Stuart had changed his eyeglasses a little over a year ago and was surprised that his vision had changed so dramatically in such a short time. Any writing on the TV screen came out as a blur to him, and highway signs, no matter how big, were sometimes hard to decipher in the glare of sunlight or with headlights while driving at night.
“Why do I need a change of lenses so quickly,” he asked the optometrist. “You don’t,” she answered. “What you need is a cataract evaluation.”
He had been told previously about the cataracts, one in each eye. But they had worsened quickly as they sometimes do. Two months later, he had surgery to remove them, and he now realizes how much he was missing. “Colors are brighter; the fog has disappeared; and now I can read the newspaper without struggling to find proper lighting.”
A cataract is a clouding of the normally clear lens of the eye. It usually occurs as a natural consequence of aging although younger people too can have cataracts. The clouding typically happens gradually over many years and is barely noticed until the later stages when glare and reduced vision suddenly begin to make life difficult for the patient.
Only a few decades ago, cataract surgery was a major ordeal requiring a hospital stay of several days with heavy sandbags to prevent any movement whatsoever. Stuart remembered the coke-bottle thick lenses of his former newspaper editor in the 1960s who had to hold copy within inches of his eyes to read it.
Today, he learned, cataract surgery is one of the most common and simplest of operations and can be performed in 10 to 15 minutes in a doctor’s office. The success rate is more than 98 percent.
What Comes Next?
The first step is an evaluation appointment with an ophthalmologist followed by tests a week or so before surgery to measure the size and shape of your eye and determine what type of lens implant will work best.
If you’re taking warfarin or other blood-thinning medications, you might have to temporarily stop these to reduce the risk of bleeding during the procedure. It’s also necessary to fast for 12 hours.
Although the procedure itself takes only 10 to 15 minutes, you’ll spend an hour or more at the site. Local anesthetics will be used to numb the area, and you may be given a sedative to help you relax.
The procedure itself is fairly straightforward–a small opening is made through which the old lens is removed and a new intraocular lens (IOL) inserted. The IOL is made of clear plastic, acrylic or silicone with an optical power designed to restore normal vision. It will remain in the eye indefinitely and needs no further care.
Several surgical methods are presently used:
Phacoemulsification, the most common procedure, involves a tiny incision in the front of the eye through which a needle-like probe is inserted into the area of the lens where the cataract has formed. Through ultrasound waves, the probe then breaks up the cataract and gently suctions out the fragments.
The lens capsule at the very back of the lens is left in place to provide support for the new intraocular lens.
Extracapsular cataract extraction requires a larger incision through which surgical tools are inserted to remove the front capsule of the lens and the cloudy portion where the cataract has formed. Again, an IOL is inserted, and the back capsule is left in place.
Stitches may be necessary to close a larger incision, but the trend is to smaller and smaller cuts. What’s known as microincision cataract surgery, introduced about 10 years ago, requires only a 1.5 to 1.8 millimeter incision–sometimes even less. And results have been good.
Laser-assisted procedures have also become increasingly common. A study published in Ophthalmology [October 11, 2013] concluded that this option was effective, allowing more precision and less damage to surrounding tissue, but considerably more expensive.
Another study [Opthalmology, September 30, 2013] found an increased rate of anterior capsule tears with the laser-assisted procedure.
Whatever procedure you have, you’ll be able to go home that afternoon and will likely have minimal discomfort–perhaps some itching and a gritty feeling. You’ll have to avoid rubbing or pushing on your eyes. And you’ll have to avoid bending or lifting for about a week. Otherwise, recovery is usually rapid and uneventful.
Within a few days, most patients notice a remarkable improvement in vision. “I had worn glasses since I was 16,” Stuart said. “Then, suddenly, I was able to see all the colors and well defined lines that I had been missing.”
A monofocal lens, the most common, will usually restore normal distance vision for driving and every day tasks. Reading glasses may be necessary for close-up work.
Also available are IOLs that work as bifocals to provide both distant and close-up vision. Patients getting multi-focal lenses were more likely to be able to go without glasses but more likely to have glare problems and to eventually need a replacement IOL, according to one study published in Ophthalmology [September 24, 2013].
One common complication of cataract surgery is posterior capsule opacification. This is a clouding over of the lens capsule that was left in place. This can be easily treated. A beam from the YAG laser is aimed at this secondary cataract, opening a hole through which light can pass.
Other rare but possible complications include infection, bleeding inside the eye, swelling of the retina, swelling of the cornea and retinal detachment. Some of these can lead to partial or complete loss of vision. Partly for that reason, the strategy is usually to treat one eye at a time, waiting a few weeks to make sure recovery is complete before treating the other eye.
Getting cataracts removed is always voluntary. As long as you can see well enough to do everything you need and want to do safely, there is no need to do anything.
In most cases, a cataract reduces vision enough to create significant impairment, and studies have found that people live longer and happier lives when they have timely surgery to remove cataracts.
Why be satisfied with seeing a cloudy vision of the world around you?
REFERENCES:
Alcon, a Novartis Company, “Cataract information guide,” August, 2013.
American Academy of Ophthalmology, “Cataract surgery,” eyeSmart, 2013.
Laurie Barclay, M.D., “Multifocal IOLs may improve vision but need replacement,” Medscape Medical News, October 9, 2013.
Laurie Barclay, M.D., “Anterior capsule tears after laser-aided cataract surgery,” Medscape Medical News, October 3, 2013.
“Eye health and cataract surgery,” WebMD Health Center, reviewed by Alan Kozarsky, M.D., September 9, 2012.
Marcia Frelick, “Cataract laser surgery effective, but expensive,” Medscape Medical News, October 17, 2013.
Gary Heiting, O.D., “Cataract surgery,” AllAboutVision.com, updated May 6, 2013.
Pawel Klonowski, et al, “Microincision cataract surgery,” Expert Reviews in Ophthalmology, 2013;8(4):375-391.
Damian McNamara, “Cataract surgery may up retinal detachment risk 4-fold,” Medscape Medical News, September 13, 2013.
Norra MacReady, “Cataract surgery may promote longer overall survival,” Medscape Medical News, September 17, 2013.
Mayo Clinic Staff, “Cataract surgery,” MayoClinic.com, July 30, 2013.
Shelley Wood, “Statins linked to cataracts in large, retrospective study,” Heartwire, September 20, 2013.
01/27/2014
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