Is Your Vision Cloudy? It May Be Time for Cataract Surgery

What Is a Cataract?
How Can You Tell if You Have a Cataract?
How Rapidly Do Cataracts Progress?
How Are Cataracts Treated?
Who Decides When to Remove a Cataract?
Preparing for Cataract Surgery
Intraocular Lenses
How Are Cataracts Removed?
What Is the Day of Surgery Like?
What Can I Expect After Surgery?
What Complications Are Possible?
Cataracts and Diabetes


dsfvsxbvWhat Is a Cataract?

In the normal human eye, light rays travel through the pupil into the eye and are focused though a clear lens onto the retina. A cataract is the clouding of this lens and can cause blurry, cloudy, or dim vision. Cataracts are a normal part of aging, although they can also be caused by hereditary/congenital factors, other eye diseases or eye surgery, excessive use of steroid medication, or eye injury. Several major studies have shown that prolonged exposure to sunlight over many years, especially the ultraviolet-B rays (UVB), can play a role in hastening the development of a cataract.

Cataracts are one of the most common causes of vision loss, but the good news is that they are treatable with cataract surgery.


How Can You Tell if You Have a Cataract?

You may notice a gradual blurring or dimming of vision which may be more noticeable at distance or near. In the early stages of a cataract, using a bright reading light may make vision better. However bright light may also make vision worse. It all depends on your individual eye. Some people see a “halo” or haze around lights, especially at night, and/or have hazy or double vision. This may be especially noticeable around traffic lights or oncoming headlights.

In the early stages, a cataract may not disturb your vision or cause any symptoms at all. You may not even notice an advanced or dense cataract if your other eye sees well, in which case you might only become aware of the problem if you happen to cover the “good” eye. Symptoms may also only occur in dim light or when you face bright oncoming car headlights.

Eye pain, headaches, and eye irritation are not symptoms of a cataract. Unless a cataract is very dense and white, it will not be visible to the naked eye of a casual observer.


Once a Cataract Begins, How Rapidly Does It Progress?

As a rule, no one knows why some cataracts develop rapidly and others slowly. Cataracts may even develop at different rates in the left eye versus the right eye. Generally, the clouding of the lens is a slow, gradual process that takes a long time—sometimes decades. On the other hand, there are some conditions, such as poorly controlled diabetes, in which a cataract can progress rapidly.

Recent studies show that antioxidant vitamin supplements, especially vitamins C and E, may help slow the process or even reduce the risk of developing cataracts. But other so-called “treatments,” such as medication or exercise, do not help at all. Once cataracts have formed, they cannot be reversed or cured.


How Are Cataracts Treated?

The only effective treatment is surgical removal of the cloudy lens and implantation of an intraocular lens. Cataract surgery is one of the most effective and safest operations performed today. The high success rate (about 99%) is due to advances in microscope technique, ultra high-tech phacoemulsification instruments, and an advanced assortment of intraocular lens implants. Since the 1980s, our surgeons have been using state-of-the-art technology combined with their mastery of small incision cataract surgery to restore vision without complications to thousands of patients.

Cataracts are not treated with lasers. If the cataract is not very advanced, surgery may be postponed for a while and your vision may be helped by changing your glasses prescription. If you have cataracts in both eyes, surgery is never done at the same time. You must wait for the first eye to heal before it is safe to proceed with the second eye surgery, typically about one month.


Who Decides When to Remove a Cataract?

You do! You can postpone surgery until the cataract interferes with your vision so much as to make a difference in your livelihood or the quality of your life. Since everyone’s visual needs differ, this point will differ from one person to another. It is not necessary to wait until the cataract is completely “ripe” (totally opaque) before having it removed.

Our physicians will advise you if you are a candidate for the surgery and how much improvement in vision you can expect from a cataract removal that is free of complications. You will then have to decide if the cataract is causing you enough trouble to warrant surgery. If you elect to postpone surgery for a time, your physician will advise you as to how often you should return to have a cataract check-up.

There are certain rare circumstances that require cataract removal regardless of how your vision is being affected: if the lens begins to break down (become “overripe”), if the lens begins to release chemicals (breakdown products) that might damage the eye and contribute to a type of glaucoma, or if the cataract is so dense that it prevents observation or treatment of some other eye problem or disease.


Preparing for Cataract Surgery

Patients who are prepared for cataract surgery and who take an active role in their care can recover in less time and with fewer complications. When you schedule cataract surgery, we will provide you with a Patient Information packet that will let you know what to expect before, during, and after cataract surgery. This booklet will contain all of your appointment dates, times, and locations, and will provide you with the information you need to get yourself, your family, and your home ready for surgery.

Before having surgery, you will need to see your primary care provider (PCP) (or cardiologist, if applicable) for a pre-surgical physical in order to clear you for surgery. You should schedule this appointment right away.

You will also need to come in for a pre-operative appointment with one of our surgical technicians. At this appointment all paperwork will be finalized, you will receive a pre-operative kit, and your eye(s) will be measured to determine the correct lens for implantation.

