WHAT ARE CATARACTS?
Cataracts are a clouding of the eye’s lens. Because they block light from passing through the lens, cataracts make it difficult to see clearly and can even cause blindness over time.
Although cataracts are more common in older adults, people in their 30s, 40s, or even younger can also develop cataracts. Some cataracts are associated with injuries, medications, inflammation, and certain systemic diseases such as diabetes. For most of our lives, our eyes provide us with good vision, though many of us may require glasses, contact lenses, or refractive surgery to sharpen that vision. 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 about the eye and how it works.
The eye is 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 or sensor 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 Presence of Cataracts
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 people in their 60s and in over 80 percent of people older than 70 years of age. In one recent large study, 15 percent of people 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 or center of the lens are the ones that are usually responsible for vision being blurrier in bright sunlight rather than in dim light.
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.
Frequent Asked Questions
Here are the answers to a few of the most commonly asked questions we hear about cataracts.
Cataracts are a cloudiness that develops on the natural lens of the eye when we age, causing vision to become blurred. When cataracts progress to a certain point, traditional contacts and glasses can’t correct your vision and surgery is needed to replace your eye’s natural lens with a synthetic intraocular lens. Cataracts can form in the center of the lens, at the cortex or outer lens covering, or at the back of the lens.
Yes. As you age, the lens of your eye ages as well, growing thicker each year and eventually becoming cloudy, forming a cataract.
Cataracts slowly develop with age and are painless. They often go unnoticed until a doctor discovers them during an eye exam. Symptoms include blurry vision with colors that seem dim or faded with a yellow or brown tint, bright light sensitivity, halos that appear when looking at lights, heightened sensitivity to bright lights and glare, changes in vision that cannot be corrected by a change in eyeglass or contact lens prescription, and poor night vision.
Cataract Treatments of the Past
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 several weeks, but recovery was usually painful. Patients 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.
Contemporary Cataract Surgery
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.
Either local anesthesia (a painless injection beneath and behind the eye) or, as usually happens, 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 is topical anesthetic drops. In all cases, a specialist in anesthesia monitors the patient for safety throughout the cataract surgery.
Modern cataract surgery has been made possible by the operating microscope. This high-powered microscope allows the surgeon to see better to remove the cataract and implant 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 by 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 only the cloudy central portion can be removed (extracapsular technique). Another extracapsular technique is phacoemulsiﬁcation, where a tiny ultrasonic, vibrating instrument is placed into the cataract to break it up into fragments that are liqueﬁed and suctioned out through a small incision in the eye. This is sometimes mistakenly called the ‘laser technique’, but that is not an accurate description. Phacoemulsiﬁcation (ultrasonic) cataract removal with intraocular lens implantation gives excellent visual results, but the ophthalmologist must weigh all factors before he or she can tell their patient which technique will be best for them. We personally favor performing phacoemulsiﬁcation because it allows for a smaller incision and usually no stitches. The patient feels relatively comfortable during the operation and the actual procedure usually takes approximately 12 minutes or less.
With outpatient cataract surgery, it is possible to resume most normal activities the following day. Follow-up visits to the eye doctor over the next 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.
IOLs and Other Natural Lens Substitutes
Three kinds of substitutes for the natural lens of the eye are currently available. Each of these three substitutes for the natural lens has certain advantages and disadvantages.
1. Spectacles (thick cataract glasses)
Cataract glasses are the oldest and most conservative way to restore sight after cataract surgery. Usually, these glasses can only be used comfortably after a patient has had the cataract removed from each eye. 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 distort side vision, and 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. No one really requests this method of correction and surgeons have abandoned this old method.
2. Contact lenses
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 older patients are unable to wear contact lenses because of discomfort and irritation in addition to insertion and removal problems.
3. Intraocular lens implants (IOLs)
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 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 no foreign body to irritate the surface of the eye.
IOL implants have been performed in increasing numbers over the last 35 years. Older lens types and 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 an implant at the time of their cataract surgery. The most recent IOL advancements are multifocal or pseudo-accommodative lenses that allow patients to see close up and in the distance. Technology continues to improve implants and there will be changes and improvements yet to come.
Summary of Cataract Facts
We do not yet know exactly what causes the cataracts associated with aging, but we can summarize many things that we do know about them:
- Cataracts would most likely develop in every person if he or she lived long enough.
- Cataracts are not tumors or cancers. They cannot spread. They are not contagious.
- A cataract is not a film or a growth over the surface of the eye, and thus it cannot be removed simply by peeling a film off of the eye.
- A cataract is a clouding of the lens, which is inside the eye. Cataracts are not caused by eyestrain or using your eyes too much, as in reading or watching television.
