A cataract is a cloudiness of the normally clear lens that sits in the front part of the eye. The lens in located inside of the eye, behind the iris, the colored part of the eye, but in front of the vitreous cavity. The lens focuses light rays on the retina in the back of the eye to produce a crisp image of what we see.
As the cataract increases in density and cloudiness, vision is often impaired. Clouded vision may make it more difficult to read, drive a car or perform daily activities. Cataracts develop slowly over time and are a natural result of aging.
What are the Symptoms of Maturing Cataracts?
- Blurry or dim vision
- Poor night vision
- Halos around lights
- Sensitivity to light and glare
- Need for brighter light for reading and other activities
- Frequent need to change eyeglass prescriptions.
Cataract development can be accelerated by trauma, diabetes and other long-standing medical conditions, use of certain medications, and genetic factors.
Cataract surgery is very common and is the only way to remove a cataract. There are no medications, eye drops, exercises or glasses that will remove the effect of cataracts on vision once they have formed. Surgical removal of the cataract is indicated when the visual impairment due to cataracts impacts the patient’s quality life.
The goal of surgery is to replace the cloudy lens with a permanent, transparent, intraocular lens, made of a specialized plastic. This new lens is placed in the exact anatomic location where the natural lens once was. Any power lens can be implanted into the eye, resulting in a decreased dependence on glasses after cataract surgery. After the cataract is removed, it cannot return.
Cataract surgery facts:
- Cataract surgery is performed one eye at a time
- The two surgeries are usually separated by several weeks.
- Dr. Lally performs cataract surgery in an operating room at an outpatient surgical center.
- She uses an operating microscope and microsurgical instruments to perform the surgery.
- A small incision is made on the side of the eye and specialized instruments are used to fragment and suction the cloudy lens from the eye.
- The back membrane of the lens (called the posterior capsule) is left in place and the plastic intraocular lens implant will be placed inside the capsular bag.
- The incision is made in such a precise way that usually, no sutures are required at the end of the case.
Prior to the surgery, a series of precise measurements are taken using laser technology and theoretic calculations are done to aid the surgeon in selecting the desired lens power. Despite the precision of the measurements, there is no absolute guarantee of the final vision result. There are many factors that go into the patient’s post-operative visual acuity, including final position of the intraocular lens, individual healing and scarring patterns and slight irregularities in an individual patient’s pre-operative calculations.
Over 98% of cataract surgeries result in improved vision. A small number of patients however may have problems and/or complications including infection, bleeding, persistent swelling, lens dislocation and retinal complications.
At Summit Eye Surgeons, the Femtosecond laser can be used to assist Dr. Lally during the cataract surgery. The Femtosecond laser is a highly specialized laser that uses a highly refined light beam to precisely measure, cut and vaporize tissue. It can assist the surgeon during certain steps through the cataract surgery, including:
- Making corneal incisions
- Correcting mild corneal astigmatism
- Creating an opening to the lens
- Fragmenting and softening the cataract
While the Femtosecond laser does not result in superior visual outcomes, it can be beneficial for certain cases. The use of the Femtosecond laser is highly recommended when using a Multifocal lens to ensure optimal lens centration.
Following cataract surgery, approximately 10-50% of patients will develop clouding of the posterior capsular membrane within months to years following cataract extraction. The capsular bag is a very thin layer of tissue that acts as a scaffold for holding the implanted intraocular lens in place. With time, cells collect on the capsular bag and create visual clouding. This phenomenon is sometimes referred to as a “secondary cataract”, but this terminology is a misnomer- the clouding is due to capsular haziness, not the development of another cataract.
If the cloudiness from the capsular membrane causes decreased vision, a YAG laser can be used to precisely remove the clouded membrane. Dr. Lally performs this procedure in the office. It is completely painless and can be completed in roughly 10 minutes with no associated down-time or need for post-laser medication. Patients will notice floaters in their vision after the laser, but they will gradually resolve over several days. As with any surgery or procedure, there are possible risks and complications with YAG capsulotomies. These include swelling, increased eye pressure, movement or dislocation of the intraocular lens dislocation and/or retinal tears or bleeding.