What are Cataracts?
A cataract is the clouding of your eye’s natural lens. Cataract surgery is an option, if your vision is poor enough that you are having difficulty doing the things you want to do, or if your vision is significantly annoying to you. With cataract surgery, we take your cloudy lens out and put a new, clear lens in, a “lens implant” or “intraocular lens”.
What causes cataracts?
The most common cause of cataracts is aging. Sooner or later, most of us will develop cataracts. Other causes include trauma, medications such as steroids, systemic diseases such as diabetes, and prolonged exposure to sunlight.
Cataracts usually develop and progress slowly, causing a gradual and painless decrease in vision.
Other changes you might experience include:
- Glare, particularly at night. This is the most frequent reason people choose to have surgery.
- Frequent changes in your eyeglass prescription
- Decrease in color intensity
- Yellowing of images
- Double vision
What is the treatment for cataracts?
With a routine, outpatient surgical procedure for cataracts in York, PA our skilled ophthalmologist (Eye M.D.) can remove the cataract by making a small incision in the eye and removing your natural lens with ultrasound (phacoemulsification). A synthetic intraocular lens (IOL) is inserted at the time of cataract extraction to replace the focusing power of the natural lens that was removed. IOLs can be monofocal (fixed-focus for a preset distance) or multifocal, which allows focused vision at many distances. The time to have cataract surgery is when the cataract is affecting your vision enough to interfere with your normal lifestyle or when vision is substantially annoying.
Cataract surgery is a very successful operation. One and a half million people have this procedure every year in the United States, and 98% have a successful result. As with any surgical procedure, complications can occur during or after surgery, and some are severe enough to limit vision. But in most cases vision, as well as the quality of life, improves.
Cataract Surgery in York, Lancaster, Harrisburg PA
Phacoemulsification is the surgical method used to remove a cataract. An ultrasonic oscillating probe is inserted into the eye. The technology is similar to the ultrasound the dentist uses to clean your teeth (the inventor of phacoemulsification came up with the idea while sitting in the dentist chair!). The probe breaks up the hard center of the lens. The fragments are suctioned from the eye as they’re created. This allows for a small incision that does not require sutures to be used. Most of the lens capsule, the membrane around the lens, is left behind and a foldable intraocular lens (IOL) is implanted permanently within the membrane to help focus light onto the retina. Vision usually returns quickly, and one can resume normal activities within a short period of time.
Your Glasses Prescription After Cataract Surgery
The IOL can be any power that we want it to be. It’s a little like having a contact lens inside the eye. That gives us a lot of options. We can eliminate, reduce, or even induce, nearsightedness, farsightedness, astigmatism and presbyopia (that trouble we have with focusing up close after age 42 or so). Here are some other things to think about. If all this seems confusing or to be too much information, don’t worry. Dr. Lander, a leading cataract surgeon in York, will be happy to recommend a good option for you.
For patients having surgery on only one eye
Normally, we put that eye in focus at distance, allowing you to see from infinity to about a yard away (you would need glasses for things closer than that). Note: If you have a lot of far- or nearsightedness in the other, non-operated eye, we will have to leave you with some far- or nearsightedness in the operated eye. That is because if you need a strong glasses’ lens for the non-operated eye and a minimally powered lens for the operated one, the two eyes would not be able to work together, and you would see double. The glasses’ prescription for the two eyes has to be in the same ballpark. The exception to this is for those who can wear a contact lens in the non-operated eye.
For patients having surgery on both eyes
Now you have more options:
- The commonest arrangement is to make the dominant eye in focus for distance and the non-dominant one for intermediate range (such as computer or store shelves). This is a nice option, because it makes you relatively independent of glasses. Most people still need reading glasses for prolonged reading or fine print. These can be prescription readers or over-the-counter readers, depending on need. This is called modified monovision.
- Full monovision is similar to modified mono, except the non-dominant eye has a full near correction. We recommend this only if you know that you like this from having worn full monovision in contact lenses.
- A multifocal lens or variable focus lens has concentric rings alternating near and distance focus. The brain sorts out which image to pay attention to, depending on the task at hand. This lens gives you the best chance of being totally free of needing glasses. However, it sometimes causes some halos around lights at night and can cause other compromises to the quality of your vision. The best candidates for this lens are those that really value being totally glasses-free and are willing to tolerate some compromises in quality of vision to achieve that. For such people, this lens has a high success rate. There is a considerable out-of-pocket cost.
If you have astigmatism, we can reduce or eliminate it. What is astigmatism, you ask? The cornea, the clear dome in the front part of the eye, is ideally spherical. When the cornea is more curved along one axis than another, like a football is, it causes astigmatism, a focusing defect in which some light rays focus on the retina and others in front of or behind it. Your astigmatism is being corrected now by either glasses or contact lenses. If we correct your astigmatism at the time of cataract surgery, you will be able to see better without glasses. If we don’t correct it, you will need glasses or a contact lens to see properly, as you do now.
If you have significant astigmatism, a toric implant can give you good naked-eye vision, maybe for the first time in your life! Like a conventional implant, a toric implant’s focal distance is set to where you would like it to be — distance, near or in-between. Most patients opt for naked-eye distance vision in the dominant eye and at approximately computer distance for the non-dominant one. There is an out-of-pocket charge for the toric IOL, as insurances do not pay the entire cost of these “premium lenses”.
If you have only a little astigmatism, you can opt for limbal relaxing incisions. These consist of a partial-thickness groove made in the very periphery of the cornea. It will not affect the care or restrictions after the surgery. The results are less predictable than those with a toric implant, and LRIs are suitable for patients with only a modest amount of astigmatism. There is no out-of-pocket charge for LRIs.
If you have only a little astigmatism, it is to your advantage to leave it uncorrected. A little astigmatism helps with your depth of focus and so can be helpful, especially in cases of modified monovision.
The technology we have today of determining your prescription after cataract surgery is good, but it is not perfect. Sometimes patients become a little more near- or far-sighted than intended. Rarely, it is a lot more. In these cases, patients may be more dependent on glasses than hoped, but the quality of vision, with glasses, is unaffected. If this is a really big problem for the patient, it can be corrected by either replacing the implant with another one, wearing a contact lens or having excimer laser surgery, such as LASIK.
It is common for the membrane behind the IOL to become cloudy after the original cataract surgery. This causes cloudy vision, similar to having the original cataract. When this happens, the ophthalmologist (Eye M.D.) can create an opening in the capsule with a laser. This procedure is called a posterior capsulotomy. This is done in-office, takes three minutes, causes minimal discomfort and does not restrict your activities.
My Pledge to You
- I will not talk you into cataract surgery that you don’t need.
- I will not talk you into lenses or lasers that cost you extra out-of-pocket expenses. They will be offered, for your consideration, if appropriate/applicable.
- I will consider your pocketbook when I prescribe eye drops.
- I will use up-to-date technology to maximize the chance of success.
- If there is a problem, I will be direct and honest with you about what it is and what we can do about it.
- If your case is unusually complex and requires special techniques that I don’t do or equipment I don’t have, I will refer you to another doctor who does.