Cataracts

Typical symptoms:

Blurred or foggy vision, double or triple vision in one eye, ghosting, dimness of vision, glare, difficulty driving at night, frequent changes of glasses, and inability to correct vision with glasses or contact lenses

Description: 

Cataracts are a cloudiness of the natural lens of the eye. They occur most commonly as a result of aging and most people will eventually get cataracts. Certain types of cataracts are caused by medications such as steroid use. Other types of cataracts are hereditary and can run in families.

Because the lens of the eye becomes opaque, light is not focused on the retina and the vision is blurred. Some patients compare it to trying to see through a fogged up windshield.

Cataracts can be corrected surgically by removing the cloudy lens. A lens implant is then inserted to replace the lens. Because the lens implants are made in many different powers, it is possible to select a lens implant so as to focus the vision for any distance desired. Patients therefore not only experience improved vision from removal of the opaque cataract, but often enjoy a freedom from distance glasses that they may not have had previously. New lens implants such as the Restor lens correct vision for both distance and near, and patients having this newer implant often never have to use glasses or contacts again. Although low degrees of astigmatism can often be corrected at the same time as cataract surgery, patients can also have LASIK after cataract surgery to correct any need for glasses if desired.

Treatment:

Cataracts used to be removed in whole pieces through large incisions. Because of this, it was often easier to remove them when the lens became old and hard, or 'ripe'. Patients often had a long and slow recovery, and because lens implants were not inserted, patients often had to wear thick glasses to correct their vision. The procedure has changed a great deal over the past 20 years, resulting in faster surgical time and healing.

Today, cataracts are generally removed using ultrasonic energy. The basic principle is that a small opening is made in the front surface of the membrane that encases the natural lens of the eye. The cloudy 'pulp' of this lens is then removed by breaking it in to smaller pieces that are evacuated from the eye. After removal of the lens tissue, a lens implant is generally inserted into the 'bag' of capsular tissue that remains. This membranous tissue will effectively shrink-wrap around the lens implant and support it in place.

Cataract surgery is performed as an outpatient, with patients returning home the same day. The surgery is often performed with light sedation similar to other procedures such as colonosopies. Often a shot is not even required to perform the surgery with anesthetic eye drops being used to assure the procedure is painless. Because the cataract incisions are so small, stitches are generally not necessary. If sutures are used, they can be removed easily in the office. Visual recovery is generally rapid as long as the rest of the eye is healthy, with many patients seeing as soon as they leave the surgery center.

Prognosis:

Cataract surgery is generally very safe and effective in correcting vision. Complications are rare but do occur. They include bleeding, pain, and infection. Although problems occur very rarely, severe bleeding or infection can lead to a loss of vision even more rarely a loss of the eye. About 5% of patients per year develop an 'after cataract - this is a clouding of the membrane of the original lens that was left behind to support the lens implant. The problem is easily corrected with a very short laser procedure performed in the office and does not require a return to the operating room. Patients with corneal, glaucoma or retinal problems may require additional surgeyr.