When you and your ophthalmologist decide that it is the right time for cataract surgery, the defective lens that causes blurring and light distortions will be replaced with a new lens. You may choose between a clear lens referred to as a single vision "monofocal" or a full range multifocal lens. Cataract surgery is an opportunity to improve your vision and attain independence from glasses or contacts. Check out our vision chart for more information on the different options available.
Lifestyle Questionnaire
Click on the link below for a questionnaire which will help you think about how you use your eyes in order for you and your ophthalmologist to determine the best option for you.
A cataract is a cloudiness of the eye's natural lens, which lies between the front and back areas of the eye.
What Causes Cataracts?
There may be a variety of causes, but no one knows for sure other than cataracts occur as we age.
There are actually three layers to the lens. It consists of an outer layer and that is a thin, clear membrane. The outer layer covers the second layer of soft, clear material. The center of the lens is the harder material or the nucleus.
A cataract can form in any part of the lens.
As we age, our lenses in your eyes become less flexible, less transparent and thicker. The lens is composed mostly of water and protein fibers that are arranged in a precise manner that makes the lens clear and allows light to pass through without interference. However, that structure of the protein fibers breaks down over time. They clump together and cloud small areas of the lens. The cataract will generally continue to cloud and become denser and spread over the eye.
The studies that have been done indicate that ultraviolet light or other types of radiation may be associated with the development of cataracts. Also, people with diabetes may be at risk as well as users of steroids, diuretics and major tranquilizers. Other risk factors include cigarette smoke, air pollution and heavy alcohol consumption.
Some of the recommendations to prevent or forestall cataracts include wearing a wide-brimmed hat and sunglasses to lessen exposure to the sun and a diet high in vitamins A, C and E.
The best course of action is to get regular eye exams. If you develop a cataract, you and your ophthalmologist can discuss the appropriate treatment. There is no reason for a cataract to impede your normal daily activities when it can be easily corrected.
Are cataracts found only in older people?
About half of the population has a cataract by age 65, and nearly everyone over 75 has at least one. But in rare cases, infants can have congenital cataracts. These are usually related to the mother having German measles, chickenpox, or another infectious disease during pregnancy, but sometimes they are inherited.
My doctor says I have a cataract, but he wants to wait a while before removing it. Why?
A cataract usually starts very small and practically unnoticeable but grows gradually larger and cloudier. Your doctor is probably waiting until the cataract interferes significantly with your vision and your lifestyle. You need to continue to visit your eye doctor regularly so the cataract's progress is monitored. Some cataracts never really reach the stage where they should be removed. If your cataract is interfering with your vision to the point where it is unsafe to drive, or doing everyday tasks is difficult, then it's time to discuss surgery with your doctor.
When is the best time for cataract surgery?
Your eye doctor can help you determine when it is time to have cataract surgery.
It is likely you will have time to consider your options. In most cases, waiting to have surgery won't harm your eye. The decision to have surgery depends on your vision and your comfort level. Even if you have been told you have a cataract, it may be years before you need or want surgery and sometimes never.
When to have surgery depends on the extent of your vision loss due to cataracts and how it impacts your daily life. If you are working, can you see to do your job? Can you drive safely? Are you having problems reading or watching TV? Are cooking, shopping or yard work more difficult? What about climbing stairs or taking your medications? Has your vision loss affected your independence in any way? Even if the vision loss is minor it might cause you problems with glare or double vision.
There may be other eye-related problems that determine the removal of the cataract such as diabetic retinopathy, retinal detachment, or macular degeneration.
Is cataract surgery serious?
All surgery involves some risk, so yes, it is serious. However, cataract surgery is the most commonly performed type of surgery in the United States. Many cataract surgeons have several thousand procedures under their belt. Choosing a surgeon with this much experience will reduce the risk of something going wrong.
How is a cataract removed?
A small incision is made into the eye. The surgeon will use ultrasound to break it up, and then remove it. The back membrane of the lens (called the posterior capsule) is left in place. Usually, a replacement lens (called an intraocular lens, or IOL) is inserted.
What happens during cataract surgery?
The surgeon removes the eye’s clouded lens and replaces it with a new lens. The type of new lens depends on what option you have chosen prior to surgery.
Before your scheduled surgery the ophthalmologist/surgeon will measure the size and shape of your eye and discuss the various vision options with you to determine the proper power of the lens implant.
