Cataract


What is a cataract?
Normally, the lens inside the eye is clear. When the natural lens inside of the eye becomes cloudy its called a cataract.  The lens, which is located behind the pupil, bends light to a focus on the retina.  When the metabolism of the lens is slowed down by aging and other factors, the lens becomes cloudy and we lose our ability to see clearly.

How are cataracts detected or diagnosed?
Cataracts can be diagnosed by a Doctor of Optometry or an Ophthalmologist during a routine eye exam. In some cases, it is not necessary to dilate the pupils in order to see a cataract formation. The doctor can look at your natural lens by using a high powered microscope, called the biomicroscope.

What causes cataracts?
Aging is the main cause of cataracts. As our metabolism slows, the cells and proteins in the lens are altered and become cloudy. Ultraviolet (UV) light exposure over a lifetime can help accelerate the aging process. There is evidence that the greater the UV exposure, such as at high altitudes, the greater the incidence of cataracts. Many other factors can help influence this. Family history, certain diseases such as diabetes, certain medications such as corticosteroids, trauma, and a history of past eye surgery all seem to increase one's risk of getting cataracts.

Cataracts are most often found in persons over age 65, but are also occasionally found in younger persons, even newborns. Cataracts usually develop in both eyes, but often at different rates. Some cataracts develop slowly over a period of years and others form very rapidly within a few months.

What are the symptoms of cataracts?
● Blurry, hazy, smoky, distorted or foggy vision.
● Dimming of vision and colors. Colors may seem washed our or yellowed.
● Problems driving at night because of glare from headlights.
● Sensitivity to the sunlight.
● Frequent and/or large changes in your eyeglass prescription.
● An increasing need for more light to see clearly.
● A tendency to become more nearsighted because of increasing density of the lens.
● Double vision.

All, or many of these symptoms are usually gradual in onset, but may develop more quickly in some than others. These symptoms also can be signs of other eye problems. See your eye doctor to find out what you have and how it can be treated. A regular eye exam is all that is needed to find a cataract. 

How do I decide whether to have surgery?
Your doctor cannot make your decision for you, but talking with your doctor can help you decide. Many times all that is needed is a new eyeglass prescription. Sometimes, though, a change in glasses may not improve your vision. There are several factors to be considered in deciding whether a cataract needs to be removed.

1. How much is your blurred vision affecting your daily activities?
2. Can a change in your eyeglass prescription actually improve your vision?
3. Is the cataract causing other eye problems, such as glaucoma?

Your doctor can help you with the second and third question, but only you know the answer to the first. How well do you perform your daily activities or even your hobbies:
● Does the glare from headlights prevent me from driving at night?
● Can I still perform my job adequately?
● Can I still perform tasks around the house?
● Can I still do my hobbies, like reading, golf, playing cards, watching TV?
● Do I find that I don't go outside as much because the sunlight hurts my eyes?

How are cataracts treated?
The only way to treat a cataract is to surgically remove the lens, which is done by making an incision in the cornea or sclera. The lens is softened with sound waves and then removed through a needle. The lens capsule is left in place to hold the implant. It is fairly routine now to replace your cataractous lens with an artificial lens. The latest techniques now utilize incisions that don't require sutures. This shortens the healing time and induces little or no astigmatism.

No general anesthesia is used. A sedative is given to assure that the patient will remain still through the surgery. A local anesthetic injection may be given, but many times topical eye drops are all that is needed to numb the eye for the procedure. The procedure itself takes about 15-20 minutes and your are on your way home in about 2 hours.

What restrictions or inconveniences will the surgery bring?
It is no longer necessary to stay overnight in the hospital for cataract surgery. You will go to either an outpatient surgery center or the ambulatory portion of a hospital, have your cataract removed, then leave after a short recovery period. However, you will need a friend or family member to take you home. Also, you will want someone to stay with you for at least the day of surgery to help you while you have a patch on your operated eye. There are only a few restrictions for the first week after surgery and it will take a month or two for your eye to heal fully. Your eye doctor will check your progress and make sure you have the care you need until your eye recovers fully. 

Are there any risks with cataract surgery?
Most people who have cataract surgery recover with no problems and improved vision. In fact, serious complications are not common with modern cataract surgery. This type of surgery has a success rate of 98 percent in patients with otherwise healthy eyes. But no surgery is risk free. Although serious complications are not common, when they occur they could result in loss of vision. Possible complications include:
● High pressure in the eye
● Drooping eyelid
● Artificial lens dislocation
● Severe bleeding inside the eye
● Retinal detachment
● Infection inside the eye
● Blindness
● Loss of the eye

Can a cataract return?
A cataract cannot return because all or part of the lens has been removed. However, in about a third of all people who have cataract surgery, the lens capsule becomes cloudy. This can develop a few months or years after surgery or not at all. It causes the same vision problems as a cataract does.

The treatment for this condition is a procedure called YAG capsulotomy. This procedure uses a laser beam to make a tiny hole in the capsule to let light pass through. This surgery is painless and is done right in the office.

Most people see better after YAG capsulotomy, but, as with cataract surgery, complications can occur. Your doctor will discuss the risks with you. YAG capsulotomy should not be performed as a preventive measure.

Should I have cataract surgery?
You will be able to make the right decision for yourself if you know the facts. Ask your doctor to explain anything you do not understand. There is no such thing as a "dumb" question when it comes to your health.

Can I have my Post-surgical follow-up care performed by Dr. Quiring?
Yes, Dr. Quiring is Board Certified and has been performing post-surgical follow-up care for patients for years. He works closely with many cataract surgeons in the area to diagnose and treat any post- surgical complications. Ultimately, it is the patient who decides who he/she would like to perform follow-up care; the cataract surgeon or referring Optometrist.