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.
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.
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.
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.
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.
I have astigmatism but I am not sure what it is and if it can be treated.
As you probably know, people with astigmatism generally do not see sharp and crisp, either close up or in the distance. If you have a large amount of astigmatism, your vision may be very blurred. Straight lines running in one direction may be more blurred than lines running in another. For example, only the vertical edges of a window may appear out-of-focus.
The cornea is the clear window-like structure that lies directly over the colored iris and is a major part of the focusing mechanism of the eye. Astigmatism is present when the cornea is not spherical. It can be described as being more football shaped rather than basketball shaped.
There are a few treatment options, one of them is called Limbal relaxing incisions (LRI). An LRI is an incision that is placed on the far peripheral aspect of the cornea (the limbus) making the cornea more round. The astigmatism is reduced and vision is improved.
LRI can be completed in a few seconds. The eye is numbed with anesthetic drops. The patient experiences little if any post-operative discomfort. It is safe and does not cause glare or starburst as occurs with some other corneal incision procedures.
Limbal relaxing incisions are frequently combined with the cataract operation to reduce pre-existing astigmatism. The patient experiences better post-operative vision without glasses.
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.
Note: Not everyone is a candidate for multi-focal lens and results will vary.
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