During the actual procedure, the surgeon makes a small incision where the cornea meets the conjunctiva and then uses a probe that transmits ultrasound waves to break up the cataract and suction out the fragments. The inner layer is still intact and the new lens is implanted.
The new implant known as an intraocular lens (IOL) is made of acrylic. It requires no care and becomes a permanent part of your eye. Cataract surgery normally takes 10 minutes per eye and requires only a local anesthesia.
Our office can provide information on cataract surgery options and send you a Lifestyle Questionnaire to help you decide.
My wife’s doctor says she needs to schedule cataract surgery. What can we expect after surgery?
First, before she has cataract surgery be sure that you find out about all of the options in lens implant types. Instead of the standard clear lens, there is the multi-focal lens that is available and will restore vision and minimize or eliminate the need for glasses.
Following surgery, patients can go home on the same day of your surgery. Your wife will not be able to drive and will need a ride home. Activities may be limited such as bending and lifting the day of the surgery. She will follow up with the eye doctor the next few days, the following week and a month later to check how the eye is healing.
There may be itching and mild discomfort for a couple of days after surgery. Your wife should avoid rubbing or pressing on her eye. She will need to clean her eyelids with tissue or cotton balls to remove any crusty discharge. The doctor may prescribe medications to prevent infection and control eye pressure. After a couple of days, all discomfort should disappear. Generally, complete healing takes about six weeks.
If the multi-focal lens is selected, glasses will probably not be needed. However, if the standard lens is chosen, glasses will be needed and she will most likely need a new prescription. The doctor can let her when she should get new glasses.
If astigmatism still remains after surgery, she will be given some options to get rid of the astigmatism so that she will be much less dependent on glasses.
How do I find the best doctor for my cataract surgery? Should I always go with the one that my optometrist or general doctor recommends?
You do not have to go with the doctor that is recommended. You may want to review and evaluate others. Ask your friends and business acquaintances for referrals. When it comes to cataracts, be sure that your doctor can discuss and offer you several choices for lens implants. Not all ophthalmologists provide the latest procedures. This can mean the difference of wearing or not wearing glasses following your cataract procedure.
You want a doctor who has had experience with the cataract extraction procedure. Often a board-certified physician is a good choice as the certification procedure utilized by the American Board of Medical Specialties ensures a certain amount of experience in the special area of your procedure. Becoming a licensed, board certified physician means meeting the most rigorous training and continuing education offered in the field of medicine.
Keep in mind that the Board certification is time-limited, and to maintain their certification, doctors are periodically reevaluated. They must present evidence of licensure and scope of their practice and pass an examination every 7 to 10 years, depending on the specialty.
There have been many technological advances in the area of eye surgery and a Board Certification is a good indication that your doctor has made a commitment to continuing education and is keeping up with the latest findings in his or her field.
Call Insight Eye Center to meet with me. I am board certified and have performed more than 12,500 microsurgical and laser procedures for cataract.
I've heard that lasers are sometimes involved?
YAG lasers are used in a later procedure to create a clear opening in the lens-containing membrane, if the membrane becomes cloudy in the months following the original cataract removal. Also, some doctors use a laser to break up the cloudy lens before removing it.
My father had cataract surgery a few years ago, and he had to wear thick glasses afterward. Is this still necessary?
Nowadays, cataract patients who have intraocular lenses (IOLs) implanted during surgery may need reading glasses for close vision, or at worse thin glasses for distance and reading. In fact, with the newer multifocal IOLs, even reading glasses are often unnecessary. People who don't receive IOLs wear contact lenses for distance vision, with reading glasses for close up. Or they may wear multifocal contact lenses for all distances. Rarely does anyone have to wear thick eyeglasses now. (See section on multifocal lens).
How much does cataract surgery cost?
It varies from one doctor to the next; it also depends on the eyewear that is prescribed. Most health insurance plans will cover cataract surgery. Multi-focal lens implants are not covered by insurance, however, the cataract surgery is covered.
What are possible side effects of cataract surgery?
As with any surgery, pain, infection, swelling, and bleeding are possible, but very few patients experience serious problems. In fact, the newer techniques don't cross any blood vessels therefore the risk of bleeding is greatly reduced. What's more, people on blood thinners do not have to stop their medications.
