Written by Dr. James Lehmann on 06/5/18

What is Cataract?

Eyes consist of natural transparent lens, similar to that of artificial contact lens, which bend the light and allows us to focus on near and distant objects. For one reason or the other, the lens becoming cloudy and impairing the normal vision is known as cataract (https://www.aao.org/eye-health/diseases/what-are-cataracts). The fibers in the lens are flexible and undergo modifications as we age. If these fibers crystallize, the lens becomes opaque, and the vision starts clouding, eventually leading to blindness. Cataract is considered the leading cause of blindness worldwide that can be prevented.

Causes of Cataract

The most common cause of cataract is aging. As we age, the fibers in the lens undergo a number of physical and chemical changes associated with the aging process of the body. The other causes of cataract include trauma, in form of penetrating injury or due to chemical or electrical burns. Cataract can also be caused by chronic diseases of the body such as Diabetes Mellitus, Wilson disease etc.

Sign and Symptoms of Cataract

The sign and symptoms associated with Cataract can be sudden in onset, as in case traumatic cataract or gradual, such as is the case with age related cataract, which might take years to develop. The most common sign and symptoms include blurring or yellowing of vision, double vision, difficulty to see in low light, and sensitivity to bright light leading to the formation of halos.

Cataract Surgery

Surgery is the only definitive treatment method of cataract. In cataract surgery, the opacified lens is replaced with an artificial lens. The most commonly used method for cataract surgery in United States is phacoemulsification. This technique involves the use of ultrasound to breakdown the cloudy lens into small fragment that can be aspirated. The previously used method included a large incision in the capsular bag containing the lens and removing it in one piece, which was associated with comparatively more complications than the newer methods.

We at Focal Point Vision (https://focalpointvision.com/) use the latest technology available, which is one step ahead of phacoemulsification, the widely used method. The latest technology consist of the use of Laser to make incisions in the eye, correct astigmatism and to break down cataract lens into small fragments so that it can easily be extracted. Previously, the Ultrasound was used to breakdown the lens but since the FDA approval of LenSx Femtosecond Laser device in 2012, it has replaced the older methods.

Timings for Cataract Surgery

Depending on the cause of cataract, the surgery can be preponed or postponed, since it is not a life-threatening condition. If the cataract is due to old age, then you can wait till you feel the need for better vision. Depending on the vision of both eyes, a single eye and both the eyes can undergo this procedure. Sometimes if the cataract is in the initial stages in one eye, then we might treat one eye and postpone performing surgery on the other, all these scenarios varies according to the individual patients, and so does their treatment modalities.

If the Cataract is due to other causes such as trauma or burns then the surgery can be performed as soon as the inflammation due to injury has been settled and the patient is healthy otherwise. If this condition is secondary to other systemic diseases such as Diabetes, then we will recommend a strict control of diabetes before we perform the surgery, since there are chances of impaired healing and scar formation, leading to a condition known as secondary cataract (https://focalpointvision.com/what-is-yag-laser-treatment/), if the underlying disease is not controlled.

Surgical Procedure

The initial surgical preparation is similar in cataract surgeries with little variation. They consist of an initial eye examination, dilation of the pupil and local anesthesia to the eye. The next step consist of evenly increasing the intraocular pressure in the eye with minimal to no distortion of the structure of the eye. This is known as docking. Once docking is done, the mapping of the anterior segment of the eye is performed, which identifies the anatomical landmarks especially the posterior surface of the lens, to avoid perforating the posterior capsule (https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3249813/).

At this point, the previously programmed incisions can be modified, depending on requirements, as judged by the surgeon. The laser is activated, and a small incision is made in the cornea and later in the anterior capsule, after which the cataract lens is broken down into small fragment and removed via suction. The intra ocular lens (IOL) is added and adjusted into the position. The incisions are small enough to heal themselves, which is why they are not stitched. The whole procedure takes about 10 to 15 minutes, and the patient is wake throughout the procedure, though immune to pain.

Choosing the Lens

The choice of the Intra Ocular Lens (IOLs) used in the eye, depends upon a number of different factors. These factors include patient’s wishes, the cost of the lens and the surgeon’s recommendation. The most commonly used lens are Monofocal lens, since they provide the best contrast vision, and are therefore the best choice for patients who are relatively young, since the vision contrast decrease with age. On the other hand, you might still need to wear glasses for either near or distant vision.

If you are not willing to wear glasses and are looking for precise and detailed vision then you might like to think about multifocal lens. They contains different areas on the lens for near and distant vision similar to that of multifocal glasses. The major drawback of these lens is that, they can distort night vision by creating halos and worsening the glare in the bright light.

How Can We Help?

Visit us at your nearest center or call us to make an appointment. We are available to discuss the treatment option open to optimize your vision. The most frequently asked questions related to the cataract surgery are available at our website (https://focalpointvision.com/laser-cataract-surgery/), which include the relative cost for different plans, the aftercare, returning to work, use of other medications and most common complaints after surgery.

To learn more about Focal Point Vision, or to schedule an appointment, please call us at (210) 614-3600.