WHAT IS A CATARACT?
A cataract is a clouding of the lens inside the eye and it is one of the most common eye problems affecting people over the age of 65. The lens of the eye works much like the lens of a camera to keep your vision in focus. The lens is located inside the eye, just behind the iris (the colored part of the eye.) It is about the size of a small cough drop. When you are born, the lens is clear, like glass. As you grow older, the lens becomes more yellow or cloudy and this is called a cataract. Contrary to popular belief, a cataract is not a film over the surface of the eye. As the lens inside your eye turns yellow or cloudy your vision can decrease. That’s why people with significant cataracts can have a hard time seeing road signs until they are right on top of them, or trouble seeing print on the TV. They may have trouble driving at night because of decreased vision or bothersome starbursts and halos around lights. They may have trouble recognizing faces across the room, or difficulty following a golf ball after they hit it. They may also experience trouble reading a newspaper or seeing a computer screen.
WHAT CAUSES CATARACTS?
Usually, cataracts occur simply as a result of getting older. Cataracts are extremely common after the age of 65. But there are other causes of cataracts as well. Diabetes can cause cataracts to form at an earlier age. Previous eye or head injury, and previous eye surgery can also increase the risks of cataracts.
Use of certain medications, especially steroids (like cortisone or prednisone) increases the risk of developing cataracts. So does exposure to radiation or chemicals such as cleaning solvents. Chronic inflammation inside an eye, called “iritis” or “uveitis” can also lead to cataracts. And rarely, one can be born with cataracts. The good news is that cataracts are almost always treatable.
HOW ARE CATARACTS TREATED?
Bothersome cataracts are treated with a quick, usually painless, and very low-risk operation. Approximately 2 million cataract operations are done each year in the United States alone. It is considered one of the safest operations in all of medicine. Dr. Angelique Pillar at One to One LASIK, is an expert, board-certified cataract surgeon with years of experience. She offers the most advanced cataract surgery technology, including small incision, sutureless cataract surgery, bifocal and astigmatism correcting intraocular lens implants (also known as “toric” lens implants) that can reduce or often eliminate the need for glasses after surgery. They offer “ORA” (Optical Wave Refractive Analysis) during surgery to help refine the power and/or placement of the lens implant to best meet your particular vision needs. She also offers laser-assisted cataract surgery in which certain steps of the procedure are performed with laser light instead of surgical instruments. One to One LASIK has been awarded repeated “Top Doctor” honors in annual surveys conducted by San Diego Magazine, “Patients Choice” honors every year the award has been offered (putting them in the top 1% of physician’s nationwide), and was in the top two “Best of San Diego” recipients in the San Diego Union’s 2015 “Best of the Best” readers poll.
WHEN SHOULD I HAVE CATARACT SURGERY?
In the earliest stages of cataract formation, just a change in your glasses or contact lens prescription may help you to see better. When you can no longer see well enough to do the things you need to do or like to do, even with your best glasses or contact lens prescription, you should consider cataract surgery. Signs that you may be ready for cataract surgery include difficulty seeing road signs, difficulty driving at night, trouble seeing print on your TV or computer, or difficulty reading small print. You may be having trouble seeing well enough playing golf, tennis or other sports, or to enjoy hobbies like sewing, painting, or woodwork. You may be bothered by starburst around lights at night or by glare in bright sunlight. Your vision may seem dim and colors may look more yellowed or dull than they used.
Cataracts often come on slowly, making it hard to realize that your vision is deteriorating. During a routine eye examination, we can tell you whether or not you are developing cataracts and whether cataract surgery might help you.
WHAT DOES CATARACT SURGERY INVOLVE?
Cataract surgery usually takes less than 30 minutes and is done as an outpatient procedure, which means there is no overnight stay. You’ll usually be in the outpatient surgery center for about two to three hours and you will need someone to drive you there and to drive you home. We specialize in advanced, small-incision cataract surgery which usually provides a quick return of vision and of normal activities.
There are two ways to perform cataract surgery – phacoemulsification and laser-assisted phacoemulsification. Both methods are painless, safe and highly effective. Phacoemulsification is covered by Medicare and most insurance plans. Laser-assisted phacoemulsification involves fees that are not covered by Medicare and other insurance plans and are paid out-of-pocket. While any form of surgery involves some degree of risk, cataract surgery is considered to be among the safest operations in all of medicine.
WHAT IS “CONVENTIONAL” CATARACT SURGERY?