The measurement of the eye(s) is a critical element to having a successful surgery and visual outcome. At Olympia Eye Clinic, we use both optical coherence and ultrasound biometry units to obtain the most precise preoperative measurements possible. We use sophisticated software programs to analyze our results, refine our techniques, and fine-tune our calculations for maximum accuracy in order to provide our patients with the best results.

Prescriptions for eye drops, which are essential in promoting recovery and preventing infection after surgery, will also be sent to your pharmacy at this visit.


Intraocular Lenses

lenses
Advances in intraocular lens technology has contributed to the extremely high success rate of cataract surgery. We customize the replacement lens for each patient based on your specific eye anatomy, pathology, and visual requirements.

Guided by the highly sophisticated computerized mapping of the eye that takes place at the pre-operative appointment, we can eliminate nearsightedness or farsightedness during surgery. In fact, when appropriate, our advanced surgical techniques also allow us to treat astigmatism!

Our surgical technicians can help explain your lens options to you at your pre-operative appointment and guide you through the process of picking the implant that will best suit your individual needs.


How Is a Cataract Removed?

A micro-incision is made in the front of the eye. This incision is so small that it will be self-healing, thus requiring no stitches.

Our physicians use the newest technique of cataract extraction called phacoemulsification (FAKE-oh-ee-mull-sih-fuh-KAY-shun). With “phaco,” a tiny needle-like instrument that vibrates at high speed is inserted into the cataract to break it up. The tiny fragments are gently irrigated and suctioned out.

Modern lens implants are made of a flexible material that we can roll up, much like a burrito. The implant is inserted through that tiny incision and is then unrolled inside the eye.


What Is the Day of Surgery Like?

Follow your Pre-Surgical checklist carefully to ensure you are ready for surgery. Don’t forget that you will need an escort the day of surgery.

Our surgical procedures are performed at our beautiful, state-of-the-art outpatient surgery center in Downtown Olympia. A typical cataract surgery takes 30 minutes or less, but expect to be at the surgery center for 1 ½ – 2 hours in total.

Olympia Eye Clinic only uses board-certified physician anesthesiologists to provide our patients with the highest level of comfort and confidence. Cataract surgery takes place under sedation in combination with local anesthetic so that you can follow instructions. You will not see any instruments or objects coming at your eyes—you will just see shadows and colors. Most patients have no recollection of the procedure and do not experience pain or discomfort. 

lobby outside of building operating room

 

 

 


What Can I Expect after Surgery?

You may experience some discomfort or a slight headache for a day or two after surgery, for which you may take Tylenol. It is normal to experience flashes of light, floaters, and/or blurred vision during the first few days or even weeks after your surgery. You also may experience redness, tearing, and/or a scratchy, gritty feeling in your eye. These symptoms should all subside as your eye heals.

It is very important to wear sunglasses when outside to protect your eyes from UV rays. You may experience increased light sensitivity for some time after surgery, and sunglasses will also help with this.

It typically takes 1–2 weeks for you to achieve your best vision after cataract surgery. Cataract surgery is very successful in restoring vision, and more than 9 out of 10 people who have cataract surgery regain very good vision, somewhere between 20/20 and 20/40 uncorrected distance visual acuity. This meets legal minimum standards to drive without correction.

Recovery is rapid after cataract surgery. You should expect to be back to normal within a few days to a week after surgery. Unless otherwise instructed, you should be able to return to work the week after surgery. Follow your discharge instructions carefully to ensure that you have an optimum recovery.

 


What Complications Are Possible?

As mentioned previously, cataract surgery is one of the most commonly performed, safe, and successful surgeries today. However, no surgery comes without risk. Risks of cataract surgery include infection, bleeding, glaucoma, corneal problems, chronic intraocular inflammation, or retinal swelling and detachment. Fortunately, these are usually temporary and/or can be treated with medications or surgery.

Surgical results can never be guaranteed, but the odds are excellent that you will have a successful surgery and you will see just as well after the operation as you did before the cataract developed, and perhaps even better.

Don’t hesitate to bring up any questions or concerns with your surgeon or the pre-surgical technician. It is our goal to provide you with all of the information you need to make an informed decision about cataract surgery.


Cataracts and Diabetes

It has been known for many years1 that patients with diabetes develop a worsening of their retinopathy following cataract surgery, leaving many if not most patients with worse vision than they had prior to the surgery. Recent scientific work2 has shown that this is true even with the latest technique of small-incision cataract surgery. In response to these studies, Dr. Bodoia has developed a special protocol for pre-treatment, surgery, and post-operative care for patients with diabetic retinopathy. This protocol has been scientifically proven to eliminate the worsening of retinopathy in nearly all patients, and Dr. Bodoia has successfully performed over 1000 cataract surgeries with this protocol, restoring vision to many happy patients with diabetes.

Ref 1: Benson WE, Brown GC, et al. Extracapsular Cataract Extraction with Placement of a Posterior Chamber Lens in Patients with Diabetic Retinopathy. Ophthalmology 1993; 100: 730–738.

Ref 2: Hong T, Mitchell P, et al. Development and Progression of Diabetic Retinopathy 12 months after Phacoemulsification Cataract Surgery. Ophthalmology 2009; 116: 1510–1514.

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