How do I know if I have a cataract?
Not all cataracts impair vision or affect daily vision. But they can gradually develop to a point where they interfere with a person's quality of life. Because of this gradual onset, we often find that patients aren't aware of the degree to which they struggle because they have grown accustomed to poor vision.
The symptoms of cataracts often include one or more of the following:
- Cloudy, fuzzy, foggy, or filmy vision
- Decreasing contrast
- Increased glare from lamps or the sun
- Shadowing of lettering on signs or the television
- Multiple changes in eyeglass prescriptions
- Need for more light when reading
- Difficulty performing daily tasks because of vision problems
Cataracts can often mimic a dirty windshield in our automobiles – under certain lighting conditions we are driving along just fine, but other times with a low rising or setting sun, glare from headlights, or with decreased light as on a cloudy or rainy day, it can be very tough to see with distinction, especially when objects are either backlit or "hidden" in shadowy areas.
It is among the safest surgeries performed worldwide. In recent years more than three million cataract procedures are performed annually in the U.S. with over a 98% success rate. In our hands we have been able to keep the complication rate to less than one half of one percent.
I can certainly advise you in this area. Generally, one considers surgery when any of the above symptoms arise. Another indicator is trouble with the standard for driving (20/40 on the eye chart). In the past, with much higher complication rates and less sophisticated equipment, patients would wait to have surgery until they were completely incapacitated, and the lens was removed in a solid piece after years of hardening. Today, modern surgery requires that the lens be softer and more gelatinous in order to achieve a higher success rate, thus surgery is done sooner than later.
The natural lens is comprised of a lens capsule and its contents (the lens cortex). In the typical cataract it is this cortex that becomes cloudy. After the cortex is removed in surgery, the artificial intra-ocular lens (IOL) is placed in the capsule. The IOL has little spring-like arms that spread from one end of the capsule to the other to hold it in place.
While the complication rate is extremely low, it is still not wise to have "all your eggs in one basket" so to speak. It is medically conservative to separate your surgical experiences by several days or a couple of weeks.
A majority of patients need glasses after conventional cataract surgery. This is because the IOL that is used will have only one focal point as a monofocal lens. The focal point that is most often chosen by patents is distance/infinity vision. Thus, the majority of patients will need glasses to assist with near tasks.
Occasionally, patients that have been near-sighted their entire life will be given a monofocal IOL to retain near-sightedness (where they see fine up close with the naked eye). In this case, they will wear glasses that assist them with distance/infinity vision.
There are some patients, regardless of whether they are near-sighted or far-sighted that will wear bifocals simply for convenience.
Finally, patients that have moderate or excessive astigmatism may be required to wear glasses for all fields of vision (near, intermediate and far) although many can be helped to great near or far (but not both) vision through the use of what is called a Toric IOL (a Premium lens for which there is an upcharge beyond the normal insurance coverage). I use the Acrysof Toric Intraocular lens from Alcon Laboratories, the world’s leader in ophthalmic surgical products. Many professions as well as leisure activities such as golf, biking, bird watching, and flying require or are at least improved by excellent uncorrected distance vision such as the Toric IOL offers.
Several proven technologies, some newer and some longer term, can allow today's cataract patients to decrease their dependence on glasses and in some cases even eliminate them all together. These include Monovision with Intraocular lenses (IOLs); Multifocals such as ReStor and Technis Symfony; as well as the Crystalens accommodating IOL. These options are discussed for your consideration below.
Monovision occurs when a monofocal (single focus) IOL corrects one eye to achieve good vision at near and the other eye for far vision. This is done to decrease the need for glasses. This condition, induced with IOL surgery, is really only recommended for those patients who have had monovision via contact lenses in the years prior to cataract surgery. For those with much astigmatism a Toric lens can be used (see above) to provide monovision.
An Accommodating IOL such as the Crystalens from Bausch & Lomb will perform in such a way as to provide far, near, and intermediate focus. This is accomplished by a lens that accommodates or flexes to provide a "zoom" function. As mentioned above, the IOL rests in the natural lens capsule which is connected by marionette-like strings called zonules to the same muscles that provided our natural lens with the ability to accommodate or zoom itself before we experienced presbyopia. By exercising these muscles we can cause a bowing of the Crystalens and induce accommodation to provide varying degrees of near vision. Relaxing these same muscles allows the lens to focus at distance.
Multifocal lenses like the ReStor from Alcon Laboratories, the ReZoom from American Medical Optics, or the Technis Symfony multifocal, provide two focal points, far and near, with what is called "simultaneous vision." That is, portions of the IOL focus at distance, while other portions or zones of the same lens focus at near. The brain naturally takes the portion that is required for the given task and dismisses the other portion or zone. These lenses may also be referred to as "zonal" lenses.
Accommodative and Multifocal IOLs can be a great way to minimize or, in some cases, eliminate dependence on glasses. There are several factors involved when considering whether someone is a good candidate for these lenses including the presence and degree of astigmatism, diseases of the retina (diabetic maculopathy and macular degeneration among them); diseases of the optic nerve (including severe glaucoma) and other ocular diseases.
Accommodative and Multifocal lenses, just like Toric lenses, are considered Premium IOLs and as such they are usually not reimbursed by insurance carriers and thus the patient must incur some additional expenses in the process.
My many years of experience, along with your optical history, your desired activities and to some extent your pocket book will determine which model lens is right for you. The power determination is performed by my Certified Ophthalmic Technician using the most up to date equipment; viz. the IOL Master from Zeiss. This sophisticated device employs a technique called Optical Interferometry combining two or more light waves (in this case laser waves) in such a way that interference occurs between them. The amount of interference gives us the precise measurement we are looking for – the distance from your existing lens to the retina. This is the same distance at which the artificial lens must focus. Since the power of any lens is a reciprocal of its focal length, once we have that length we can just work "backwards," if you will, and derive the power needed.
Drops are used both ahead of and after cataract surgery to reduce both infection and inflammation as complications. The drops help keep our complication rate so low. A more complete list of possible complications can be seen in our cataract consent forms.
You will never need another cataract surgery. However, in the majority of cases, a small membrane will form in the eye months or even years later as cells deposit themselves between the IOL and the back wall of the lens capsule a condition known as posterior capsular opacity (PCO). This membrane is removed in the office using a simple 20-second laser procedure known as a YAGcapsulotomy.
Over 95% of patients can expect to return to normal activities within 24 hours of surgery. I will counsel you on this subject at your first post-operative appointment on the day following your surgery. While you will be asked to use eye drops after surgery they need no refrigeration so they travel well.