Vision Problems with Aging: Cataracts
by Drs. Bruce R. Cassidy, Robert W. Daly, William S. Holt, and Elizabeth G. Serrage
Few of us are happy to learn that we may need surgery, but in the case of cataract surgery, recent improvements are so great that it may actually be welcome news. To help understand how this can be and what new developments might mean for you, the doctors at Eye Care and Surgery Center of Maine offer the following information./p>
What are cataracts?
People often think that a cataract is a film that grows on the eye causing blurry or double vision. However, a cataract does not form on the eye but rather is a clouding or haze that occurs within the natural lens of the eye. The lens is located just behind the colored iris and pupil, and helps to focus visual images on the macular area of the retina. The lens is contained within a sealed “bag” or capsule. Over time the lens material within this capsule may become hard and opaque causing clouding of the lens. The resultant changes do not allow light to pass through the eye normally, thereby causing visual problems such as difficulty driving, reading or performing normal daily activities. When the lens becomes cloudy or discolored, it is then referred to as a cataract./p>
Can cataracts be prevented?
Cataract formation, in most cases, is a result of the natural aging process and eventually affects a high percentage of older adults. They may also result due to eye injuries, certain medications, and diseases such as diabetes./p>
Perhaps because cataracts are so common, there are many theories and alleged preventatives or cures. “You will find many remedies advertised that claim to slow or prevent cataracts,” says Dr. Elizabeth Serrage, “but there is no scientific proof that any are effective. These include the so-called ‘eye vitamins’, various herbal eyedrops, UV absorbing sunglasses, and eye exercises. None of these has been shown to have any effect. Your best bet is to have a regular eye exam to detect when the cataract is beginning.”/p>
How do I know if I have a cataract?
Frequently people with cataracts notice symptoms such as blurring or distortion of vision, haloes around lights, excessive glare, or the sense of a “film” over the eyes. A person wearing glasses may keep trying to clean the lenses, believing they are dirty. If you have any of these symptoms, you should see your eye doctor — you may need to consider cataract surgery. During the eye exam, many tests will be performed to determine if you have cataracts and to make the necessary calculations to prepare for surgery./p>
The surgical treatment of cataracts
The goal of the procedure is to restore the ability of the eye to focus light clearly. This is accomplished by removing the hazy lens (cataract) and inserting a replacement lens (the IOL or intraocular lens). “The surgery is done on an outpatient basis, often in an ambulatory surgical center like ours at Eye Care,” explains Dr. Bruce Cassidy. “Thanks to several advances in recent years, it is one of the most successful procedures in medicine.”/p>
Numbing the eye — a comfortable procedure.
In recent years, cataract surgeons have learned how the anesthetize the eye in a safe way even in patients who have multiple medical problems or who take many medications. Dr. William Holt explains, “In our center the patient wears comfortable casual clothing. The eye is anesthetized in a pain-free manner using topical medications, often without using any needles at all! The procedure takes less than an hour to complete, and most find there is no pain. The anesthetic wears off quickly afterward and most patients have a rapid return of good vision within hours!”/p>
A small incision — freedom from restrictions.
The first step is the creation of a tiny (about 1/8-inch!) incision at the edge of the clear cornea. “This incision is cleverly made to be self-healing and strong without needing any sutures” explains Dr. Serrage. “The cataract is then broken up into tiny pieces and aspirated using an ultrasound device called a phacoemulsifier (not a laser). An implant lens, made of a type of silicone or other plastic, is then inserted into the same location from which the cataract was removed. Because the entire procedure can be done through this tiny incision, there need be no restrictions of activities after surgery and a normal lifestyle can be resumed immediately. Quite a change from the ‘old days’ when bedrest and severe restrictions were needed!”/p>
The lens implant (IOL) — good vision after surgery.
After the cataract is removed, the natural lens that gave the eye its sharp focus is gone. The eye can still notice shapes but they are blurred unless a new focusing lens is used. In years past, thick eyeglasses or contact lenses were used. Now, a permanent lens implant is the standard of care and is used in nearly all patients. “This implant is one of the true marvels of modern technology,” explains Dr. Holt. “Before surgery, we measure and calculate the optical power that will restore natural vision. After surgery, the patient often sees better without glasses than he or she has for years. Even if the patient has been very near- or far-sighted before surgery, choosing the correct IOL power can eliminate this. Over the past 20 years lens implant materials and design have improved so much that nearly everyone can be assured of excellent vision, often without glasses!”/p>
Are there risks?
“This is not to say that results can be guaranteed 100% of the time,” warns Dr. Robert Daly, “but no procedure in modern surgery has a better success rate. For the first time in human history what has been a curse has been turned into a chance for restoration of nearly perfect vision.” Possible problems after surgery include hemorrhage, infection, swelling of the macula, or blurred vision from a hazy posterior capsule. These can most often be treated with either eyedrops or laser treatment./p>
What about lasers?
There is much misunderstanding about the use of lasers in cataract surgery. According to Dr. Cassidy, “At this time lasers are not used anywhere for removing cataracts — lasers can cut tissue but they cannot remove it. However, the YAG laser is used in assisting in cataract care. At some point after cataract surgery, about 20% of people will develop a clouding of the natural capsule that holds the lens implant. This is treated quickly and painlessly with the laser which is used to make a ‘window’ in the cloudy capsule which then restores vision.”/p>
Seeing well without glasses
There is a lot of excitement these days about Laser Vision Correction (LASIK), a technique used to reduce or eliminate the need for glasses in adults who are nearsighted, farsighted, or have astigmatism. This technique uses the Excimer laser and is not designed for use in the treatment of cataracts. However, eye surgeons have learned a lot from doing LASIK, especially that most people would love to be free of their dependence on glasses!/p>
“A wonderful benefit of cataract and implant surgery is that new advances in technique can be used to reduce or even eliminate pre-existing astigmatism, nearsightedness or farsightedness at the same time that the visual changes from the cataract are being treated,” says Dr. Serrage. “The techniques discussed earlier — small incisions, topical anesthesia, accurate IOL calculations, and techniques for reducing astigmatism — have made this possible. In some ways the need for a cataract operation may actually be welcome news given the possibility of such significant improvement in vision.”