Cataracts: Overview


 

Check out Dr. Raja's new Podcast on Cataracts!  Also available on Apple Podcasts!


cataract

What is a cataract?

When the natural lens in an eye becomes cloudy over time, it becomes a cataract.  This is a natural process of getting older, caused by proteins depositing in the natural lens.  Initially, this cloudiness causes a change in prescription, typically increased nearsightedness, that can be corrected with new glasses.  Eventually, this cloudiness can cause blurry vision, difficulty with night driving, and trouble with normal daily activities that cannot be fixed with glasses.  That is when cataract surgery becomes an excellent option to help restore sight!



Cataract Surgery 

Cataract surgery is one of the most commonly performed and safest surgeries done in this country!  During cataract surgery, the cloudy interior of the cataract is removed and replaced with an artificial intraocular lens (IOL) implant.  Since the natural lens places a strong role in helping us see, it is imperative that an IOL be placed. Truly, cataract surgery should be called lens replacement surgery!  Preoperative measurements are taken, which help us predict what power IOL goes into the eye.  Over time, thanks to technological advancements, the goal of cataract surgery has changed.  It has become cataract refractive surgery, with the goal for many to be as spectacle-free as possible.  This is accomplished by the following steps:

  • Selecting a brand of IOL that custom matches each patient’s corneal curvature
  • Simultaneously correcting any visually significant astigmatism.
  • Using special lifestyle IOLs to help patients see at near and intermediate, in addition to distance.

A variety of tests are performed preoperatively to assess what options are available to each patient.  Unfortunately, not every patient may be eligible for every type of IOL.  Dr. Raja will make the determination as to what each patient is a candidate for at the preoperative visit.

Our cataract patients often have dry eyes and glaucoma. In order to help improve the vision, comfort and convenience for our patients, Dr. Raja has added a few more steps.

  • Screen and treat for any dry eyes before getting preoperative IOL measurements.  This results in more accurate measurements and increased comfort after surgery. 
  • Decrease the need for glaucoma drops postoperatively by doing minimally invasive glaucoma surgery (MIGS) with the cataract surgery. This typically only adds a few more minutes to the surgery with no additional healing time.

Dr. Raja calls this five-point strategy CatRx, his personalized Cataract Surgery Prescription for each patient.  He believes that cataract surgery gives each patient a unique opportunity to improve vision and decrease eye drops and truly enhance the quality of life.  


CATARACT FAQ

What causes cataracts?

Cataracts are a natural part of aging.  They are caused by proteins depositing in the clear lens.  There is no "plumbing" to get rid of these waste products, so they accumulate and interfere with light passing through them.  They are associated with trauma, diabetes mellitus, steroid use, and even statin use (cholesterol medications) among other things!

Can they be prevented?

Unfortunately, no, not at this time.  There are no medications that have been proven to prevent cataract formation.  Antioxidants such as vitamins A, C and E, lutein and zeaxanthin may be helpful, but there is no hard scientific evidence.  The main way of dealing with cataracts is with glasses or cataract surgery.

When should cataracts be removed?

When eyeglasses are unable to improve the vision or symptoms adequately, then it is reasonable to consider cataract surgery.  Insurances have certain criteria that they like to see met (e.g. 20/40 best-corrected vision or 20/40 vision with glare testing), but questionnaires are the best way to assess this because we believe in treating people, not numbers.  Simply put, if your vision is not good enough to do the daily tasks you would like, then you should have cataract surgery. 

How do you treat astigmatism?

Astigmatism occurs when the eye is shaped like a spoon or egg and not like a baseball.  If left uncorrected, it causes ghosting or a shadow image at distance and tends to cause fatigue with near or intermediate use.  It can be considered a separate problem from the cataracts and therefore requires a separate solution.  Minor amounts of astigmatism are negligible and do not need to be corrected.  Milder amounts can be treated with laser-assisted cataract surgery.  Moderate and severe amounts of astigmatism are best treated with special toric (astigmatism-correcting) IOLs.  These can be considered "add-ons" to the normal cataract surgery that give you the best chance to be glasses-free postoperatively.