Retinal detachment also occurs in a few people. Generally, be on the lookout for excessive pain, vision loss, or nausea, and report these symptoms to your eye surgeon immediately.
I’m 65 and I was told I will need cataract surgery and that there is new type of lens that will completely restore my vision. Is that true? Is it covered by Medicare?
Cataract surgery is one of the most commonly performed surgical procedures in the U.S. The good news is that almost anyone in good enough general health to qualify for traditional cataract surgery will also qualify for the procedure with the new lens. The lens may even work for those with astigmatism, or unusually shaped corneas.
The bad news is that Medicare will pay for the standard cataract surgery but not the additional cost of multifocal lens implants. Traditional cataract surgery uses a monofocal lens which improves near vision, or distance vision, but usually not both. The new multifocal lenses are designed to improve both distance and close vision, and sometimes the vision of distances in between.
Cataract surgery with either type of lens implant is performed on an outpatient basis and requires just a few hours with little discomfort. The new lens has given many aging adults the ability to see without glasses.
What are some of the symptoms of cataract? Does everyone eventually develop cataracts?
Cataract is a clouding of the lens and is a normal part of getting older. About half of Americans older than 65 have some degree of clouding of the lens. After age 75, as many as 70 percent of Americans have cataracts that are significant enough to impair their vision.
Cataracts don't typically cause any change in the appearance of your eye. Symptoms of a cataract include:
· Clouded, blurred or dim vision
· Increasing difficulty with vision at night
· Sensitivity to light and glare
· Halos around lights
· The need for brighter light for reading and other activities
· Frequent changes in eyeglass or contact lens prescription
· Fading or yellowing of colors
· Double vision in a single eye
If you have a cataract, light from the sun, lamps or oncoming headlights may seem too bright. Glare and halos around lights can make driving uncomfortable and dangerous. You may experience eyestrain or find yourself blinking more often to clear your vision.
Generally, you do not need to seek treatment or surgery until your vision is impaired enough to affect your everyday life.
What will my vision be like after cataract surgery?
Following the standard monofocal implant cataract surgery, most patients will continue to wear contacts or glasses after their cataract removal. There is some recovery time while the eyes adjust to seeing without the cataract. If only one eye is operated on then the eyes will learn to work together again.
If you elected to have multi-focal lens instead of the clear implants you will be less likely to depend on glasses or contact lens either for near or far. Patients who choose multifocal lens implants typically experience a greater overall freedom from glasses allowing them to participate in most everyday activities without dependence on, or the hassle of glasses.
Generally your everyday activities can be resumed soon after cataract surgery. You may experience blurry vision for a time. Your doctor will let you know when you should begin driving following surgery. The clear lens implants, intraocular lenses (IOLs), may cause some color distortion at first. This should resolve itself within a few months as the eyes adjust.
As with any surgery, there are a few risks with cataract surgery. The most common effect is a clouding effect on the capsule holding the lens. Corneal swelling or edema is a natural reaction to cataract surgery and generally heals. Please be sure to discuss risks with your doctor prior to eye surgery as well as any other questions you have.
Will my vision be the same or better or worse following cataract surgery?
The vision that you will have after cataract surgery depends on the overall health of your eyes before surgery and which vision option you chose before surgery.
It is important that you understand all of your vision options prior to surgery. Cataract surgery can allow you to see far or near without glasses or contacts. You can also elect to be able to see at all distances without glasses, or minimal need for glasses.
Be sure that your doctor is qualified for all types of cataract surgery options otherwise you will receive the standard lens implant and perhaps be able to see far without glasses, but will need glasses for reading. Your choices will depend on an evaluation by the doctor and a determination of how you use your eyes.
Choosing a vision option depends on your lifestyle and the activities you enjoy. Some people are more interested in being able to see up close, to read, to sew, or other activities and may want surgery that allows them to do this without the aid of glasses. They may not care that they need glasses for distance. Other individuals will be just the opposite and are comfortable with glasses for reading but prefer to see at a distance without aids. If you want to see at all distances without minimal or no dependency on glasses, you can elect that option. Be aware that the costs vary.
Our staff can provide you with a Lifestyle Questionnaire to help you think about how you want to see after cataract surgery and provide a basis for a discussion with Dr. Rom.
