Modern cataract surgery is considered a form of refractive surgery. In the field of cataract surgery, our surgeons at Hoopes Vision are leaders in Utah, and they are consistently recognized for their experience, innovation, and success. Residents who are looking to undergo cataract surgery at a practice in the Salt Lake City, Provo, or Ogden areas will find the region’s premier surgeons and facilities at Hoopes Vision. Contact our office today to schedule a free consultation.
For most of our lives, our eyes provide us with good vision (although many of us, in time, require glasses to sharpen that vision). We take good vision for granted until it changes or is threatened, and then we quickly learn to appreciate the precious gift of sight. While surveys have shown that fear of blindness is second only to fear of cancer, cataract surgery thankfully provides a way to potentially reverse the effects of vision loss.
Cataracts are far and away the most common treatable cause of poor vision. To better understand what a cataract is, it is helpful to know something about the eye and how it works.
The eye is actually a very complex structure that is closely related to the structures of the brain. To put it simply, the eye is like a camera. Light enters through the clear front of the eye (the cornea); passes through the pupil (the opening in the center of the iris, or colored portion of the eye); and is focused by the lens, which lies behind the pupil and the iris, onto the retina. The pupil is similar to the aperture or opening of a camera. It gets larger or smaller depending on how much light the eye is exposed to. The normally clear lens of the eye is like the lens of a camera in that it focuses light to provide clear, distinct detail. In the back of the eye is the retina, which is like the film in a camera. It receives the light, but instead of storing it to be developed into a photograph, it transmits the light to the brain through the optic nerve. If the retina is in good condition, the picture will be clear; if the retina is damaged or has aged considerably, the picture may not be so clear.
The lens is normally clear and surrounded by a special capsule that holds it in place and helps it change shape to focus each image. When this lens becomes cloudy, a cataract is present. The entire lens does not need to be cloudy for the problem to be termed a cataract. A cataract can consist of cloudiness or opacity anywhere in the lens.
Most cataracts are a natural part of the aging process and are found to some degree in up to 65 percent of persons in their sixties and in over 80 percent of persons older than 70 years of age. In one recent large study, 15 percent of persons 52 to 85 years of age had cataracts that reduced their visual acuity to below normal. It is estimated that 5 million to 10 million people throughout the world become visually disabled each year because of cataracts. In this country alone, some 1 million cataract operations are performed each year. Patients who refuse cataract surgery constitute the second largest group of blind persons in the United States.
Some cataracts advance rapidly and impair vision in a matter of months, while others progress slowly and take years before they cause any significant problems. A cataract may be present in only one eye, or, if present in both eyes, the cataracts may worsen at different rates. Those that develop on the back of or in the center of the lens are the ones that are usually responsible for vision being blurrier in bright sunlight than in dim light.
We do not yet know exactly what causes the cataracts associated with aging, but we can summarize a lot of things we do know about them:
Cataracts can be responsible for glare, haziness, difficulty in reading or driving, and halos around lights at night. If a cataract is more developed in one eye than in the other, the patient may experience a loss of depth perception. Only when a cataract is in an extremely advanced stage does it produce pain, discomfort, or red eyes, a point at which cataract surgery is highly recommended.
Although cataracts are more common in older persons, people in their 30s or 40s or even younger can also develop cataracts. Some cataracts are associated with injuries, medications (steroids), inflammation, and certain systemic diseases such as diabetes.
Cataract surgery has improved and advanced dramatically during the last several decades.
Many patients recall how frightened their parents or grandparents were at the thought of having cataract operations. Not only were they in the hospital for as long as several weeks, but also the eye was usually painful after the operation and they had to lie still for several weeks and remain inactive for many months. Furthermore, their vision was not fully recovered until they had been fitted with thick, heavy cataract glasses. Often, after the first eye was operated on, the visual symptoms became worse due to the confusion of the vision between the eye seeing through a thick cataract lens on the operated side and the eye seeing through a regular, thin lens on the other side. This situation often required them to cover one eye or the other to prevent double vision.
With today's modern surgical techniques and scientific advances in technology, cataract surgery has become practically painless, is much easier on the patient, and provides better vision. The operation can be performed on an outpatient basis most of the time and usually requires no stitches. The eye feels relatively comfortable from the time of the operation, and the patient is usually able to return to regular activities within a day or two. If you decide to have cataract surgery, yours will be one of the more than 1 million cataract operations performed each year in this country.
