Cataracts

Information About Cataracts

Steven Kane, MD

This information is provided purely for educational purposes to improve your understanding of cataracts. It is not a substitute for receiving medical care from your doctor. If you think you may have cataracts or would like to be evaluated, please call your doctor or make an appointment at Tailored Eyes to discuss further.

To learn more about laser cataract surgery, the types of lens implants (IOLs) and astigmatism please see the topic Astigmatism and Lens Implant Options and Femtosecond Laser Cataract Surgery. Eyeglasses or contact lenses are usually required for best vision after cataract surgery.

What Is a Cataract?

A cataract is a clouding change to the naturally clear lens inside the eye. Normally, light enters the eye and passes through the lens without difficulty. When a cataract develops, the light may scatter or be blocked by the cloudy changes in the lens leading to blurry vision. Cataracts can develop from normal aging changes, from an eye injury, from metabolic changes (like diabetes), or from some medications (like steroids). Cataracts cause blurred vision, dulled vision, increased light sensitivity and glare, and/or ghost images. If the blurry vision from the cataract interferes with your daily activities, then cat\ract may need to be removed. Eye surgery is the only way to treat or remove a cataract. The good news is that cataract surgery today has evolved tremendously. For most patients, the procedure takes a few minutes and there are many excellent options to improve your vision at the time of the procedure. You can decide not to have the cataract removed. However, if you don’t have cataract surgery your vision loss from the cataract will continue to get worse.

Types of Cataracts

There are many different types of cataracts. The three most common types are nuclear cataract, cortical cataract, and posterior subcapsular cataract. A nuclear cataract is a gradual hardening and yellow/brown color change to the lens in the eye. This type of cataract tends to progress slowly over the course of years. In addition to blurry vision, nuclear cataracts can cause a gradual dulling and yellowing of colors. A cortical cataract is a white change to the lens. These cataracts can be associated with glare, light sensitivity, and decreased vision too. A posterior subcapsular cataract tends to progress the most rapidly (can progress over months) and can be associated with a relatively rapid decline in vision. This type of cataract can cause significant glare which can make driving at night difficult. Each of these types of cataracts can cause different problems with the vision and you may have more than one type of cataract at the same time. The good news is that all types of cataracts can be effectively treated with cataract surgery.

Cataract Evaluation

There are many steps involved in the evaluation of a cataract. The first step is a visit with your ophthalmologist (eye surgeon) to see if there is any other cause of vision impairment beyond a cataract. If a cataract is the reason for the vision decline, the next step is to assess vision limitations and the level of impairment on your daily activities. How much the cataract inhibits your activities helps guide the treatment discussion and together you and your eye surgeon will decide if it is time to proceed with treatment (surgery).

Prior to surgery, your eye surgeon will evaluate the overall health of the eye and take precise measurements of your eye to help determine the power needed for your lens implant (IOL). Sometimes the surface of the eye (the cornea) is too dry or in need of repair prior to undergoing cataract surgery measurements. Optimizing the cornea surface improves the accuracy of your eye measurements and the quality of your vision after surgery. For example, your eye surgeon may recommend a corneal polishing procedure or dry eye treatments to smooth a rough/irregular eye surface prior to surgery. Once the corneal surface is optimized you will then proceed with the eye measurements.

Many patients have dry eye disease which can worsen after any eye surgery and can last for several months. It is common to need to improve control of dry eye disease prior to surgery. There are many options for treating dry eye and some preoperative treatments may include lubricating eye drops, oral supplements, warm compresses, and procedures such as Lipiflow.

It is important to review all your medications with your doctor prior to surgery and you may be asked to adjust some medications before surgery. You may also be asked to start eye drops prior to your surgery to help reduce swelling and inflammation and risk of infection after surgery.

Cataract Treatments

The only way to treat a cataract is with surgery. Cataract surgery is a procedure to remove the lens inside your eye when it is cloudy and affecting your vision. During cataract surgery, the cloudy lens is removed and replaced with a clear lens implant called an IOL (Intraocular Lens Implant). The purpose of the natural lens in your eye is to bend light rays into focus so you can see clearly and the implant will serve the same function. There are many different kinds of lens implants, each with advantages and disadvantages. An exam and discussion with your ophthalmologist will help you select the right intraocular lens implant for your vision needs.

Contact Lenses and Cataract Testing

If you wear contact lenses and need of cataract surgery, you must leave the contacts out of  your eyes for a period of time before your eye exam and measurements. This is done because the contact lens rests on the cornea and distorts its shape. This distortion can affect the accuracy of the cataract surgery eye measurements used to calculate the power of your lens implant. When you stop wearing your contact lenses, the cornea returns to its natural shape.

  • If you wear SOFT contact lenses, Stop Wearing them at least 1 week before your cataract surgery testing appointment.
  • If you wear HARD (Hybrid, Rigid, or Scleral) contact lenses, Stop Wearing them at least 3 weeks before your cataract surgery testing appointment.

Measurements for Cataract Surgery

The method used to calculate the power of the lens implant (called an IOL) for your eye is very accurate in most patients. However, the final vision result after surgery may be different from what you and your surgeon planned. For example, as the eye heals the lens implant can shift very slightly toward the front or the back of the eye. The amount shift is not the same in everyone, and it may cause your final vision to be different than predicted.

  • Patients who are highly nearsighted or highly farsighted have the greatest risk of differences between planned and actual outcomes.
  • Patients who have had LASIK, PRK, RK or other refractive surgeries are difficult to measure precisely and can also experience big differences between planned and actual vision outcomes.

If the eye’s visual power after surgery is considerably different than what was planned, additional surgery to replace the lens implant or refractive surgery might be considered.

Vision After Cataract Surgery

The goal of cataract surgery is to correct the decrease in vision that was caused by the cataract. During the surgery, the ophthalmologist (eye surgeon) removes the cataract and puts in a new artificial lens called an intraocular lens or IOL. The IOL will be left in the eye permanently. Cataract surgery will not correct other causes of decreased vision, such as glaucoma, diabetes, or age-related macular degeneration. After basic cataract surgery, most people still need to wear glasses or contact lenses for best vision for either near and/or distance vision and/or astigmatism correction. Today, there are custom or premium cataract surgery options for patients interested in more freedom from glasses or readers after cataract surgery.

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