I understand that there are choices for what my vision will be after cataract surgery but I have heard that insurance does not cover anything but the standard surgery. What are the choices and what is available without spending a lot of my own money?
First of all there are always new products and techniques coming into the vision market so it’s best to talk to your ophthalmologist about the very latest procedures and lenses that are available. Today you can choose to see both near and far without the aid of glasses or contact lens following cataract surgery and that is the multi-focal lens that you can purchase. The Insight Eye Center charge is $1900 per eye.
Many of our patients are opting for what is called the Toric lens because it is reasonably priced at generally $800 per eye and it addresses other visual problems at the same time it corrects symptoms caused by cataracts. The Toric lens can correct for astigmatism. As a result, the patient only needs an inexpensive pair of reading glasses they can purchase from the drug store following cataract surgery.
Every individual is different in how they want to see and if they wish to use glasses or not and to what extent. Your personal lifestyle will help determine the best choice for you. If you choose to receive the standard cataract implant lens, it will be covered by insurance, but you will require visual aids, glasses or contacts, for either seeing far or close.
You can find a Lifestyle Questionnaire form on our website or call our office for more information on what’s best for you if or when you should need cataract surgery.
What is involved with cataract surgery? Any other options?
Surgery is the best solution if your cataracts are seriously impairing your vision and affecting your daily life. The procedure is a simple, relatively painless procedure to regain vision. Your doctor can best advise you on whether or not you are ready for this step.
Before surgery, your eye will be instilled with an anesthetic eye drop so that you will feel little, if any discomfort. Then a tiny incision will be made and a small instrument will be passed through it. Using ultrasound from the tip of the instrument, the cataract can be broken into pieces small enough to be washed away. They are pulled up through the instrument and removed from the eye.
Once the cataract is removed, it will be replaced by a new permanent Intraocular Lens Implant. The new lens is inserted and placed in position through the same tiny incision at the outer edge of the cornea through which the cataract was removed.
After a short stay in the outpatient recovery area, you will be ready to go home. Home treatment includes eye drops and protecting your eye during sleep and in sun or bright lights.
The standard lens that is inserted in your eye is a “monofocal” lens meaning that you most likely will still need glasses. As long as you are having the surgery, you might want to check out the “multifocal” lens that restores vision and minimizes or eliminates the need for glasses or contact lenses.
NEW TORIC LENS CORRECTS ASTIGMATISM!Can cataract surgery help my astigmatism or will I still need corrective eyewear?
As you may know, the cornea of a perfectly shaped eye have a smooth circular surface, like a ball. With astigmatism, the cornea will have more of an oblong, football-like shape.
You can have a toric lens implanted that will treat the cataract and the astigmatism at the same time. If you do not request a toric lens, then the standard lens implant surgery will remove the clouded natural lens with an acrylic one. It will not correct astigmatism and you may still experience blurred or distorted vision. You would still need corrective eyewear.
You will want to discuss your cataract surgery options with your ophthalmologist prior to any surgery. A toric lens is safe and whether or not you would need a toric lens would depend on the degree of your astigmatism. It does not always require a toric lens if the cornea has a minor distortion.
If your doctor determines that you are a good candidate for a toric implant, it can restore focus to the eye when the natural lens or cataract is removed. It is designed to correct preexisting astigmatism using the same technology that has been successfully used in contact lenses for many years. The best part is that the surgery to correct the cataract and the astigmatism is all done at the one time and generally takes 15 minutes per eye.
Our office can set up a comprehensive eye exam and answer any questions you may have.
I would like to prevent cataracts from ever happening. What are the causes and how can I prevent them?
The development of cataract is part of the aging process. The eye’s lens becomes clouded over and vision is impaired until surgery can correct the problem. Although there is no single cause of cataract, there are believed to be risk factors. Some of these can be controlled and others can’t.
The following are risks that can be controlled:
· cigarette smoking
· drugs: some eye drops used to treat eye problems contain steroids. If unsupervised and taken over a long time, they can cause cataracts.
· diabetes: proper treatment can reduce the risk of cataract
What cannot be controlled is the most important cause of cataract – aging. Other causes of cataract include family history of cataract, eye conditions such as inflammation, severe trauma to the eye, and possibly ultraviolet light.
