Cataracts
Our staff of Pittsburgh cataract surgeons, know that cataracts are a normal part of the aging process. A cataract is a clouding of all or part of the normally clear lens within your eye that results in blurred or distorted vision. Cataracts are found most often in people over the age of 55 but they are occasionally found in younger people. Studies show that over half of all people will have some cataract formation before the age of 60 and almost all will develop them after the age of 70. So it is important that you find a cataract eye doctor who is skilled in the treatment of cataracts.
The human eye functions much like a camera. Light passes through the lens of the camera and is focused on the film. Like a camera, the eye also has a lens. Normally this is a clear, transparent structure through which light can freely pass and focus on the retina. As the cataract develops, the clouded lens reduces the amount of light that can enter the eye, resulting in blurred or foggy vision.
Some signs of cataracts are increasing glare from bright lights and sunlight, faded and washed out colors (especially blues and greens), and vision that becomes indistinct and hazy, making it difficult to read or perform simple tasks. Cataracts may affect both eyes at a different rate, or they may affect only one eye.
WHEN TO SEEK MEDICAL CARE
Everyone should have a routine visual examination on a yearly basis. Eye-care professionals may mention during a routine eye exam that you have early cataract development even if you are not yet experiencing visual symptoms.
Although your doctor will be able to tell when you first begin to develop cataract symptoms, you will generally be the first person to notice changes in your vision that may require cataract surgery.
Since cataract development rarely causes any long-term damage to the eye, cataract surgery should be considered only when visual symptoms begin to develop. Whenever significant vision problems are noted, you should schedule an exam by an eye-care professional. Typical cataract symptoms may include blurry vision, difficulty with glare or night vision, poor color vision, or frequent changes in eyeglass prescription.
For early cataract changes, vision may be improved by simply changing your eyeglass prescription, using a magnifying lens, or increasing lighting when you do visually demanding tasks. Eventually, cataracts get to a point where the only effective intervention is performed by a cataract eye surgeon. This decision is made based mainly on the degree of visual limitation that you may be experiencing.
VISUAL EXAMINATION
To detect a cataract, your eye-care provider examines your lens. A comprehensive eye examination usually includes the following:
Visual acuity test: An eye chart test is used to measure your reading and distance vision.
Refraction: Your eye doctor should determine if glasses would improve your vision.
Glare testing: Vision may be significantly altered in certain lighting conditions and normal in others; in these circumstances, your doctor may check your glare symptoms with a variety of different potential lighting sources.
Potential acuity testing: This helps the ophthalmologist get an idea of what your vision would be like after removal of the cataract. Think of this as the eye's vision potential if the cataract was not present.
Contrast sensitivity testing: This checks for your ability to differentiate different shades of gray, which is often this limited by cataracts.
Tonometry: a standard test to measure fluid pressure inside the eye (Increased pressure may be a sign of glaucoma.)
Pupil dilation: The pupil is enlarged with eye drops so that the ophthalmologist can further examine the lens and retina. This is important to determine if there are other conditions which may ultimately limit your vision besides cataracts.
TYPES OF CATARACTS
Cataracts are classified as one of three types:
A subcapsular cataract begins at the back of the lens. People with diabetes, high farsightedness or retinitis pigmentosa, or those taking high doses of steroids, may develop a subcapsular cataract. This is a cataract in which the opacities are concentrated beneath or within the capsule of the lens.
Clinical features:
Symptoms: glare and decreased visual acuity especially during bright sunlight, but see well in dim illumination.
Signs: granular opacities in the posterior pole of cortex adjacent to the posterior capsule.
May be age-related or occur as a complication of other conditions such as intraocular inflammation (e.g. chronic uveitis), steroid administration, vitreoretinal surgery and trauma. This may also be related to irradiation and systemic conditions such as diabetes mellitus.
A nuclear cataract is most commonly seen as it forms. This cataract forms in the nucleus, the center of the lens, and is due to natural aging changes.
Clinical features:
Symptoms: Myopic refractive shift which patients notice as an improvement in their near vision
Decrease in distance vision, difficulty with night driving, monocular diplopia and loss of color discrimination ability.
Signs: Gradual opacification of the central portion of the lens nucleus. Age related, involves the hardening (sclerosis) and either yellowing or brown to black darkening (brunescense) of the lens nucleus.
When the reduction in visual function associated with the cataract interferes with daily activities, cataract surgery may be considered.
A cortical cataract, which forms in the lens cortex, gradually extends its spokes from the outside of the lens to the center. The opacities are located in the cortical layer and initially develop in the lower portion of the lens. This is the most common form of a senile cataract.
Clinical features:
Symptoms: Minimal symptoms of decrease in visual acuity.
Mild to severe glare and night vision difficulties and may impair driving.
When the lens opacities are in the visual axis, patients may complain of monocular diplopia (double vision).
Signs: The opacities are located in the cortical layer and initially develop in the lower portion of the lens.
In a more advanced stage, spoke-like or wedge-shaped peripheral opacities progress circumferentially, initially sparing the clear central axis of the lens.
LENSE REPLACEMENT OPTIONS
There are a variety of intraocular lens types available for implantation. An intraocular lens (IOL) is implanted in the eye in place of the clouded natural lens. Shown is Alcon's AcrySof Natural IOL; it filters out blue light, which may be harmful to the eyes.