Phacoemulsification is performed through a tiny incision the size of a pencil tip. The incision is made at the edge of the cornea (the clear front window of the eye) after the eye has been numbed. An instrument about the size of a pencil tip is then inserted through the incision. This instrument sends out high frequency sound waves known as ultrasound. Sound waves break the cataract into tiny dust-like fragments and gently vacuums those fragments out of the eye. Next, a clear plastic lens called an intraocular lens implant or “IOL” is inserted, folded up, through the same tiny incision. The lens implant unfolds inside the eye, stays inside the eye forever, and restores the focusing power of the eye that is lost when the cloudy lens, or cataract, is removed. To learn more about lens implants, including conventional implants, multifocal implants (also sometimes called bifocal implants,) and astigmatism-correcting or “toric’ implants, click here.
The power of the lens implant needed for your eye is determined by painless measurements that are done in the office a week or so before surgery. The lens implant power can be refined or confirmed during the surgery itself using a technology called “ORA,” or Optical Wave Refractive Analysis. ORA has many potential benefits but is not covered by insurance, so it does involve a modest out-of pocket payment. To learn more about ORA intra-operative lens power measurements, click here.
WHAT IS “LASER-ASSISTED CATARACT SURGERY?”
Laser-assisted cataract surgery is a relatively recent advance which makes use of light from a laser called a “femtosecond laser” to perform three of the preliminary steps in cataract surgery that would otherwise be performed with microscopic surgical instruments. The first step is making the incision in the cornea. The second step involves making an opening in the thin front skin of the cataract, called the “anterior capsule.” The third step that can be performed with laser is dividing the cataract into several large pieces. Even when laser light is used to perform these steps, the surgeon still uses a hand-held ultrasound instrument to break the cataract into smaller pieces and vacuum those pieces from the eye. Laser-assisted cataract surgery was deemed safe and was approved by the FDA in 2011. Scientific studies have been under way ever since to help determine whether laser-assisted cataract surgery offers any significant advantages over conventional cataract surgery. At this point, both methods are considered effective and there is no strong evidence that either is better than the other. The one potential advantage of laser-assisted cataract surgery is the ability to customize the size, shape, and location of the cataract surgery incision to reduce astigmatism at the time of cataract surgery. Astigmatism is a distortion of vision caused when the cornea, or front window of the eye, is shaped more like a football than a basketball. Reducing astigmatism during cataract surgery can mean less dependence upon glasses after surgery. But there can be other ways of reducing astigmatism during or after cataract surgery as well. We can explain the advantages and disadvantages of conventional vs. laser-assisted cataract surgery during your in-office cataract surgery consultation. They’ll help guide you to the technique that will be best for your individual vision needs and your budget.
WILL I FEEL ANY PAIN DURING OR AFTER CATARACT SURGERY?
No. Cataract surgery is essentially painless, both during and after. The surgery can be done with either topical anesthesia or local anesthesia. Topical anesthesia means that a drop is used to numb the eye, so you won’t feel any discomfort. You’re awake during the surgery, but very relaxed thanks to the sedative. You’ll likely see blurred images, and what seems like a colored-light show during the procedure with this form of anesthetic. With local anesthesia, the eye is numb and the vision is blacked out, so you usually see nothing at all. You’re awake and alert during the surgery but, again, relaxed from the sedative. You’ll hear what’s going on but you won’t feel or see what is going on. If you choose a local anesthetic, the anesthesiologist will give you an IV medication to make you sleep for one or two minutes. The local anesthetic is administered while you are asleep. It is an injection like the Novacaine that a dentist uses but you’ll be asleep so you won’t even know you’re getting it. It is administered in the skin just below the eye and behind the ear – not into the eye itself. During your pre-operative consultation, we will help you to choose whether a local anesthetic or a topical anesthetic would be best for you.
WHAT HAPPENS AFTER CATARACT SURGERY?
Whether you choose conventional cataract surgery or laser-assisted cataract surgery, you should be able to go home within a half hour or so after the surgery is completed. Cataract surgery is not generally associated with any significant post-operative discomfort. You can resume most of your normal activities the very next day – though we ask that you not drive until your vision allows it (which can be from one to four days, depending upon how rapidly you heal). There are very few restrictions on your activities. We ask that you not go under water swimming or into hot tubs, and that you not lift more than 30 pounds over your head. There are eyedrops to take for a couple of weeks and you’ll be asked to where a protective shield over the operated eye during sleep for the first few days. You’ll have a post-operative office visit the day after surgery, about 3-5 days after surgery, and a few weeks after that. Of course, we are available on-call 24/7/365 to answer any of your questions or concerns.
IS CATARACT SURGERY DONE ON BOTH EYES AT THE SAME TIME?
No. For safety, we operate on one eye at a time and generally the worst eye first. Cataract surgery on a second eye, if indicated, can often be scheduled within a few weeks of surgery on the first eye.