The Natural Lens
The eye’s natural lens is the transparent structure located immediately behind the colored portion of the eye (iris). The lens consists of an elastic capsule filled with a clear paste-like protein.
The Cataract
With aging, the natural clear lens clouds and hardens. This prevents light from reaching the retina and the ability to focus on the retina. Trauma, heredity, diabetes, and even some medications could also cause the clouding. Cataracts result in blurred or fuzzy vision and sensitivity to light. Cataract formation can affect one or both of the eyes at the same or different rates. The rate can be so gradual that the patient may not even realize the vision has gone down.
Types of Cataracts
- Congenital – from birth of prematurity
- Acquired – from disease from eye or body
- Traumatic – injury
- After Cataract – after surgical implant or cataract
Common symptoms
- Night vision is not as good as before
- The patient is having difficulty with headlight and/or streetlight glare
- The patient sees halos around lights
- Print has become blurrier
- The patient cannot see the TV as well
- Colors may seem dull
- The patient fails their DMV eye test
- The patient’s vision is 20/50 or worse in both eyes
- The doctor’s technician will then test the patient’s vision with various tests and then dilate the eyes for an internal look at the natural lens of the eye and the back of the eye (retina)
At this point, the doctor looks at these test results and determines the patient has a cataract in each eye, with varying degrees of density and type of cataract. The doctor explains to the patient that they are not seeing well due to cataracts. The doctor then explains why the patient may need surgery to improve visual function for activities that the cataract could limit.
The surgical coordinator then explains why the patient may need surgery to improve visual function for activities that the cataract could limit. The type of replacement lens will also be discussed with the patient—whether to have an Array or Monofocal lens.
Restoration of Vision
If the cataracts are not limiting activities at the time of diagnosis, the patient could wait before having them removed until the cloudiness progresses to the point that it interferes with the daily routine or totally blocks vision. Cataracts are then surgically removed. The lost optical power is replaced by an appropriate lens, either with a plastic (hard), silicone or acrylic (foldable) intraocular lens (IOL). Both steps are generally done at the same time.
Cataract Surgery (Removing the Clouded Lens)
In order to remove the cataract and replace it with a new lens, incisions are made either on the clear cornea or the sclera. The extent of the incision depends on the technique chosen for the cataract removal.
Phacoemulsification
This procedure requires a small incision of only 3.2 mm or less on the cornea. A small ultrasonic probe is then inserted into the eye. This probe breaks (emulsifies) the cloudy lens into tiny pieces and gently sucks (aspirates) those pieces out of the eye. The incision generally does not require stitching.
Extracapsular cataract extraction
This method requires a large incision of 10-12 mm in length in the scleral part of the eye. It removes the cloudy lens in one piece. The posterior (back) part of the lens capsule is left behind to support the intraocular lens (IOL). The incision is closed with stitches.
What to Expect
Intraocular (IOL) options available to meet the needs of the patient:
Conventional IOL Option: a single focus lens, which offers excellent vision for distance or near. http://www.tecnisiol.com/physician.htm
Premium IOL Option: Offers the multifocal benefit of correcting your vision for both distance and near needs. Most patients have no need for glasses after this lens has been implanted in both eyes. (http://www.tecnismultifocal.com/us/)
Premium Toric Option: offers the benefit of immediate post-op and long-term stability to correct high astigmatic patients.
Yag Laser Treatment
The capsule holding the IOL may become cloudy weeks or years after surgery. A laser can be used to create an opening in the capsule, reducing the clouding and allowing light to enter, thereby improving your vision. This is a short procedure, which takes a few minutes after the eye has been dilated. You can usually go home within an hour after treatment and you will be seen back in the office about a week later to check the vision and pressure of the eye.
Research is currently under way to find the cause of this clouding of the capsule that holds the IOL.