Either local anesthesia (a painless injection beneath and behind the eye) or, usually, topical anesthetic eye drops are used. After talking with the patient and the patient's family, the ophthalmologist will choose the type of anesthesia that will make the patient most comfortable before, during, and after the cataract surgery.
For the majority of patients, the simplest and easiest solution would be topical anesthetic drops. In all cases, a specialist in anesthesia monitors the patient for safety throughout the cataract surgery. The actual operation usually takes about 12 minutes or less.
The best way for you to see well after cataract surgery is to receive a man-made substitute for the natural lens that has been removed. Four kinds of substitutes for the natural lens of the eye are currently available:
Each of these four substitutes for the natural lens has certain advantages and disadvantages.
Cataract glasses are the oldest and most conservative way to restore sight after cataract surgery. Usually, these glasses can only be used comfortably after the patient has had the cataracts removed from both eyes. Cataract spectacles have several drawbacks: they are extremely thick and heavy; they make objects appear about one-third larger than they really are; they make straight objects seem curved, and they distort side vision. As a result, they can be difficult to get used to and some people never adjust to them. They can also cause difficulties when the wearer is going up or down stairs. Very few people request this method of correction anymore.
A contact lens is a small, thin lens that rides on a layer of tears on the eye's surface. Several kinds of contact lenses are now available: hard, soft, and extended-wear soft contact lenses. However, many patients are unable to wear contact lenses because of discomfort and irritation, in addition to insertion and removal problems.
Traditional Intraocular Lenses
The third kind of man-made substitute for the eye's natural lens is the intraocular lens (IOL). This is a tiny, synthetic lens made of plastic, silicone, or acrylic that is permanently inserted into the eye and will last indefinitely. Since this lens is placed in about the same place in which the cloudy natural lens had been, the restored vision is more natural. Side vision and image size are normal and there is no discomfort. There is also no foreign body to irritate the surface of the eye. This is currently the most commonly-used option.
Multifocal Intraocular Lenses
The fourth option is a revolutionary new set of intraocular lenses designed to provide functional vision for both near and far viewing. Many patients require no corrective eyewear for seeing things at a distance or reading after having these lenses implanted. There are several types of these lenses available, including ReSTOR®, crystalens®, and ReZoom™ lenses. The surgeons at Hoopes Vision are experienced with and credentialed for the use of each of the new multifocal lenses, and they can therefore help determine which lens is right for each patient based on each patient’s unique vision, physiology, and lifestyle. These lenses do cost more than the traditional IOLs, but many patients find it to be worth it given that they could possibly avoid needing distance or reading glasses. The surgical process is very similar to that for implanting the traditional IOLs.
IOL Implantation and Cataract Surgery
IOL implants have been performed in increasing numbers over the last 30 years, particularly in conjunction with cataract surgery. Older lens types and implantation techniques were not uniformly successful, but with modern, high-quality IOLs and highly sophisticated surgical techniques, most patients can achieve excellent vision. Almost all patients now receive implants at the time of their cataract surgeries. Technology continues to improve implants, and there will be changes and improvements yet to come.
Many prospective patients have questions about cataracts. Here are the answers to a few of the most commonly asked questions regarding the condition.
Most cataracts associated with aging progress slowly. Some patients do not notice the extent of the visual loss because of the slow onset. Other cataracts, especially in younger people and diabetic patients, progress rapidly over a few months. It is not possible to predict exactly how fast cataracts will progress in any given patient.
A medical eye examination, including a check for glasses prescription (refraction), is necessary. In the early stages of cataract development, a change in glasses may be all that is required to improve vision. During the examination, your eye doctor will determine whether there are other causes of vision loss.
The usual test for visual acuity, the letter eye chart, may not reflect the true extent of your visual loss. Other tests that measure glare, sensitivity, night vision, color vision, and side or central vision may be useful. Some of these tests may help predict the degree of visual recovery that can be expected after cataract surgery.
If cataract surgery is deemed necessary after an evaluation at our Salt Lake City, Utah-area office, located between Provo and Ogden, we can then proceed to the next step. Contact Hoopes Vision to arrange your initial consultation.
There are two circumstances in which removal of a cataract by way of cataract surgery should be considered even though improvement in vision may not be expected. A cataract may be so advanced that diagnosis or treatment of other eye diseases cannot be performed properly. In this situation, it may be best to remove the cataract through surgery so that the interior of the eye can be examined. It is also possible for a cataract to become so advanced that the cataract itself causes other eye diseases, particularly inflammation or glaucoma. These rare situations are the only ones in which cataract removal may be considered an emergency necessity.
