Cataracts and Modern Cataract Surgery
What is a cataract?
When we are born the natural lens of the eye is crystal clear. As we all get older, this lens inside the eye becomes discolored, clouded and thickened. Sometimes opacities develop within it. This is a cataract. The image can no longer be focused clearly on the retina. Bright lights become bothersome (sunlight and oncoming car headlights), and it may become difficult to drive or read. This usually happens to adults over the age of 55, but can happen at any age. The result is a problem performing or enjoying common visual tasks.
What causes cataracts?
There is certainly a genetic predisposition to cataract formation. Normal aging is an important factor. Other factors include: exposure to ultraviolet light, trauma, diabetes, hypothyroidism, chronic use of corticosteroids, previous eye surgery, chronic ocular inflammation, some types of glaucoma, and high myopia.
What are options for cataract treatment?
Cataract development cannot be slowed or reversed with medication or dietary supplements. There is some evidence that UV filters in glasses can slow the progression of cataracts. Better lighting, a change in glasses, or using a magnifying lens may be helpful. Once the vision becomes significantly compromised and begins to affect a patient’s daily life and safety, it is usually wise to remove the cataract.
What is cataract surgery?
Cataract surgery is an outpatient procedure in which the opacified natural lens of the eye (the cataract) is removed and a plastic intraocular lens (IOL) is implanted in its place. The procedure is almost always performed using topical anesthesia and without general anesthesia. The patient experiences little or no pain and returns home after the procedure, mobile and able to care for him or herself. The next day the patient is examined in the office. Vision is often clear within the first few days, and almost always within a few weeks.
The surgery involves making a tiny incision (about 1/8 inch) in the peripheral cornea and inserting a small instrument which uses high frequency vibration (ultrasound) to reduce the lens to small pieces, soften it, and allow it to be aspirated from the eye. A sophisticated instrument monitors the fluid removal so it can simultaneously replace it with an equal volume, keeping the intraocular contents in the proper relationship to one another. The procedure is called phacoemulsification. The intraocular lens is then inserted through the same incision and placed into position. A suture may or may not be necessary to secure the incision.
Cataract surgery is extremely safe, and the results are excellent. Of course, it is a real operation, and as in any operation there can be occasional problems. A full discussion of the advantages and risks occurs any time cataract surgery is contemplated.
We are experts in performing the most modern cataract procedures, and often are asked to care for patients with cataracts which are difficult to remove, or with complications of previously performed cataract surgery. Dr. Engelstein edited a book, Cataract Surgery: Current Options and Problems, covering many aspects of cataract surgery. This book was popular in the United States and Japan and was translated into Spanish.
What happens after cataract surgery?
Immediately after surgery, the patient occasionally feels the after effects of the anesthetic medications. This should wear off by the time the patient leaves the surgical center. The doctor will shield the surgical eye and the patient should not remove the shield until it is removed the following day in the office. During the post-operative visit, the doctor will instruct the patient on which drops to take and how often. The most important thing to do after surgery is not to rub or touch the eye, and to avoid activities that could result in accidentally being struck in the eye.