How is a Cataract
change in your glasses,
stronger bifocals, or the use of magnifying lenses may help improve your vision
and be treatment enough. With time glasses will no longer
work. The way to surgically treat a cataract is to remove the lens and replace it with an artificial lens called an
implant (See photo).
Just because you have a
cataract does not mean it must be removed immediately. Cataract surgery should be put off until you are
no longer satisfied with the way you see. We don't
do cataract surgery on eyes that see well. With an eye examination
your eye doctor can tell
you if your decreased vision is due to a cataract on another underlying
example, there may be other problems behind the
Video of cataract surgery:
video by Dr. Matthew Niemeyer is a good example the most current surgery being
performed to date. Although many will disagree, I feel cataract surgery has
become a specialty. The surgeons who are performing over 10 surgeries per
day develop a very high level of skill that seems to translate into less
postoperative problems, less trauma induced, and corrections coming out more
accurate. Angeles Vision Clinic prefers to use cataract
specialists as our surgeons of choice. Dr.
Niemeyer with Northwest Eye Surgeons does most of our
cataract surgery here at Angeles Vision Clinic and we have been extremely
pleased with the level of care our cataract patients are receiving
How Do I Decide Whether
To Have Surgery?
Most people have plenty of
time to decide about cataract surgery. Your doctor cannot make your decision for
you, but talking with him can help you decide if you are ready for
surgery on not.
Tell your eye
care provider how your
cataract affects your vision and your life. If your vision
becomes to much of a disability removal should be considered. Circle the statements below that
apply to you and share this list with your doctor:
- I need to drive, but there
is too much glare from the sun or headlights.
- I do not see well
enough to do my best at work.
- I do not see well
enough to do the things I need to do at home.
- I do not see well
enough to do things I like to do (for example, read, watch TV, sew, hike,
play cards, go out with friends.
- I am afraid I will bump
into something or fall.
- Because of my cataract,
I am not as independent as I would like to be.
- My glasses do not help
me see well enough.
- My eyesight bothers me a lot.
You may also have other
specific problems that you want to discuss with your eye doctor.
What Should I Know About
Your doctor will discuss
the options with you before choosing the best kind of cataract removal and lens
replacement for you. He or she will also explain how to prepare for surgery and
how to take care of yourself after it is over.
People do not need to
stay overnight in a hospital to have cataract surgery. You will go to an
outpatient center or hospital, have your cataract removed, and leave when the
doctor says you are fit to leave. However, you will need a friend or family
member to take you home.
It takes a few months for
an eye to heal after cataract surgery but most people are seeing well within the
first few days. Most patients have minor discomfort for a day or two only.
Your eye doctor should check your
progress closely during this time making sure your eye recovers fully.
Removing the Lens
There are three types of
surgery to remove lenses that have a cataract:
- Extracapsular surgery.
The eye surgeon removes the lens, leaving behind the back half of the
capsule (the outer covering of the lens).
(pronounced FAY-co-ee-mul-sih-fih-CAY-shun). In this type of extracapsular
surgery, the surgeon softens the lens with sound waves and removes it
through a needle. The back half of the lens capsule is left behind.
- Intracapsular surgery.
The surgeon removes the entire lens, including the capsule. This method is
Replacing the Lens
A person who has cataract
surgery usually gets an artificial lens or implant at the same time. A plastic disc, called
an intraocular lens, is placed in the lens capsule inside the eye. Other choices
are contact lenses and cataract glasses. Your doctor will help you to decide
which choice is best for you.
Can a Cataract Return?
A cataract cannot return
because all or part of the lens has been removed. However, in about half of all
people who have extracapsular surgery or phacoemulsification, the lens capsule
becomes cloudy. This cloudiness of the lens capsule, if it occurs, usually
develops a year or more after surgery. It causes the same vision problems as a
The treatment for this
condition is a procedure called YAG Capsulotomy.
The doctor uses a laser (light)
beam to make a tiny hole in the capsule to let light pass. This surgery is
painless and does not require a hospital stay.
Most people see better
after YAG capsulotomy, but, as with cataract surgery, complications can occur.
Your doctor will discuss the risks with you. YAG capsulotomies should not be
performed as a preventative measure.
Is Cataract Surgery Right
Most people who have a
cataract recover from surgery with no problems and improved vision. In fact,
serious complications are not common with modern cataract surgery. This type of
surgery has a success rate of 95 percent in patients with otherwise healthy
eyes. But no surgery is risk free. Although serious complications are not
common, when they occur they could result in loss of vision.
