What is a Cataract?
There is a lens inside the eye which helps us to focus light and see clearly. A cataract is a clouding of the lens in the eye which can blur vision. Cataracts are more common in those over age 60, but can occur at any age. As a cataract develops, it causes worsening vision.
A cataract is not a growth or a film over the eye. In most cases, you can’t see a cataract by looking in the mirror, since it occurs inside the eye. When vision is affected by cataract, the cataract can be removed. The goal of cataract removal is to improve vision.
What Causes Cataracts?
Most cataracts occur as we age. Because they are a normal part of the aging process, everyone will eventually develop a cataract if they live long enough. Some cataracts are caused by injuries or by medical conditions and the medicines used to treat them. Diabetics are more likely to develop cataracts. Heredity also plays a role. Smoking can cause worsening of cataracts as can spending time in the sun without protecting the eyes from the ultraviolet light.
Once a cataract starts to develop, there is not much that will slow its progress. You may be able to slow worsening of cataract by quitting smoking, protecting the eyes from ultraviolet light (with hat and sunglasses), and taking supplements containing modest doses of Vitamin C, Vitamin E, Omega 3 Fatty Acids, and Lutein. Some have claimed that using eye drops containing Acetyl-L-Carnatine can improve certain types of cataracts, but this has not been scientifically proven.
When Should a Cataract be Removed?
A cataract should be removed when blurred vision from cataract begins to affect your normal activities and lifestyle.
Symptoms of difficulty reading, seeing the television, or recognizing faces are common as cataracts develop. In earlier stages, cataracts can cause glare, often making driving difficult due to sunlight reflects or the brighteness of oncoming car headlights at night.
Glare and reduced contrast can also affect vision with cataract, and are commonly noted when driving, walking or playing golf. Some find cataracts reduce the sensitivity of the vision, making it harder to see the golf ball, or to read print which is not dark and distinct.
When the cataract makes it more difficult to do what you want to or need to do, that’s when it should be removed. With modern cataract surgery, it is never necessary to wait until a cataract is “ripe.”
While it usually does no harm to the eye to leave a cataract alone, it does mean vision will worsen with time. Worsening vision can increase th erisk of injuries due to falls and automobile accidents.
Waiting too long to remove the cataract can also make the surgery more difficult for the surgeon, increasing the risk of complications during surgery. It’s best to remove the cataract once it begins to cause trouble with the vision.
How is a Cataract Removed?
At Hawaiian Eye Center, we pride ourselves on offering the latest techniques and technology for cataract care. In our modern hightech Surgicenter, we generally use only eye drops to completely numb the eye. This means there is usually no injection needed and no pain during the procedure. The cataract is removed using a procedure known as
phacoemulsification in which high frequency sound waves (ultrasound) are used to break up and remove the cloudy cataract. This technique allows for safe removal of the cataract utilizing a tiny incision often less than 1/8″ wide.
The ultrasound breaks up the cataract, and it is vacuumed out through the tiny incision in the eye.
Please inform our doctors or staff before the day of surgery if you wear contact lenses.
Once the cataract has been removed, a tiny lens implant is folded an dplaced into the eye to restore the focusing power lost with the removal of the lens (cataract). The lens implant is usually placed in the same location the natural lens of the eye occupied. A thin bag called the lens capsule is left in place when the cataract is removed. The new lens implant can usually be placed in this bag, allowing it to remain in place indefinitely.
Once the procedure is finished, the incision is so small its seals by itself, often without the need for stitches. Thus the term, “no-stitch” cataract surgery. The most common procedure to remove a cataract uses ultrasound energy to remove the cataract. Lasers are not usually used in cataract surgery. There are a few situations in which a surgeon may opt to perform a laser assisted cataract procedure, but in the vast majority of cataracts, laser is not needed.
People are generally awake, but relaxed during surgery. Some sleep through the procedure and others report seeing an enjoyable display of colored lights during surgery. Medication is given to make sure you are relaxed. Thanks to anesthesia and modern surgical techniques, there is almost never any pain or discomfort.
As the cataract procedure has seen significant advances in recent years, the lens implants used to correct vision have also become more advanced. Modern implants can be placed in the eye through a tiny incision because they can be folded. Once the implant is in place, it’s permanent and you never know it’s there. It can’t be felt, usually can’t be seen, and doesn’t need to be changed or cleaned. The standard lens implant is designed to provide good focus for distance vision. Most people who receive the standard lens implant do need glasses after cataract removal, either for reading or for clearest vision for both distance and reading.
Advanced lends implants can help reduce dependence on glasses after surgery. New advanced technology implants have recently been developed which can help provide good distance and reading vision after surgery. Other implants can reduce astigmatism. These implants can require special measurements and procedures to provide best possible vision without glasses. They areno better for your eye than the standard implant, but can provide a greater range of focus without glasses. These special implants have some unique characteristics and are not covered by insurance. Be sure to ask your doctor about them if you’re interested in reducing your dependence on glasses after surgery.
Lens Power Calculation
Good focus after surgery depends on the choice of the proper lens implant power. Power of the implant is determined by measurements of the length of the eye and of the power of the cornea of the eye before surgery. A computer is then used to calculate the appropriate lens power for your eye. Your doctor will usually recommend we focus the eye for good distance vision, which usually means glasses would be necessary for your reading. If you prefer your eyes to focus differently, please discuss this with your doctor. New techniques allow us to offer an elective “premium” procedure in which the goal is to reduce the need for glasses following surgery for distance, near and mid-range vision.
