State-of-the-Art Cataract Surgery
What is a cataract?
A cataract is a cloudiness of the normally transparent lens that is situated behind the iris. The lens focuses light rays on the retina at the back of the eye to produce a sharp image of what we see. When the lens becomes cloudy, the light rays cannot pass easily through it, and the image becomes blurry. It would be equivalent to having the lens in your camera becoming murky.
This can come from trauma, certain diseases like diabetes, medications, and heredity, but most commonly is just a consequence of age, as the proteins in the lens breaks down. So, once diagnosed, a cataract only worsens with time.
How can a cataract be treated?
Surgery is indicated when the impairment outweighs the risks. Generally, when the symptoms of diminished visual acuity, difficulty driving at night because of glare or struggling to read have become bothersome or reduces quality of life to some degree, then it makes sense to operate. There is no rush to do surgery, but there is a point when waiting too long is not good, either, as the complication rate begins to rise. This happens when the cataract has become too dense, or the patient is older, or develops a concomitant disease.
Surgery is the only way to remove a cataract. There are no medications, eye drops, exercises or glasses that will cause cataracts to disappear once they have formed.
What are the benefits of surgery?
The aim of surgery is to replace the clouded lens with a transparent one made of plastic, called an intra-ocular lens (IOL). In most cases, the focusing power of the natural lens is restored by replacing it with a permanent intra-ocular lens implant.
The main measure of success is restoring the health of the eye vis-à-vis the lens, and improving the potential visual acuity of the eye. But note that even with successful cataract surgery, the ultimate vision may be limited by other problems in the eye, which may or may not be completely obvious pre-operatively.
An additional benefit from cataract surgery is that the replacement lens can compensate for a refractive error that a patient might have had throughout life. Very precise measurements taken with lasers pre-operatively and theoretic calculations are done to choose a lens power. Many times a degree of spectacle independence can be achieved, particularly when using one of the “advanced technology intra-ocular lenses.”. However, despite the precision of the measurements, the doctor cannot guarantee the final refractive result because that depends upon the final position of the IOL and that, in turn, depends on individual healing, which cannot be predicted beforehand. It is important to note that none of the IOLs used today totally replicate what nature provided us at birth. Sometimes glare, rings, and unwanted visual images may occur.
How is surgery done?
Under an operating microscope, a small incision is made into the eye. Microsurgical 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.
A plastic intraocular lens implant will be placed inside the eye to replace the natural lens that was removed. The incision is so small that, usually, no sutures are required.
What makes surgery so much safer than before is the minimally invasive nature of the surgery and intra-operative control. Minimally invasive implies use of a specially constructed bloodless incision that is so small that it self-seals, without the need of a suture. Control is achieved by keeping the eye at the same pressure and volume throughout the procedure, by using microprocessor-controlled flow of fluid in and out. In that controlled situation, the clouded lens is liquefied by ultrasound and washed out of the eye. Cataract surgery is usually painless and patients usually can resume most day-to-day activities by the day after surgery.
When is laser used?
At the Princeton Eye Group, there are over a dozen lasers in use. Lasers are highly refined light beams which can be used to measure things, cut tissue, vaporize surfaces, create tissue planes, stimulate the immune system and create thermal effects, such as coagulation. For cataract surgery, lasers are used to make critical measurements of the eye and to precision-cut capsules, all painlessly.
Will cataract surgery improve my vision?
Over 98% of cataract surgeries improve vision, but a small number of patients may have problems.
Infection, bleeding and swelling or detachment of the retina are some of the more serious complications that may affect your vision. Call your ophthalmologist immediately if you have any of the following symptoms after surgery:
- Pain not relieved by non-prescription pain medication;
- Loss of vision;
- Nausea, vomiting or excessive coughing;
- Injury to the eye;
- Swelling of the eyelids.
It is also important to recognize that cataract surgery is real surgery, and there are always some risks involved. Remember, even if the doctor says the rate of a severe complication is one in a thousand, that one is a human being. The doctors of Princeton Eye Group understand this and strive for clinical excellence in as compassionate setting as possible.
If the eye is healthy, the chances are excellent that you will have good vision following removal of your cataract. Problems with the eye, such as macular degeneration (aging of the retina), glaucoma and diabetic damage may limit vision after surgery. Even with such problems, cataract surgery may still be worthwhile.
Where is the surgery done?
That setting is the Surgery Center of Central New Jersey, a state-of-art ambulatory surgical center run by Wills Eye Hospital in North Brunswick. Complication rates at this center are among the lowest in the country. Wills Eye Hospital, based in Philadelphia, has been rated number one or two in the nation year-in and year-out by many surveys, and has deemed the Princeton Eye Group a Center of Excellence. Nearly all of the doctors of the Princeton Eye Group were trained at Wills Eye Hospital and they continue to maintain a strong presence there with teaching responsibilities.
Will I need glasses after the surgery?
The eye functions much like a camera and needs to be focused. When you get ordinary eyeglasses, there are three components to the prescription: the sphere (addressing near-sightedness or far-sightedness), astigmatism (extra power in one direction), and reading add (addressing presbyopia or near needs when over 45 years old). A basic monofocal Intra-ocular Lens (IOL) addresses only the sphere. A toric IOL addresses the sphere and astigmatism. A ReSTOR IOL addresses the sphere, some astigmatism and most of the near needs. A ReSTOR-toric combination addresses all three components. Your doctor will help you determine the best lens for your individual needs and goals. To read more about your potential IOL choices, click here.
What if I need cataract surgery and I have glaucoma too?
There are procedures available which may help to lower your eye pressure after cataract surgery. To read more about this, click here. Your doctor will help determine if these procedures are appropriate for your glaucoma.
What can I expect if I decide to have surgery?
When you and your ophthalmologist (Eye M.D.) have decided that you will have your cataract removed, be sure to mention any special medical risks you may have. Ask your Eye M.D. if you should continue your usual medications.
Your eye will be measured to determine the proper power of the intraocular lens that will be placed in your eye during surgery.
The day of surgery
Surgery is usually done on an outpatient basis. You may be asked to skip breakfast, depending on the time of your surgery. Upon arrival for surgery, you will be given eye drops, and perhaps medications to help you relax.
A local anesthetic will make the operation painless. Though you may see light and movement, you will not be able to see the surgery while it is happening and will not have to worry about keeping your eye open or closed.
The skin around your eye will be thoroughly cleansed, and sterile coverings will be placed around your head. When the operation is over, the surgeon will often place a shield over your eye.
After a short stay in the outpatient recovery area, you will be ready to go home. You should plan to have a family member or friend drive you home. In the event no help is available, transportation can be arranged prior to the time of your surgery.
You will need to:
- Use eye drops as prescribed;
- Be careful not to rub or press on your eye;
- Use over-the-counter pain medicine if necessary;
- Avoid very strenuous activities until the eye has healed;
- Continue normal daily activities and moderate exercise;
- Ask your doctor when you can begin driving;
- Wear eyeglasses or a shield as advised by your doctor.