Is laser-assisted cataract surgery safer than manual cataract surgery?

For the most part, no.  Manual cataract surgery is quite safe and laser assisted cataract surgery is best suited for correcting mild amounts of astigmatism and for ensuring centration of multifocal IOLs.  Certain corneal conditions and dense cataracts do benefit from the laser by decreasing the amount of energy needed to destroy the cataract.

What type of anesthesia do you use?

Cataract surgery is a minimally invasive outpatient procedure.  You go home that day.  Typically, IV medications are given to help reduce anxiety.  Occasionally, anesthetic injections around the eye can be given to provide extra comfort if needed.  At all times, you should be able to breathe on your own.  Patients may fall asleep but many patients are awake and relaxed during surgery.  Discomfort is minimal and fleeting.

How much does it cost?

Medical insurance typically covers standard cataract surgery with a monofocal IOL and any glaucoma procedures.  Usually, a copay, coninsurance, or deductible will apply.  If any astigmatism is corrected with laser-assisted cataract surgery or a toric IOL, or if a multifocal IOL is placed, then there will be additional costs for being more glasses-free.  Our surgery counselor will discuss your costs at your consultation and present options to you.

Can my cataract grow back?

Not in the standard sense, no.  After cataract surgery, a film can grow behind the IOL.  It could be months to years after cataract surgery, but it is very common.  The solution is much more convenient--a simple laser procedure here in the office.  After fifteen minutes, the vision should be much improved!

Are both eyes done at the same time?

We usually operate on the second eye approximately two weeks after the first.  This gives ample time for one eye to heal before operating on the other eye.  This makes the recovery process much easier and less stressful on the patient. 

What can I expect after cataract surgery?

After surgery, a shield will be placed on your operative eye and you will remain in the recovery area for approximately 20 minutes.  You will be given a drink to sip and the nurse will go over your postoperative instructions.  Due to anesthesia, you will need a ride home that day.  You should start the drops when you get home.  

You will have an appointment at the office the next day, where we'll check your vision and eye pressure and ensure that the eye is healing well.  Some blurry vision over the next few days is normal.  The majority of the healing occurs sometime before the one week postoperative visit, but everyone heals at their own pace and sometimes it can take longer.  Drops will be continued for a few weeks as per the schedule printed for you at each visit.  

We recommend no bending, straining or heavy lifting over 15 lbs during the first week and no swimming for a month.  If eyeglasses are needed, these will be prescribed at the one month postoperative visit.  At this point, you should be able to enjoy that wonderful, clear vision!

Why should I get my cataract surgery done at Orlando Eye Institute?

We understand that the idea of surgery can be daunting for some patients.  Our job is to help make cataract surgery as smooth and relaxing as possible.  To accomplish this, we want to be there for you before, during and after the surgery.  To help better educate our patients preoperatively, Dr. Raja holds monthly "lunch-and-learn" cataract surgery lectures at our office.  He is able to go into greater detail than is possible during an office visit so patients can feel knowledgeable and comfortable making an informed decision. 

We pride ourselves on being comprehensive with our preoperative testing.  We strongly feel it is better to be proactive than reactive.  Prior to having any measurements taken, a complementary tear film analysis is done to assess whether the ocular surface is suitable to get preoperative IOL measurements.  If not, then we recommend delaying the measurements until the condition has improved.  We want to be your advocates and we try our best to treat things beforehand to ensure that your postoperative course is trouble-free.

We also promise to offer the latest technologies for our patients, from laser cataract surgery to intraoperative aberrometry to the newest IOLs and glaucoma devices.  For instance, did you know we were the first practice in Orlando to place the Symfony IOL and the first in Central Florida to use the miLOOP technique for dense cataracts?  Know that your eyes are in good hands with Orlando Eye Institute!  Call us at 407-704-3937 to schedule your initial consultation with us.

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