Oftentimes, prospective patients are reluctant to undergo cataract surgery because they still have uncertainties regarding the procedure. Read the answers to the most frequently asked questions about cataract surgery.
Modern cataract surgery has been made possible by the operating microscope. This high-powered microscope allows the surgeon to see better as he removes the cataract during the surgery and implants the IOL into the eye. In addition to using the operating microscope, the modern cataract surgeon uses an extracapsular surgical technique. This means that the surgeon removes the lens contents but leaves the back portion of the natural lens capsule in place. Although this technique is much more difficult for many surgeons to perform, it provides the patient with many benefits.
The old cloudy lens can be removed using several different techniques. The technique chosen depends on the type of cataract and other factors about the patient. The whole lens can be removed (intracapsular technique), or the cloudy central portion alone can be removed (extracapsular technique). Another extracapsular technique is phacoemulsification, in which a tiny, ultrasonic vibrating needle is placed into the cataract to break it up into fragments that are liquefied and suctioned out through a small incision in the eye. Additionally, new lasers have been FDA market cleared to perform many of the initial steps of cataract surgery. These new lasers are capable of providing a level of precision and accuracy not possible with manual techniques. Hoopes Vision is the first vision correction facility in the world to offer multiple laser cataract platforms. During your examination, our surgeons will evaluate all options including custom laser cataract surgery and decide what technique or combination of techniques will provide the best results for each individual.
There is no single technique that is best for all eyes. In most cases, phacoemulsification cataract removal with intraocular lens implantation (which can be paired with the custom cataract laser platforms) gives the best visual result, but the ophthalmologist must weigh all factors before telling the patient which type of cataract surgery will be best. The preferred technique for cataract surgery at Hoopes Vision is phacoemulsification because it requires a smaller incision and no stitches.
Find out which form of cataract removal surgery is best for you. If you live in the Salt Lake City, Utah area, contact Hoopes Vision to schedule a consultation today.
Cataract surgery has a very high success rate. Useful vision is restored in over 90 percent of cases. However, it is important to understand that complications can occur; as with any surgery, a good result cannot be guaranteed. Nonetheless, those who undergo cataract surgery at our Sandy facility, which serves the greater Salt Lake City area, including Ogden and Provo, Utah, can feel secure in the knowledge that their surgeons are among the most experienced and skilled in the country.
There may be other reasons for vision loss besides cataracts, particularly problems involving the retina or optic nerve. If these problems are present, the patient’s restored vision after cataract removal may not be perfect. In fact, should these conditions be severe, removal of the cataract may not result in any visual improvement at all. An examination by an ophthalmologist can help predict whether such improvement is likely.
Cataract surgery is the only effective way to remove a cataract. When cataracts cause enough loss of sight to interfere with your work or lifestyle, it is time to remove them. You and your eye doctor should decide together when cataract surgery is desirable. If you live in or near Sandy or Salt Lake City, Utah, the surgeons at Hoopes Vision would be happy to help you regain your vision.
Surgery is not necessary just because a cataract is present. Symptoms may be mild and well tolerated at first. On the other hand, there is seldom a need to delay surgery when vision loss from a cataract interferes with your daily activities. It is a misconception that cataracts need to be “ripe” before they are removed. Cataract surgery can be performed whenever visual needs require it. If you are having problems and wish to see better, then you can usually have the surgery. If you are not having problems, wait until you do. The ability to operate a motor vehicle safely is a consideration for some people.
With outpatient cataract surgery, it is possible to resume most normal activities by the day after surgery. Follow-up visits to the eye doctor over the subsequent six to eight weeks are extremely important. In many cases, vision can be restored to normal levels long before the end of that time, but the healing process, regardless of the technique, will take about four to six weeks. Observation and counseling of the patient during the postoperative visits are critical.
If you are considering undergoing cataract surgery and reside in or near Salt Lake City, Ogden, Provo, or other areas of Utah, Hoopes Vision hopes to be given the chance to meet your vision needs. The combination of our state-of-the-art facility, our commitment to personalized care, and our experienced staff and surgeons has made our institute the leading center for vision restoration in the state. Contact Hoopes Vision today to schedule a time to come in and speak with us in person.