Cataracts and Cataract Surgery

What is a Cataract?

A cataract is a dirty lens that develops with age, medications, sunlight, trauma, and/or certain diseases such as diabetes. When you are young, the lens inside of your eye (behind the iris, or the colored part of the eye) is clear and flexible, allowing you to see at distance and near without the need for reading glasses or bifocals. As the lens hardens with age, you lose your ability to accommodate, or to see at near, without the help of reading glasses or “cheaters.” Eventually when the lens becomes dirty enough, you can start losing vision, even with the best possible pair of glasses.

At this time, the only way we can improve vision from a cataract is to completely remove it and put a replacement lens in your eye. This is achieved using a machine that uses ultrasound energy to break up the lens. In addition, we can calculate the power of lens we can put in your eye with pretty good accuracy. If your lens power is set for distance vision, you will most likely need reading glasses in order to see up close.

What are the risks of cataract surgery?

While cataract surgery is safe with a high success rate (approximately 98-99% for routine cases), there are risks to surgery. Sometimes, the anatomy of your eye does not lend itself to safe surgery. Even with the safest technique, there are times when there is resulting damage to the eye which may require a second surgery to remove lens material and/or to put in a new artificial lens. There is also a risk of an infection developing inside of your eye (one in every 1000-2000 cases), which may result in irreversible vision loss even with treatment. This is why we do not typically offer surgery unless your vision is debilitating so that the risks of surgery are outweighed by the potential benefit.

What is a Multifocal Lens and am I a candidate?

A multifocal intraocular lens (IOL) is a type of artificial lens placed inside of the eye that may help increase your range of vision. While the surgery to remove the cataract is the same as with a monfocal (or standard) lens, the lens that is placed in the eye has a range of power to increase your range of vision. This may allow you to see distance (driving, reading signs, watching TV), intermediate (computer), and/or near (reading).

While the idea of a multifocal lens sounds fantastic, the lens will cause significant glare and halos (that is how you know the lens is working)! Not everybody can tolerate this. In addition, if you have had previous eye surgeries, especially refractive surgery (such as LASIK, PRK, or RK), have an irregular cornea, or have other eye diseases that may require surgery in the future, a multifocal lens should not be placed.

Multifocal lenses are improving with time and advancing technology. In coming years, we hope there a perfect multifocal lens for everyone! For now, please talk to your surgeon to determine whether a multifocal lens is right for you.

What is a Toric Lens?

A toric lens is a type of lens placed inside of the eye during cataract surgery that corrects for astigmatism. While it sounds like a scary disease, astigmatism just means that your eye isn’t perfectly round - almost no one has eyes that are a perfect circle, believe it or not. If your eye is shaped more like a football than a basketball, then you most likely require glasses or contact lenses that correct for astigmatism. When it comes time to needing cataract surgery, a toric lens will correct for most of the astigmatism to minimize your need for distance (or near) vision correction after surgery.

Because the extra cost of toric lenses are not covered by most insurance carriers, these lenses carry a premium and you will most likely be expected to pay an out-of-pocket fee. Please talk to your provider to determine if you are a good candidate for a toric lens. If paying the premium is not an option, you can always elect to forgo the toric lens, with the expectation that you will most likely need glasses or contact lenses for the best possible vision after surgery.

What is small incision cataract surgery (SICS)?

If you have a very dense lens that cannot be broken down with the machine, sometimes we have to perform a surgery called small incision cataract surgery (SICS). In this case, we have to make a big incision (despite the name!) and take out the lens in one piece. This is also a safe surgery, although you can have some to a lot of astigmatism (or an irregular cornea) after this surgery due to the big incision, which can be corrected with glasses or a contact lens.

*This is how we used to do surgery before the ultrasound (phacoemulsification) machine was invented!