Cataract Surgery

What is a Cataract?

Cataract is clouding of the natural lens within the eye. When we are younger the lens inside our eyes are clear and allows light rays to enter our eyes much like the light that enters the rooms in our house through an open window. However, as we get older, this clear lens inside our eyes become cloudy and allows less light to enter our eyes and less light to reach our retina which is located in the back of our eyes. Also, this clouding of the lens results in scattering of the light rays as it enters our eyes. These changes inside the lens causes blurred or “fuzzy” vision, glare, sensitivity to light, and halos around car headlights at night. These changes can cause difficulty with watching television, reading small prints, sewing clothes, working on a computer, driving a car, and sometimes even seeing the faces of our loved ones clearly can all be a problem in our day-to-day life.

Colors may not appear as bright as they once were. However, most cataracts develop so slowly that people usually don’t realize that their color vision has markedly deteriorated. A cataract may make light from the sun or a lamp seems too bright, causing the glare described above. People with symptomatic cataracts often describe the sensation as looking through a piece of wax paper.

What is the meaning of the word “Cataract”?

The word cataract refers to a large waterfall. The word originates from the Greek word kataraktes, meaning something that is rushing down. Later, in Latin it was called cataracta that meant a waterfall, a flood-gate or a portcullis (a castle’s vertical grated gate that ran in grooves in the wall and it could be dropped very rapidly to bar entrance). The earliest English usage was to “the cataracts of heaven”, referring to the flood-gates that were supposed to keep back the rain. Subsequently it meant a large waterfall, where the water plummets over a precipice. This came from the Latin use of the word to describe the Cataracts of the Nile. Looking through a cataract may be considered like looking through a waterfall.

What causes a Cataract?

Cataracts are caused by alterations in the lens protein of the eye, which results in the lens becoming cloudy. Some of the causes of a cataract are listed below:

• age is a major cause for developing cataracts
• injury or trauma to the eye
• inflammation within the eye, e.g., iritis or uveitis
• diabetes mellitus
• ultraviolet light exposure from sunlight
• medication use, such as long-term use of steroids, phenothiazines, statins
• smoking
• heavy drinking
• a family history of cataracts
• rarely, present at birth, or early childhood secondary to hereditary enzyme defects
• Environmental factors such as toxic chemicals

Cataracts usually become noticeable by about age 55 years, with most of the population having them by age 75 years.

 What are the symptoms from a cataract?

Some of the symptoms may be as follows:

• Cloudy, “fuzzy” or blurry vision
• Difficulty reading and needing more light to read
• Night driving problems especially with the oncoming car headlights
• Difficulty seeing in bright lights
• Increased eyestrain
• Double vision
• Colors seem faded or more yellowish
• Frequent changes in eyeglass prescription

What can be done about a Cataract?

If left untreated, cataracts can cause “avoidable blindness.” The treatment for cataract is surgery. It does not mean that if you have cataract, you need to have cataract surgery. If the blurred vision from a cataract is interfering with your daily activities and you want something done, then you may consider having cataract surgery.

There is a myth that cataracts have to “ripen’, before they can be removed. This was true before about 1930, when the surgical technique to remove cataracts was quite “primitive” and the surgical outcome was essentially not very good, even in uncomplicated cases. Patients essentially had to be blind from their cataract before surgery, so they could appreciate the poor vision that their very thick glasses provided afterward. These days, when the average cataract patient usually sees better after surgery than his or her peers who may have minimal cataract, we wait until the patient finds that the cataract is interfering with his or her lifestyle. Patients have cataract surgery because they are having difficulty doing their daily activities which will vary from person to person. For some it may be difficulty with seeing the golf ball, or reading the financial pages, and for others it may be seeing the faces of their loved ones clearly or difficulty driving their car at night. The most common response on the day after surgery often is, “when can I have the other eye done?” often followed by “why did I wait so long?”.

Tell me more about Cataract Surgery

It is an outpatient surgery, meaning you get to go home the same day after your surgery. It is an elective surgery. it is not done under general anesthesia, instead it is performed under intravenous sedation and usually topical anesthesia. Therefore you do not have the risks from general anesthesia. Using the most up-to-date methods and instrumentation, cataract surgery is typically performed using a small-incision phacoemulsification technique. This means that the cataract surgery is accomplished using a very small incision, and removal of the lens material is accomplished using an ultrasonic needle.

There is a common misconception that cataract surgery is done using a laser. This is not the case, and has never been the case to remove all types of cataracts. The use of laser energy produces too much heat to be adapted for this purpose, and can cause irreversible damage to the delicate tissues inside the eye.