Measurements of the eye are not always exact. Sometimes, our calculations do not give us the exact lens power needed for the vision you would like without glasses, even if you choose an advanced implant designed to reduce the need for glasses. Sometimes astigmatism can keep you from having good vision without glasses after cataract removal. Many people do still need glasses after cataract removal. Many people do still need glasses after cataract surgery for the clearest vision. Rarely, if you are uncomfortable with your focus after surgery the lens can be changed or another procedure performed to improve the focus.
It is more dificult to find the correct implant power if you’ve had previous refractive surgery such as LASIK and PRK. If you have had LASIK or PRK, please inform your doctor before the day of surgery. In addition, contact lenses need to be out of the eyes for a period of time (one week for soft lenses, 3-4 weeks for gass permeable or hard lenses). Please inform our doctors or staff if you wear contact lenses.
It is important for you to understand that no surgical procedure is without risk. Complications sometimes happen although they are rare. Most problems which occur can be corrected and only slow the healing process. rarely, additional surgery may be required for the best possible outcome. In very unusual cases, vision loss, chronic pain, and even blindness can occur due to complications of surgery. While the risks of cataract removal are small, the benefits are usually considerable.
Other conditions that affect the vision such as diabetes, glaucoma, macular degeneration or stroke can also affect the vision, limiting the vision even when surgery is perfect. We can’t always accurately predict the outcome of surgery.
Before surgery, and after explaining the details of surgery as they apply to your eye, we will ask you to sign informed consent forms for your operation, indicating that you understand the optinos regarding the procedure and possible complications and risks. If there is something you d not understand, please clarify it before you sign the forms. We are here to help you and be sure you understand as much as possible about the procedure. We also have a video available with information about risks and benefits of surgery if you’d like to watch it.
Most insurance plans pay for cataract surgery. Many also pay for a pair of glasses after surgery. The amount you will pay for the procedure will depend on your insurance and the procedure you require. We will provide you with a written estimate prior to surgery which is as accurate as possible so you have an idea of what your costs will be. Please note: Sometimes our estimates are inaccurate due to changing insurance rules. Payment amounts amy need to be corrected when we receive payment or other notification from your insurance plan. If complications occur associated with your surgery, additional procedures may become necessary. Additional procedures usually also mean additional costs. Many of these costs are covered by insurance, but there could be additional fees for you. While this is rare, you should be aware that further surgery could be required, and there could be additional costs.
There are certain options we offer with cataract surgery which are not covered by insurance. Using special measurements and advanced lens implants, we are often able to offer patients improved vision with less need for glasses after surgery. If you choose to have this additional work done, we will give you an estimate of the additional costs that are not covered by insurance.
We are Hawaii’s leaders in personalized eye care. Our skilled, friendly staff is here to help you and answer your questions.
Before your procedure, we will give you instructions on how to prepare your eye. You will need to use some eye drops, clean your face on morning of surgery, and eat very little breakfast. Diabetics will receive special instructions on diet and the use of their medicines. Someone should drive you to the Surgicenter on the day of surgery as you will not be able to drive home. We usually have transportation available if you arrange it in advance.
If you wear contact lenses, they must be out of your eyes for 1-3 weeks prior to surgery. Please inform your doctor or the staff if you wear contact lenses so we can go over instructions on when to remove them before surgery.
Please arrange for someone to bring you to the Surgicenter on the day of surgery, as you will not be able to drive home. If you need trasnportation, we can often arrange pick up in our courtesy van. Please speak to the staff to arrange transportation before the day of the procedure. For patients traveling from the neighbor islands, we can help you arrange air transportation and will have our courtesy van meet you at the airport and take you to our Surgicenter.
With modern advances in cataract care, there are very few limitations on your activities after cataract surgery. You will need to use some drops for a few weeks, and will get instructions both immediately after surgery, and on the day following the procedure.
After the procedure, it is best to rest since you will be tired from the effects of the anesthesia. However, it is OK to return to normal activities as soon as you feel up to it. We recommend you wear something to protect the eye (usually sunglasses), avoid getting water in the eye or rubbing the eye, and cover the eye with a protective shield at night for the first several weeks to reduce the chance of injury.
You will be instructed to call the office immediately if you have any problem at all after surgery. There is always a doctor available.
It is OK to bathe after surgery, but avoid getting water in your eye. You may find that the vision is blurry at first or that you feel off balance from the changes in your eye. You may also temporarily see some spots in the vision, an arc or shadow in the peripheral vision, or other changes in your vision. This is normal and improves with time. You will be instructed to call immediately if you have any problem at all after surgery. There is always a doctor available to answer your call.
When the cataract is removed, a small membrane called the lens capsule is left in the eye to support the placement of the new lens implant. Months to years following the cataract procedure, this capsule can become wrinkled or cloudy. Often this blurs the vision, making it seem the vision is hazy or cloudy. Sometimes, it feels as if the cataract has returned.
If the cloudy capsule is affecting the vision, it’s easy to treat. A quick painless procedure can be done with the laser to open the cloudy capsule and improve the eye’s focus. The laser light is really just a strong focused pulse of light which opens the cloudy area. The procedure takes only a few minutes, is completely painless, and usually permanently sharpens your focus.