What are cataracts?
Cataracts eventually will affect almost everyone. The timing of surgical intervention is critical to achieve the best outcome and quality of vision possible. Good timing can also lower the rate of complications and prevent blindness or permanent vision impairment in many cases. Cataracts occur when the lens inside the eye gets cloudy and thick. Changes in vision resulting from cataract development can range from very subtle to extreme. Increased glare or trouble with night driving and difficulty reading are the most common presentations.
Cataracts can progress to the point of complete loss of vision. Cataracts can lead to various visual complaints such as:
- Blurred or distorted vision
- Difficulty reading
- Difficulty seeing up close, engaging in activities like knitting, word puzzles, card games, etc.
- Difficulty seeing road signs until you are ‘on top of them’
- Glare when driving at dusk, at night or on rain-slicked roads; avoiding late afternoon or evening plans for fear of driving in twilight conditions
- Increased dependency on prescription glasses; difficulty seeing well even with updated prescription glasses
- Frequent changes in glasses prescription
- Bothered by bright sunlight, bright indoor lights, fluorescent lights
Cataract surgery is the most performed surgery in the United States. Waiting for a cataract to become “ripe” is an antiquated concept. Cataract surgery is undertaken when the cataract begins to interfere with a patient’s quality of life or visual functioning. The cloudy lens is removed surgically and the artificial intraocular lens (IOL) is implanted. The surgery is done in the operating room where you are conscious but sedated. The cataract is removed through a small corneal incision using ultrasound energy. This process is called phacoemulsification. It is exceedingly rare to have any pain or discomfort with this technique. The surgery can take from 10-30 minutes and you will be at the surgery center for 3-4 hours.
You will need someone to drive you home from the procedure. Most patients are driving and back to work in 1-2 days. You will be seen in our office for a post-operative visit the following day. You will begin an eye drop regimen that lasts 4-6 weeks. During that time it is recommended that you avoid vigorous activity including heavy lifting or bending. You also need to avoid itching/rubbing the eye so that it can heal properly. Additional visits are typically scheduled for one week and one month post-surgery. If both eyes require surgery, they are typically scheduled 2 to 3 weeks apart.
Lens Implant Options
Monofocal or Single Focus Lens – Offers a single focal point, usually set for distance. Most insurance plans typically cover this implant. Reading glasses will still be needed for most patients and distance glasses may still be needed depending on the degree of astigmatism (curvature of the cornea) and many other variables. Most patients feel comfortable driving and watching television without glasses.
Multifocal Lens – Offers multiple focal points, such as near, intermediate and distance, thereby improving the range of vision. The primary goal is reduced dependence on glasses for near as well as distance. These patients can typically read a newspaper, novel, menu, price tag, etc. without glasses. Most of these patients are also comfortable driving and watching television without glasses. An additional fee applies to these lenses as insurance plans will not cover them. The intermediate range (‘arms-length’) is considered ‘functional’ for most people. For example, the car dashboard is typically clear, whereas computer font at arms-length may not be (many patients simply move their computer screen closer). Multifocal lenses are best for people who seek decreased dependence on glasses.
Accommodating Lens – These lenses mimic the natural ability to move within the eye to provide a greater range of vision and also reduce the likelihood of needing reading/intermediate glasses. An additional fee applies to these lenses as insurance plans will not cover them. The current strength of this technology is intermediate range, e.g. arms-length.
Astigmatism Correction – A limbal relaxing incision (LRI) is an advanced technique only used by some cataract surgeons. Dr. Chris Zieker uses this technique in order to surgically correct astigmatism at the time of cataract surgery. For many, this increases overall visual outcomes and increases opportunity for glasses independence. This is considered an elective procedure as well and is not covered by insurance carriers.
There is no guarantee astigmatism is significantly reduced with this technique.
Which Lens Is Right For Me?
There is no single option that is best for all patients. You must consider your hobbies, activities, lifestyle, work-related tasks, etc. to determine which lens is best for you. Cost and convenience also weigh into the decision, especially determining how important it is to you to attempt reducing glasses dependence.
Dr. Chris Zieker can help you determine which options are in your best interest to pursue. Financing plans for the premium lenses are available as well.
How are cataracts treated?
Treatment for cataracts does not involve a laser. The best and most current technology is ultrasound. Dr. Zieker performs cataract surgery on an outpatient basis, using mild sedation and local anesthesia. He uses the latest, most cutting-edge ultrasound technology, and a micro-incision that doesn’t require stitches.
Those with astigmatism may be candidates for refractive cataract surgery and have both conditions corrected with one procedure, reducing the overall recovery time, and optimizing visual outcomes.
What can I expect after my cataract procedure?
The vast majority of patients report no pain from the procedure. Recovery varies among individuals, but most people are back to their normal routines with improved vision within a few days. There are minor restrictions related to bending and lifting during recovery, and eye drops are used to aid healing.