The cataract eye surgeons of Associates in Ophthalmology offer the most advanced lens options to customize your vision during cataract surgery. Based on your individual lifestyle needs and on findings during your cataract eye examination, we will recommend which lens is the best option for you. Below is information that will help you understand four different options:
· Basic monofocal lens implant
· Multifocal lifestyle lens implant
· Accommodative lens implant
· Toric lens implant
Basic Monofocal Lens
With monofocal lens implants, or single-vision lens implants, there is a high likelihood that you will need glasses for most near-vision activities after surgery, even if you do not wear near-vision glasses before surgery. These activities include such things as reading, applying makeup, shaving, and sewing, reading your watch, dialing a cell phone, and baiting fishhooks. Medicare and most private insurance carriers will pay 80% of your cataract surgery including the monofocal lens. This is considered basic coverage.
Multifocal Lens & Accommodative Lens
Multifocal and accommodative lens implants are designed to provide a full range of vision—near, far and everything in between. Medicare and private insurance provide basic coverage and allow you to pay for this “Lifestyle” lense, if you choose to do so. Based on FDA clinical data, 80% of patients never need glasses again for any activities. Those who do need glasses need them only for very specific tasks. The goal is to allow you to see things near and far with less dependency on glasses. There is an additional cost for this technology. If it is determined that you are a candidate for the multifocal or accommodative lens, we can discuss payment plans that make this option affordable for you.
Toric Lens
The Toric lens is specifically designed for people who have a significant amount of astigmatism. An astigmatism is defined as an irregular oblong corneal shape that can distort vision at all distances. In years past, cataract surgery removed the cataract, but a patient with high astigmatism still required glasses for near and distance vision. The design of the Toric lens makes it possible to reduce or eliminate the effects of astigmatism and significantly improve uncorrected distance vision. There is an additional cost for this lens implant. We strive to make the Toric lens affordable to you by offering payment options at Associates in Ophthalmology.
SURGERY
Associates in Ophthalmology has served the community for more than 100 years. Each corneal surgeon has a stellar reputation for providing the highest quality of medical care in our accredited, state-of-the-art eye surgical facility while achieving the very best visual outcome for each individual patient.
Cataract surgery involves removing the natural lens and inserting an implantable intraocular eye lens (IOL) in its place. Due to advancements in technology, cataract surgery is considered to be one of the safest and most successful surgeries in the United States today with over three million procedures done each year.
The treatment used to remove cataracts is called phacoemulsification. During this outpatient procedure, our corneal surgeons typically use topical anesthetic drops to numb the eye. Then a very small incision is made in the clear cornea. Using a tiny, ultrasonic probe, the cataract is gently broken apart and removed. Once the cloudy cataract lens is removed, a customized, clear intraocular lens, either a multi- or monofocal is implanted permanently into the eye. Since the incision is small, sutures usually are not necessary..
As the natural lens plays a vital role in focusing light for clear vision, artificial-lens implantation at the time of cataract surgery is necessary to yield the best visual results. Because the implant is placed in or near the original position of the removed natural lens, vision can be restored, and peripheral vision, depth perception, and image size should not be affected. Artificial lenses are intended to remain permanently in place, require no maintenance or handling, and are neither felt by the patient nor noticed by others.
WHAT YOU SHOULD EXPECT ON THE DAY OF SURGERY
Prior to the day of surgery, your cataract eye doctor will discuss the steps that will occur during surgery. Your cataract eye doctor or a staff member will ask you a variety of questions about your medical history and perform a brief physical exam or you will be sent to your primary care physician for a history and physical. You should discuss with your cataract eye doctor which, if any, of your routine medications you should avoid prior to surgery. Prior to surgery, several calculations will be made to determine the appropriate power intraocular eye lens to implant. A specific artificial lens is chosen based on the length of the eye and corneal curvature (the clear portion of the front of the eye).
It is important to remember to follow all of your preoperative instructions, which will usually include not eating or drinking anything after midnight the day prior to your surgery. As cataract surgery is an outpatient procedure, arrangements should be made with family or friends to transport you home after the cataract surgery is complete. Most cataract eye surgery occurs in our accredited ambulatory surgery center or a nearby hospital. You will be required to report several hours before the scheduled time for your cataract surgery. You will meet with the anesthesiologist who will work with your cataract eye doctor to determine the type of sedation that will be necessary. Most cataract surgery is done with only minimal anesthesia and numbing drops without having to put you to sleep.
During the actual procedure, there will be several people in the operating room in addition to your cataract eye doctor; these include anesthesiologists and operating-room nurses and technicians. While cataract surgery does not involve a significant amount of pain, medications are used to maximize your comfort. The actual removal of the clouded lens will take approximately 15 minutes in most instances.
After leaving the operating room, you will be brought to a recovery room where your doctor will prescribe several eye drops that you will need to take for a few weeks postoperatively. While you may notice some discomfort, most patients do not experience significant pain following cataract surgery. If you do you experience decreasing vision or significant pain, you should contact your cataract eye doctor immediately.
WHAT YOU SHOULD EXPECT AFTER CATARACT SURGERY
Following surgery, you will need to return for visits within the first few days and again within the first few weeks after surgery to assure your eye is healing properly. During this time period, you will be using several eye drops which help protect against infection and inflammation, and you will have some restrictions on activities such as lifting heavy objects and bending forward or stooping to the ground. Within several days, most people notice that their vision is improving, and they are able to return to work while resuming normal physical activities.