Any ophthalmologist will tell you that cataracts are an extremely common side effect of aging. Live long enough and most people will develop this condition—clouding of the normally clear lens—in one or both eyes.
“For as long as there have been humans, there have been cataracts,” says Vicente Diaz, MD, MBA, an ophthalmologist at Yale University. “For millennia, the goal has been to cure cataracts without blinding them. Literally, that’s the goal.”
Fortunately, cataract surgery has come a long way. It’s very safe, and with advances in the field, patients now have many options, including laser surgery and a growing number of synthetic interchangeable lenses that can also solve other vision problems.
Bifocal Contact Lenses
“The great thing about cataract surgery right now is that we can not only remove the cataract, but also restore the patient’s vision,” said Yale University ophthalmologist Yvonne Wang, MD. “They may have worn prescription contact lenses or glasses for years. Now we can fit them into their new lenses and give them better vision than ever before.”
With so many options, it can be intimidating to decide which type of surgery or lenses is right for you. We sat down with cataract surgeons at the Yale School of Medicine to answer frequently asked questions.
We’ll start with the lens, the structure inside the eye that focuses light onto the retina, producing a clear image. When the lens begins to become cloudy, it blocks the passage of light. “Then we called it a cataract. As it forms, the proteins in the lens begin to degrade. Their consistency changes and you can no longer be clear,” says Dr. Wang.
She added that blurred vision and the need to frequently change glasses or write prescriptions for contact lenses are often the earliest signs. Other symptoms may include halos, glare, and sensitivity to light, especially when driving at night. Or you might have trouble reading menus in dimly lit restaurants, adds Dr. Wang.
Age is the most common cause of cataracts. “It can happen at different ages. In some patients, this occurs at the age of 50 years. But most often, cataract surgery is performed at the age of 70,” she says.
“In addition to age, light and ultraviolet radiation can cause clouding of the lens,” says Dr. Wang. “Other risk factors for cataracts can be injuries, certain medications (including steroids), certain medical conditions (such as diabetes), and in rare cases, you may be born with a cataract.”
“I enlarge the patient’s eyes and examine them under a microscope. Cataracts may appear slightly yellowish, milky white, or cloudy,” says Dr. Wang.
When a cataract is just beginning to develop and is not very large, most patients can improve their vision by updating their prescription for glasses or contact lenses.
“However, because cataracts can get worse over time, patients may find that their prescription needs to be changed every year or even earlier, or the prescription isn’t adjusted enough,” Dr. Wang said. “Back then, the only cure was cataract surgery.”
When you decide to have cataract surgery, talk to your ophthalmologist about the surgical options available and which intraocular lens (IOL) (synesthetic lens) you want to use to replace your cataract.
All IOLs will provide a clear field of view. After cataract removal, you can choose to keep your vision as it was before surgery (meaning if you had myopia before surgery, you can choose lenses that will keep your myopia after surgery), or you can correct your vision by choosing an IOL to improve your vision at close range, at long range or something in between. In other words, IOLs are sold by prescription, just like contact lenses or glasses.
It is important to note that your insurance plan may not cover certain options, including multifocal, EDOF and toric lenses, and laser surgery.
One of the latest advances in cataract surgery is a technology called ORA (Optiwave refractive analysis), an intraoperative measurement of aberration, a tool that surgeons can use to measure refraction in the operating room to ensure optimal refractive power and lens placement.
“The machine takes additional measurements of your eye during cataract surgery, which allows you to more accurately measure the lens placed in it,” said Dr. Wang. “Accurate measurements are important for optimal vision. Lenses of the latest design provide good vision and distance reading. But to achieve such good results, very precise measurements are needed.”
Traditionally, when someone is getting ready for cataract surgery, surgeons measure the size and shape of their eyes so they can predict which lenses they will need, Dr. Diaz explained. “But a cataract can affect that measurement. ORA allows us to measure the eye again after cataract removal, which is generally more accurate, resulting in more accurate lens placement and therefore better vision,” he said.
According to Dr. Wang, cataract surgery is a common and safe procedure. It is carried out on an outpatient basis, patients return home on the same day. Patients complete surgery on one eye and usually return to surgery on the other eye after a few weeks.
“The entire cataract surgery process only takes a few hours, but the operation itself takes an average of 15 to 20 minutes,” said Dr. Wang.
First, your eye will be numb with a local anesthetic (eye drops or injection). Dr. Wang explained that you are awake during the procedure, but are given a mild sedative through an IV to keep you relaxed and comfortable.
“The procedure was generally pretty painless,” she said. “Most patients complain of slight itching or irritation at night on the first night. Their vision usually improves on the second day.”
The patient wears the bandage on the first day at home and then only at night for a week.
“We advise patients to calm down and only engage in light activities — not lifting heavy objects or bending over,” Dr. Wang said. “Besides that, you can usually be back at work within a day or two.”
In addition, patients should take a few drops of eye drops for about a month after surgery to help the eye heal and prevent infection.
Post time: Dec-08-2022
