What You Should Know About Cataracts

What is a cataract?

Eye with cataract-clouded lens.

Normal Vision		Cataract Vision

The main symptom of cataracts is a decrease in vision. Just how, and under what conditions vision decreases varies, depending on the type of cataract. Some people have difficulty reading, while others have more trouble seeing in brightly lit conditions, such as being outside on a sunny day. Many people notice that colors are not as vivid, while most find night driving especially bothersome. Lights often seem to have a spokelike appearance.

Is there more than one kind of cataract?
Although all cataracts occur in the natural lens of the eye, the cloudiness may develop in different parts of the lens. Furthermore, a number of conditions may cause cataracts. The most common kind of cataract occurs as a natural part of the normal aging process, sometimes as early as age 40, and is called an age-related cataract.

Injuries to the eye, from a sharp blow for example, can damage the clear lens and cause another type of clouding called a traumatic cataract. Other conditions, including certain infections, drugs or diabetes, can cause a secondary cataract.  In rare instances, cataracts are present at birth or shortly thereafter. These congenital cataracts can result from infections transmitted during pregnancy.

Medical science knows of no way to prevent cataracts, and of no way other than surgery to remove them. Your cataract should be removed only when you feel it is causing problems. But since other eye conditions may cause similar symptoms, we at Bennett & Bloom Eye Centers take great care to examine your eyes thoroughly. If other eye conditions are found in addition to a cataract, we use sophisticated equipment to determine just how much of the vision loss is due to the cataract and to what extent vision would be restored if the cataract were removed. We use the safest and most modern equipment and microsurgical techniques to treat your cataract, but consider surgery only if your vision could be improved. Once you decide to have your cataract removed, we can work out when and where to schedule your surgery, usually on an outpatient basis, based on your convenience and desires, and on your medical coverage. Our insurance department is skilled and experienced at determining where you can receive the best care at the least expense to you.

Traditional long cataract incision		Advanced small cataract incision

What happens during my cataract surgery?
Most of our cataract surgeries are performed using our No Needles…No Stitch…No Patch technique. That means only eye drops are needed to numb your eye. You'll be comfortable, relaxed, and alert throughout the procedure. The operation usually takes only about 10 minutes, but the total time spent in the hospital or outpatient center is considerably longer, allowing time for preparation before surgery and time for dressing and instructions following surgery.

Contrary to what is commonly believed, cataracts are not removed by lasers. By using the latest techniques and most modern, high-tech equipment, we can perform the entire surgery through the smallest possible incision, providing greater safety, faster recovery and minimal post-operative restrictions. The small incision, often less than one-eighth of an inch, is made in the sclera (the white part of the eye) or cornea (the clear front layer of the eye). This incision is specially constructed to self-seal when the operation is completed. Next, we open the lens capsule, a clear membrane like a cellophane wrapper which surrounds the cataract-clouded lens.

Once the lens capsule is opened, the entire cataract inside is removed.  We use a special ultrasonic surgical instrument called a Phacoemulsifier to do this. This instrument vibrates more than 40,000 times each second, separating the cataract so, with gentle suction, it can be easily removed from the eye through the small incision.

After removing the cataract, a tiny, precision-made lens called an intraocular lens implant is inserted into the eye in the same position where the cataract had been. With the surgery completed, the incision normally closes without the need for any stitches. No eye patch is required.

Do I need to have an implant?

Eye with cataract removed, and a new, clear intraocular lens implanted through a small incision. Light rays are now focused clearly onto the retina.

Once the cloudy, natural lens has been removed, we need to restore the eye’s focusing power. Years ago, thick eyeglasses were used. Today, we insert intraocular lens implants into the eyes of nearly all our patients. These synthetic lenses, made of high-grade plastic or silicone material, are permanent and non-toxic. Since we use specially shaped or foldable implants, we can insert them through the small incision.

The lens implants have other advantages, too. Because they stay in the eye, you will have a more natural appearance. They also can improve your depth perception as well as aid your side vision. Although you may need corrective eyeglasses after your surgery for activities such as reading, a strong prescription is generally not required.

What happens after surgery?
You will likely be ready to go home shortly after the procedure. Even though you may not need an eye patch, you will not be able to drive immediately, so most of our patients have a friend or relative drive them.   Otherwise, we can help arrange transportation.

There is usually little discomfort after surgery although some patients use nonprescription pain relievers like Tylenol or Advil. Some scratchy feelings, light sensitivity and tearing is normal.

You may bend over, sleep on any side, shower and resume most other normal activities immediately. Only a few restrictions are needed for just one week following our small incision cataract surgeries. Our staff will give you specific, written instructions about your post-operative routine.

Can cataracts grow back?
Once removed, cataracts cannot return. In some cases, however, cloudiness may occur in the lens capsule months or even years after the initial cataract surgery. To correct this, we use the beam of an ophthalmic laser to open the capsule. This procedure, using a high-tech YAG laser, is normally safe and painless, and takes just a few minutes to complete.

Frequently asked questions for cataract surgery:

Are both eyes done at the same time?
No, each eye is operated on separately, usually about 1-4 weeks apart.

Am I asleep during the procedure?
No, you are awake the entire time. You will be given some medication to relax you during the surgery. In some cases, eye drops are the only anesthesia needed.

Will my glasses need to be changed?
Yes, your prescription will change following cataract surgery. In most cases, you will still require at least a reading prescription to do near work. If you still require a distance prescription after surgery, it will be a few weeks until the eye is stable enough to obtain this prescription. Your optometrist will provide this prescription for you. You may continue to wear your old glasses for distance and reading, or, you may see better without any correction for distance after surgery. Even though the eye that just had surgery may be blurry with your old glasses, you are not hurting your eyes to wear them. In fact, they will probably help you to see clearer in the non-operated eye. You may remove the lens from your glasses for the eye that had surgery first if this helps. If you plan on driving within a few days of surgery, ask your doctor.

Is an implant lens always used?
With the exception of children with cataracts, an implant lens is used to replace the lens that was clouded with the cataract. The implant is similar to a very small contact lens. It doesn’t feel any different in your eye than the lens that is being removed. With few exceptions, the implant almost never needs to be replaced.

How long does it take to recover and see again?
Eye surgery is like surgery on any other body part, there will be a period of recovery. Fortunately for cataract surgery, this time is minimal. Your vision will be blurry right after surgery. No two patients are the same, but most patients notice an improvement in their vision the day after surgery. The vision improves day-by-day and by the 5-7th day, most patients are very satisfied with their distance vision. In most cases the eye will be blurry for reading and near work. You will probably need help to see up-close and it is ok to use your old glasses for reading until the eye is stable enough for a custom glasses prescription (often this takes 3-4 weeks). Remember, no two eyes are the same, and the second eye may seeem blurrier or even better than the first eye right after surgery. This is normal and the distance vision will usually improve with time. It is important to use your eye drops as instructed after surgery to increase the chances of healing well.

Will it hurt?
Most patients feel mild to moderate irritation for the first few days after surgery, “like an eyelash or a grain of sand” is in the eye. This feeling should get better with each passing day, and the medicated drops you use after surgery will help comfort the eye. Artificial tears may also be used as often as necessary to reduce irritation following surgery. It is important to remember, no two eyes are exactly the same, even if they are both your eyes! One eye may be more blurred, more red, and feel scatchier than the other after surgery. This is normal, as one eye may take a bit longer to heal than the other.