If you have a cataract in
both eyes, experts say it is best to wait until your first eye heals before
having surgery on the second eye. If the eye that has a cataract is your only
working eye, you and your eye
care doctor should weigh very carefully the benefits and
risks of cataract surgery.
You will be able to make
the right decision for yourself if you know the facts. Ask your doctor to
explain anything you do not understand. There is no such thing as a
"dumb" question when it comes to your health.
Here are some questions
you might ask:
- Do I need
surgery right away?
- If not, how
long can I wait?
- What are my
- What benefits
can I expect?
- If I choose
surgery, which type is best for me?
- Which lens
replacement is best for me?
- What are the
chances of developing cloudiness in the lens capsule after cataract surgery?
- What are the
benefits and risks of YAG capsulotomy?
You may wish to write down
other questions to ask your doctor to help you make an informed decision about
Benefits and Risks of
- Moving around
- High pressure
in the eye
collection inside the eye
inside the eye
lens damage or dislocation
bleeding inside the eye
- Swelling or
clouding of the cornea
- Loss of the
The Cataract surgery:
The process begins with the
creation of a micro incision with a diamond knife.
2. A round opening
is then made in the skin of the natural lens, which is like a grape, with
a skin and a softer interior.
Next, using a special probe with suction, the
interior of the natural lens is removed, leaving only the skin. This
technique is called phacoemulsification
ultrasound to remove the cataract. Lasers are not used
to remove the cataract but may be used after the surgery.
capsule is carefully cleaned and polished, providing a natural location
for the new lens (the intraocular lens) that will be inserted into the eye to
correct vision. The lens is flexible and actually fits through the tiny
initial incision, opening inside the eye into the "skin" of the
natural lens. Over time, the capsule contracts, "shrink-wrapping"
the lens in place and making it a permanent part of the eye.
5. The new lens
becomes so well integrated into the eye that even severe trauma will not
small 1/8 inch opening is created with a specific self sealing
technique. The new technique places the incision into the cornea just
next to the sclera.
is used to gently break up (or emulsify) the cloudy lens into tiny
pieces which can be removed through the tip of the "phaco"
probe instead of a wide incision.
intraocular lens (IOL) is then implanted through the smaller incision. The
size of the IOL is smaller than a dime.
final replacement lens is shown in place. The small "No
Stitch" incision does not require sutures.
Using new surgical
techniques, the removal of the cataract is a safe and straightforward process.
It is performed without sutures through a micro incision in the eye and takes
7 to 15 minutes.
No discomfort is experienced
during and none or minimal after the procedure due to complete local
DAY OF SURGERY:
care providers prefer that food intake be avoided at least eight hours prior to surgery. If
you are allowed to eat breakfast on the morning of your surgery, keep the
meal light (ie. tea or coffee and toast). Orange and grapefruit juices may
increase the effects of anesthesia -- check with your doctor beforehand.
FOLLOWING THE DAY
It is not
uncommon for many patients to experience a slight increase in
light-sensitivity (photophobia) following cataract surgery. This may cause
increased tearing and eye irritation. Lightly dab tears away from eyelids
without touching the eye directly. Avoid rubbing, poking, or applying
pressure to the eye.
soap or water in your eyes. You may shower, but do not get the operated eye
wet. During the first two weeks, hair can be washed with the head tilted
backwards (ie. hairdresser-style). No swimming for two weeks.
experience severe pain, any decrease in vision, or discharge from the eye,
call your eye care provider immediately.
The above guide is to be used for reference only. Please follow the specific
medical advice of your doctor.
YAG LASER CAPSULOTOMY
In approximately 50-80 percent of people that have
undergone cataract extraction, an additional procedure involving the use of a
laser may be required to "tweak" the vision. This procedure is
called a Yag Laser
Capsulotomy. To understand this
procedure we will review the anatomy of the crystalline lens.
Remember that the lens has two main layers: the inner nucleus layer and
the outer cortex. The lens is enclosed by the third structure termed the
capsule which is almost like a "plastic" wrap around the lens.
In modern cataract procedures, the capsule's anterior surface is removed
allowing the lens to be extracted (extracapsular) or broken up by ultrasound
(phacoemulsification). The posterior portion of the capsule is left intact
which provides a structure for the implant to be placed. Usually
with in the first two years after surgery, this posterior capsule begins to
cloud up. Prior to the onset of laser surgery, this clouding of the
capsule was termed a second cataract which required another trip to the
operating room to remove. With the advent of the Yag laser, this capsular
membrane can be painlessly broken up within the eye by laser energy thus
restoring clear vision.
thumbnail photograph shows a cloudy capsule on the left side and on the right an
implant after laser surgery.