Following proper dilation of the pupil and preparation of the surgical area using betadine or other cleansers, a topical anesthetic is administered to the surface of the eye. An incision of 2.2 to 3 millimeters in length is then created at the junction of the cornea (the clear domed structure on the front of the eye) and the sclera (the white part of the eye).

Another dose of anesthetic is then administered inside the eye through this incision. The front part of the lens envelope, known as the lens capsule, is carefully opened so that the lens material can be removed. This is accomplished using a needle-like ultrasonic device, which pulverizes the hardened and yellowed lens proteins. The pulverized material is simultaneously vacuumed from the eye.

Once all of the cataract material has been removed, and assuming that the lens capsule which was opened at the beginning of the surgery remains strong enough to support the lens implant, a folded intraocular lens specifically chosen by the surgeon to suit your individual needs is then inserted through the original incision and maneuvered into the lens capsule and then centered. The lens will remain inside your eye in this location without moving. Intraocular lenses cannot be felt or sensed in any way by the patient. Unlike a contact lens which is on the outside surface of the eye, a lens implant remains inside the eye.

In most cases, once the lens is centered within the lens capsule, the instruments are removed, and the surgery is then complete. Under most normal circumstances stitches (or sutures) are not required to keep the incision sealed. Should the incision require a suture to be placed for proper sealing, this suture is generally removed within the first week following surgery. Dr. John routinely does no-stitch, no-patch cataract surgery, and only very rarely does he use patch or sutures.

Recovery from surgery is generally very quick, with most patients achieving noticeably better vision within the first 24 hours of the procedure. Patients are generally asked to use three different eye medications, administered as drops 2 to 4 times daily starting 3 days before the surgery and then following surgery they are continued for the first few weeks. It is important that during the first 7 post-operative days patients refrain from strenuous activity such as lifting weights more than 10 pounds, or exercise strenuously. Patients should also refrain from eye rubbing during the first few weeks following surgery.

If glasses are required following surgery to achieve the best possible vision either for close up work such as reading, or for distance purposes, these will be prescribed three to four weeks after surgery when full recovery is expected. If both eyes are scheduled to have surgery within a few weeks of each other, then glasses, if needed, will be prescribed following full recovery of the second eye.

What are Premium Lens Implants?

Standard Lens Implants usually provide good, clear distance vision while near vision is usually blurred and one needs to use a pair of reading glasses for all near work especially reading. The premium lens implant usually provides good vision for both distance and near without any glasses. So this is one occasion in one’s lifetime to regain the ability to read again without glasses for the most part. Patients are usually very satisfied with the results and with the quality of vision. Medicare pays for the cost of the standard lens implant. Medicare does not pay for the Premium Lens Implant. So if you choose to have a Premium Lens Implant, the difference in cost between the standard lens implant and the Premium Lens Implant, cost difference you will be responsible. Our office has convenient, affordable finance options for every budget. Talk to our office staff and they will be glad to help you with the process of getting a Premium Lens Implant.

Are there different types of Premium Lens Implants?

Yes, there are different types of premium lens implants. These include Restor Lens, Crystalens and ReZoom lens implants.  With the Resror lens implant, FDA clinical trials show that 80% of patients are spectacle free after surgery.
The AcrySof ReSTOR lens is a foldable IOL that represents breakthrough technology because of its unique, patented optic design, which allows patients to experience the highest level of freedom from glasses ever achieved in IOL clinical trials.

The AcrySof ReSTOR IOL uses a combination of three complementary technologies: apodization, diffraction and refraction, to allow patients to experience a full range of high-quality vision without the need for reading glasses or bifocals. This range of vision without glasses is achieved through the optical properties of the IOL.

The benefit for patients is a high level of spectacle freedom. Alcon has patented the application of apodization technology to an IOL, making the AcrySof ReSTOR lens the first and only apodized diffractive IOL.

During U.S. clinical trials, the results with ReSTOR were remarkable:

1. 80% of patients reported that after lens implant surgery with ReSTOR lenses, they no longer needed glasses or contact lenses to see clearly at all distances.
2. 94% said they could drive and read the paper without contacts or glasses.
3. Nearly 94% were so satisfied that they would have the procedure again.

Which lens implant is best for you will be determined with the discussion with your doctor checking into your visual needs.

At the time of your consultation, Dr. John and staff at Thomas John Vision Institute will also discuss 1) the potential side effects of cataract surgery, 2) your eye drops regimen 3) your post-operative instructions 4) your appointment schedule for postoperative office visits, and 5) insurance plans.

Please contact Thomas John Vision Institute in Tinley Park, or Oak Lawn, Illinois to schedule a thorough eye examination with Dr. John to see if you are a candidate for cataract surgery. Thomas John Vision Institute offers cataract surgery in the neighboring suburbs of Tinley Park and Oak Lawn.