Although cataract may not be prevented altogether, it can be detected with routine eye exams and treated promptly to relieve symptoms. If cataracts do develop and surgery becomes necessary, check out the possibility of taking advantage of this opportunity to correct your vision with a multi-focal lens implant, instead of a standard clear lens, that may minimize the use of glasses.
I think that my husband has cataracts but I’m not sure if that is what’s going on. What should I look for?
Cataracts are not painful and they do not cause the eye to tear abnormally nor is the eye itchy or red so there are no outward physical signs to watch for.
Your husband may complain that he just can’t see well anymore or his eyes are cloudy. He may have trouble with activities that require clear and sharp vision. Sometimes there is a yellowing/browning of the lens and that will affect blue and purple color vision causing problems when matching clothing, seeing pictures correctly and other activities associated with color.
Your husband may also complain that he sees halos around lights or the glare from car lights at night becomes more troublesome making driving at night may be dangerous. Generally far vision is affected more than near vision, but if the condition is bad enough, reading can become difficult as well. Because independence is so important as we age, it’s a good idea to see the eye doctor regularly to maintain good vision. Cataract conditions can be corrected and the sooner the better!
I have had a cataract in one eye for some time now. When should I have surgery? What if I decide not to have surgery?
Whether to have surgery or when to have surgery depends on the quality of your eyesight and how much your vision is affected. Is your vision loss impacting your independence in any way? Are you able to do your job or see to drive? Are you having problems reading or watching TV? Is it troublesome to do yard work, climb stairs, shop, cook, or take your medications?
Except for people with diabetes, the growth of the cataract for most people is a slow process and may take years to cause serious problems. That means that generally there is time to think about a decision.
Keep in mind that there are instances when a cataract should be removed even if the vision loss is not major, such as to eliminate problems with glare or double vision or if it is interfering with treatment of another eye problem such as macular degeneration, diabetic retinopathy or retinal detachment.
If the cataract does not cause major problems over time then surgery may not be needed. Your eye is not harmed in any way by avoiding surgery.
The decision is between you and your ophthalmologist as to if and when to have surgery. If you have cataracts in both eyes, you will be scheduled for two separate surgeries, giving your eye time to heal before the second eye surgery.
I am a very active 65 year old. I would really like to see without having to wear glasses. I have been told that I am not a good candidate for Lasik anymore so what other options do I have?
Newer, multifocal intraocular lenses will correct vision at multiple ranges, without the use of glasses or contact lenses. This procedure can be done at any time but generally is done during cataract surgery where the old lens is replaced by a new multifocal lens. In the past, the new intraocular lens was clear and would correct for either near or far but not both. You would still need glasses for the distance that was not corrected by surgery. However, the multifocal lens corrects your vision and you usually do not need glasses to read or see at a distance. Both the clear lens, or monofocal lens, and the multifocal lens are referred to as intraocular lens implants.
Generally, you are considered a good candidate for intraocular lenses if you:
· are in good health
· have healthy eyes free of disease and infection
· are between the ages of 55 and 80
An ophthalmologist will examine your eyes and review your medical history to determine if you are a good candidate for this procedure. Be sure to check this out prior to having cataract surgery.
My husband is a 73-year-old man who is very healthy and active, but he has cataracts on both eyes. Our optometrist tells us that they are slow-growing. My husband thoroughly enjoys his golf games and many other activities. However, he is getting more and more frustrated. His vision is blurred. He has trouble focusing and says he sees double sometimes. He keeps getting new glasses and they don’t work out. We are not sure what to do because his optometrist feels he should wait before having the cataracts removed.
It sounds like your husband’s vision is interfering with his normal daily life and that is usually a good time to schedule a surgical consultation. When we are unable to read, watch TV, drive, or enjoy other daily activities due to cataracts, surgery may be the next logical choice.
I would recommend that he or you make an appointment with a qualified ophthalmologist who can evaluate his situation and go over the options that are available to him. Cataract surgery is one of the most successful surgeries, taking little more than 10 minutes per eye. There are few side effects and they are not long-lasting.
Depending on his eye exam and vision choices, your husband may be able to golf and do other things without glasses following cataract surgery. Costs will vary and your ophthalmologist can explain all of the details at the time of your appointment. Please call me if you or he have other concerns and questions.
Note: Not everyone is a candidate for multi-focal lens and results will vary.
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