What is a Cataract?
The crystalline lens inside the eye focuses the images in the back of the eye allowing for clear and focused vision. As the normal process of aging progresses the crystalline lens becomes more and more cloudy. In general, this is a very slow process, but at some point the lens becomes cloudy enough that it starts interfering with vision. When the lens clouds it is called a cataract. So cataract is our clear lens that has become cloudy.
As this process occurs the vision decreases making it harder and harder to see clearly. Cataract symptoms include blurred vision, glare, halos, and difficulty identifying colors.
When is Cataract Surgery Necessary?
There are three criteria to consider prior to cataract surgery:
- The presence of lens cloudiness identified by the doctor.
- Decreased vision and visual impairments consistent with cataract symptoms reported by the patient (blurred or cloudy vision, glare, halos, difficulty reading, reading signs, recognizing faces) that cannot be corrected with glasses or contact lenses.
- Evidence that the visual symptoms are interfering with activities of daily living (driving, reading, writing, watching TV, playing games, hunting, doing fine handwork, etc.). We use a questionnaire that could help you see if you may be a candidate for cataract surgery.
Where is the Cataract Surgery Done?
Cataract surgery is done at a hospital or at an ambulatory surgery center. We use two facilities:
What is the Preparation for Cataract Surgery?
There are three aspects of the preparation for cataract surgery:
- Measuring the eye: Measures of the eye are necessary to decide the prescription and characteristics of the lens that will be implanted in your eye.
- Signing the necessary forms that authorize your surgeon to perform the surgery and that inform you about the possible risks of the surgery.
- Making sure that the patient is in good physical health to undergo cataract surgery. This may involve obtaining an EKG (electrocardiogram) to evaluate the health of your heart and some basic blood tests depending on the medical conditions you may have. Finally, sometimes a clearance by your primary care doctor, cardiologist or other specialist may be required.
What is the Process of Cataract Surgery?
The day of the surgery you will arrive to the center where the surgery will be done and register. The nurses will review your medical history and prepare you for surgery. This involves checking your vital signs, obtaining an intravenous (IV) line and giving some eye drops to dilate the pupil of the eye that will have surgery. You will also meet your anesthesiologist who will be monitoring you and administering the necessary medications to ensure you have no pain or discomfort during the surgery.
The surgery could take about 10 to 20 minutes, but you should expect to be in the surgical center for at least a couple of hours throughout the process.
At the end of the surgery an eye shield is placed to protect the eye from any trauma and once you are fully awake you and your family will receive instructions about the necessary care after surgery and will be discharged.
After Surgery Care
We will ask you not to bend over or do any heavy lifting for a few days. In addition, you will start using your eye drops after surgery, these are antibiotic and anti-inflammatory drops that will be used for a couple of weeks after the surgery.
Frequently Asked Questions
When can I drive again?
This depends on how quickly you regain vision but in general about 90% of the patients are allowed to drive the next day after the office visit.
What type of anesthesia is used for cataract surgery?
There are different types of anesthesia that could be used and that depends on many different factors as the:
- Anatomy of the eye.
- The expected length of the procedure.
- The coexisting health or eye conditions.
In most cases it involves the use of intravenous (IV) mediations to induce relaxation and the application of anesthetics in drops, or local anesthetic inside or around the eye. Rarely, general anesthesia is necessary. The decision is made by the surgeon and the anesthesiologist. Regardless of the method, the goal is for the patient to be comfortable and pain free during the procedure and the anesthesiologist is by your side to ensure it.
I use blood thinners do I need to stop them?
Generally, they do not need to be stopped. If for any reason we recommend that you do, we will consult with your doctor to ensure it is safe.
Are there different types of lenses that could be implanted?
Monofocals: The most common types of intraocular lens implants are Monofocals. The monofocal lens is the most commonly implanted lens and its covered by the insurance. It gives a great quality of vision, but it does not correct astigmatism and it does not help with near vision. So if you have astigmatism you need to use glasses for distance and near and if you have no astigmatism you will still need glasses for reading. The monofocal lens is a great alternative for somebody who does not mind using glasses after cataract surgery.
Toric: The toric lens correct astigmatism so it will give a better vision for distance without glasses but patient will still require glasses for reading. This is a good option for somebody who does not mind using glasses for reading only. It is not covered by insurance and there is an out of pocket for this lens.
Multifocal: The multifocal lens gives the possibility of glasses independence for distance and near, however you may still need to use glasses for some activities. Although the new lenses are performing better than previous models, there is a small risk of halos, glare and decreased vision in low light conditions. This type of lens is not covered by insurance.
What are the risks of Cataract Surgery?
Although very uncommon and like any medical procedure there is a risk related to the procedure. We always discuss the risk of bleeding, infection, swelling of the cornea or the retina. This may lead for the need of an additional surgery, a need for the use of glasses or contact lenses, and in rare cases loss of vision.
Can you Guarantee that I Will have 20/20 and that I Will Not Need to Use Glasses?
No, unfortunately no technology can guaranty that you will be independent from glasses all the time for all distances. Every bodies eyes are different and everybody responds differently to surgery. Even with the most advanced technology some patient will not obtain 20/20 vision and may still require the use of glasses at least in some situations. A detailed discussion with the surgeon will address the most likely outcomes.
Can I use contact lenses after Cataract Surgery?
Many times, with carefully planning, cataract surgery is a possibility of making the patients independent from contact lenses. However, your ability to tolerate contact lenses is usually independent from cataract surgery and most people are able to use contact lenses after cataract surgery without difficulty after cataract surgery.
I heard my Friend had Cataract Surgery and had one eye focused for distance and one Eye for near so she did not have to use glasses, is that Possible?
That is called monovision and is a technique that has been used with contact lenses. The same can be achieved with the lens implants. Not everybody tolerates this well and may feel “unbalanced”. The only way to know if this could be a good alternative is to try it first. We use contact lenses to simulate this condition before surgery and let you experiment it. If you can tolerate it then that could be done. However, you may require the use of glasses for driving to meet the DMV vision requirements for drivers. In Texas, the requirement is that you should see at least 20/40 for distance with the worse eye. Usually, you will not achieve this distance vision for the eye that has been focused for distance and you will still need to use glasses for driving to meet the requirement even if you feel you see well for distance without glasses.