- Cataracts progress differently in different people. They progress at their own rate, regardless of whether the eyes are used or not. Not using your eyes will not slow down the progress or development of a cataract.
- There is no proof that cataracts are related to diet or that special diets will prevent cataracts.
- Cataracts are not caused by normal exposure to sunlight.
- The only treatment for cataracts at this time is removal through cataract surgery. Other treatments, such as eye exercise, vitamins, diets, and special eye drops, have not proven to be effective.
Hoopes Vision is one of the most technologically advanced cataract surgery centers in the world, specializing in the newest laser-assisted surgeries and multifocal lens implants. Our on-site ambulatory surgery center, EyeSurg of Utah, was the first cataract surgery center in the world to acquire multiple laser cataract systems.
Intraocular Lens Implant Options
Intraocular lenses – also referred to as IOLs – are implantable lenses that take the place of the natural crystalline lens after it has been removed during cataract surgery. The first IOLs were monofocal and thus able to correct sight for only one type of vision (far, immediate, or near) at a time.
Laser-Assisted Cataract Surgery
Hoopes Vision is among the earliest adopters of a new advancement in cataract treatment: laser-assisted cataract surgery. This new treatment automates the first steps in the cataract surgery procedure: the initial incisions (including additional incisions for correcting astigmatism, if necessary) and capsulotomy; and phacoemulsification, which is the breaking up of the cloudy natural lens in preparation for removal. These steps, performed with hand-held blades and ultrasound probes in the traditional procedure, are performed by a fast, extremely accurate, computer-guided laser. This leads to improved precision, which can be consistent with better surgical outcomes for patients.
DID YOU KNOW
Standard Intraocular Lens
The standard intraocular lens (IOL) is designed to give good distance vision to patients who do not have significant astigmatism. Patients who receive standard IOLs are usually able to drive, go to movies, and perform other activities requiring long vision without corrective lenses, but often require reading glasses for such close work as reading or using a computer.
PREMIUM INTRAOCULAR LENS OPTIONS
Multifocal Intraocular Lens
Modern cataract patients often have the option of a premium multifocal IOL rather than a standard IOL. The multifocal IOL features concentric rings of increasing refractive power. For patients who are good candidates for these IOLs, this can lead to excellent vision at a variety of distances with the need for reading glasses reduced or eliminated entirely.
PREMIUM INTRAOCULAR LENS OPTIONS
Toric IOLs are used to correct astigmatism. In patients with moderate to severe astigmatism, they can help greatly to reduce or eliminate dependence on eyeglasses or contacts postoperatively. A toric IOL, like a toric eyeglass or contact lens, has additional refractive power located along one axis. When properly placed by a skilled cataract specialist, this additional power corrects the patient’s astigmatism.
Learn More About Us
Our team of cataract specialists is among the most experienced in Utah. More importantly, they are among the most experienced in the country with the highest levels of cataract surgery technology: multifocal implants and laser-assisted procedures.
EyeSurg of Utah is our on-site, state-certified, Medicare-approved ambulatory surgery center. It was designed from the start to optimize cataract and other vision correction procedures, and its nursing and technician staff are all specialized for eye care. It offers advantages in speed and efficiency over a hospital or general surgery center, as well as reduced risk of infection.
Hoopes Vision was the first cataract surgery practice in the world to offer multiple cataract laser systems: the Alcon LenSx and the Optimedica Catalys. After an extensive head-to-head comparison of the patient outcomes from the two systems, our surgeons now use the Catalys Precision Laser System exclusively. Our on-site ambulatory surgery center, EyeSurg of Utah, was designed with laser cataract surgery in mind and features a purpose-built laser room.
While our goal is to provide the safest, most advanced cataract procedures possible, we are also very proud of how affordable our care is. We work with almost all major insurance companies, and any upgrades not covered by insurance are often eligible for no-interest payment plans.
For over a decade, the cataract specialists at Hoopes Vision have published an in-depth guide intended to help prospective patients understand and make educated decisions about cataract surgery. The current edition of Cataracts, Lasers, and Lens Implants: A Guide for Patients and Their Families is updated with the newest and most exciting developments in this rapidly advancing field.
Schedule Your VIP Consultation
If you have been diagnosed with cataracts, or report any of the symptoms associated with cataracts, please contact us. We would be happy to give you an examination and VIP consultation to determine your treatment options which include the new advances in cataract surgery. This visit is usually covered by medical insurances including Medicare.
“For over 40 years I relied on my clear vision to bring Utah the latest news. However, not long ago I noticed my vision changing. When I was diagnosed with cataracts, I knew that deciding where to have my cataract surgery done was a choice that would affect my vision for the rest of my life.”