy.
There are a lot of different options with a cataract surgery. We can do things from regular cataract surgery or standard cataract surgery (which is still a lens replacement) and then usually about a week after the procedure, patients get their glasses – whether it’s for driving or for reading or for both. Now for patients who would like to see without glasses or at least have us do whatever we can to minimize their need for glasses after surgery, there’s a whole host of things we can do and we consider this to be refractive cataract surgery. Of those options, one common thing would be to have both eyes corrected for distance vision. So whatever astigmatism (nearsightedness or farsightedness) that needs to be corrected, we’d be able to do that so that patients could see to drive without glasses and maybe just where some over the counter reading glasses. Other patients would like to do a little bit more where they could see far and near without their glasses. To accomplish that, we might correct one eye for distance and one eye a little more for in-close. It may be for reading or maybe just close enough to see the cell phone and do text messages without having to go off and on with their glasses. The fanciest thing we can do is to put in these lens implants that we call multifocal or extended depth of focus lenses. What those do is they enable patients to see both far and near out of both eyes – so both eyes are for distance and both eyes are for up-close. It’s kind of the fanciest thing to do. Now, all of these different techniques do have potential drawbacks. Obviously with the monovision, patients might (if they’re not accepting of it) feel a little imbalanced between the two eyes, it could be bothersome. A lot of patients have tried the monovision prior in contact lenses or with LASIK, so they already are familiar with it. With the multifocal lenses, while they’re very strong and powerful at providing both distance and near vision, one of the drawbacks is that patients might see a ring around things or a halo when driving at night – so looking at point sources of light can have kind of a ring pattern to it. Fortunately, the chance of that being a bad problem is very, very low, but it’s important for patients to know that it’s possible to see it so that they don’t panic about it if they’re noticing it and can be reassured that it typically improves over time. It’s very important that a lot of detailed testing is done at the preoperative consultation because it’s at that visit that the doctor is really able to figure out what the patient is the best candidate for and what the patient’s needs are so that their goals can be achieved.
Symptoms of cataracts can range from trouble seeing when driving at night because of glare to difficulties watching TV or reading. In more extreme cases, patients may truly be blinded from the cataract where they can barely see a hand moving in front of their face.
One of the most common things that we’ll see are patients with dry eyes. The dry eye patient will come in maybe complaining of a grittiness, kind of like there’s a grain of sand in the eye. They may complain that their eyes are red or that their vision gets rather blurry after just a short period of time reading or in front of the computer. Particularly people who are in dry climates – so maybe the midwest in the wintertime or southern California at any point in time. It’s really kind of a ubiquitous problem. Fortunately, there’s a lot of things that we can do to help these patients.
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