Cataracts & Cataract Surgery-ReSTOR®, ReZoom™, Tecnis® & Crystalens® Intraocular Lens Implants (IOL) & Lens Replacement Surgery
Years ago, cataract surgery was a cumbersome procedure for many patients. In fact, for most people with cataracts, it required overnight stays in the hospital and a lengthy recovery process to fully restore their vision. Today, thanks to advanced surgical techniques, such as "no stitch, no patch, no needle" cataract surgery and convenient outpatient facilities, called Ambulatory Surgery Centers your cataract surgery experience will be comfortable and convenient, with minimal discomfort and interruption of your daily activities and lifestyle.
How Do I Know if I Have a Cataract?
A Cataract is a clouding of the normally clear lens of the eye. It is not a film over the eye or caused by overusing the eyes.
The most common symptoms of a cataract may include:
- Cloudy or Blurry Vision
- Problems with light that may include headlights seeming too bright at night; uncomfortable glare from lamps or very bright sunlight; or even a halo around lights.
- Colors may seem faded.
- Difficulty with night vision.
- Double images, multiple images or even shadowy images.
- Frequent changes in your eyeglasses or contact lenses may be necessary.
When a cataract is small, you may not notice any changes in your vision. Cataracts tend to grow slowly, so your vision may get worse gradually. Some people with a cataract find that their near vision seems to improve, but this is only temporary.
How are Cataracts Treated?
For an early cataract, it may seem that your vision is improved by using different eyeglasses, magnifying lenses, or stronger lighting. These measures do not effectively treat the problem, as cataracts tend to change over time. Surgery is the only effective treatment. The surgical treatment of a cataract involves removing the cloudy lens and replacing it with a substitute implantable lens, called an Intraocular Lens (IOL). Today we have a number of advanced technology Intraocular Lenses that can actually help you become less dependent or even eliminate the need to wear eyeglasses, bifocals or reading glasses after cataract surgery. Until a few years ago, all Intraocular Lens Implants were of a type call Monofocal Lens Implants. Monofocal Lens Implants provide good vision, but only at one set distance-usually for far away-so that it is still necessary to wear readers or bifocals to see anything up close. While we still use Monofocal Lens Implants, many patients who wish to have the clearest sharpest vision elect to have an Aspheric Lens Implant-one which corrects the aberrations that typically cause halos and difficulty with seeing in dim lighting. Aspheric Lens Implants help to improve contrast and so they allow better vision for night driving and doing things in low levels of light. For patients with significant amounts of astigmatism, we can use Toric Lens Implants that correct astigmatism and reduce the need to wear glasses for distance vision. Astigmatism correcting Toric Lens Implants still do not correct intermediate arm's length vision or close vision as required for reading, so that you will still need eyeglasses, bifocals or readers to see up close. Last, we also have presbyopia near vision correcting lens implants that allow you to see clearly at distance, at arms length and up close without needing glasses after cataract surgery. One Intraocular Lens of this type is called Crystalens™. Crystalens™ is an advanced focusable lens that has the unique design feature of being constructed with flexible hinges that allow the lens to move and change focus so that you can see far, arms length and at near seamlessly. Another advanced Intraocular Lens is called ReSTOR®. ReSTOR® is an innovative lens design that uses a technology called diffractive optics to give patients the ability to see at all distances without being dependent on glasses. A third type of presbyopia near vision correcting lens implant is called ReZoom™. ReZoom provides clear vision for all distances by using multiple zones of a differing prescription in the lens implant design. After Cataract Surgery these advanced Intraocular Lenses help patients enjoy work activities and recreational activities without being dependent on glasses or contact lenses.
When Does a Cataract Need to be Removed?
A cataract needs to be removed when it interferes with your everyday activities, such as driving, reading, or watching TV. It is important that you and your eye care professional make that decision together. In most cases, waiting until you are ready to have cataract surgery will not harm your eye. If you have cataracts in both eyes, they are removed one at a time in order to achieve the best possible results. Sometimes, it is necessary to remove a cataract even if it doesn't seem to cause problems with your vision. This is the case if it prevents a thorough retinal examination or treatment of another eye problem, such as age-related macular degeneration or diabetic retinopathy.
How is a Cataract Diagnosed?
To diagnose a cataract, your eye care provider will consider the symptoms that the cataract is causing you to experience relative to the quality of your vision and its impact on your ability to function in your daily living activities. Your eye care provider will then thoroughly evaluate your eyes, paying particular attention to your vision and whether it is handicapped by the cataracts. They will also evaluate how glare may affect your vision. You will then undergo a complete eye exam, including tonometry to measure the pressure in your eyes, slit-lamp evaluation to look at the overall health of the eye and to assess the severity of the cataract formation. Your eye care provider will also perform a careful examination of the retina and optic nerve by viewing the back of the eye through dilated pupils. This is to help to properly prepare you for your new post-operative vision. They may also perform other tests such as ultrasound in order to learn about the structure of your eye and take measurements for the proper Intraocular Lens selection. If there are any other questions regarding the health of your eye further diagnostic testing such as fluorescein angiography or retinal tomography may be ordered to complete your evaluation.
How is a Cataract Removed?
There are two primary ways that we can remove a cataract. During your examination, your eye care provider will explain the differences and help determine which is going to be best for you. Most cataract surgery that is performed today uses a technique called Phacoemulsification, or Phaco. In this technique, a very tiny incision is placed on the side of the cornea, the clear, dome-shaped surface that covers the front of the eye. The eye surgeon then inserts a microscopic probe into the eye. This probe sends out ultrasound waves that soften and break up the cloudy center of the lens so that it can be removed by gentle suction.
Sometimes the cataract surgeon use a technique called Extracapsular cataract surgery, in which we make a slightly longer incision on the side of the cornea in order to remove the hard center of the lens. Then the remainder of the lens can be removed by a gentle suction.
In almost all cataract surgeries, the removed cataract lens is replaced lens with an Intraocular Lens (IOL). An IOL is a clear, artificial lens that requires no care and becomes a permanent part of your eye. With an IOL, you'll have improved vision very quickly because light will be able to pass through it to the retina. Don't worry, you won't feel or see the new lens.
In the past cataract surgeons could only offer you intraocular lenses that could correct your distance vision after cataract surgery. These were called monofocal intraocular lenses. Today, cataract surgeons can implant intraocular lenses that will allow you to see at a distance and up close and many intermediate arm's length distances by using intraocular lenses called multifocal lenses. ReStor®, ReZoom™ and Crystalens® are types of multifocal intraocular lenses your cataract surgeon might suggest to correct your distance vision and your presbyopia after cataract surgery.
What Should I Expect Before Surgery?
A week or two before the surgery, your eye surgeon will measure the front curvature of the cornea and the size and shape of the eye. This information helps them to choose the right type of IOL. Also, they may ask you not to eat or drink anything after midnight the morning of your surgery.
What Should I Expect on the Day of Surgery?
On the day of your surgery, you will be welcomed by a staff member of the Ambulatory Surgery Center. The Center staff will begin helping you prepare for your surgery. This usually involves putting some drops in your eyes, just as you had during your eye examination. They will give you a gown to wear over your street clothes during your actual eye surgery. They will wash and thoroughly clean the area around your eye. The surgery itself usually will take about 10 minutes. You will be awake during the surgery, but they will give you a mild intravenous sedative to help you relax. In most cases, your eye actually heals without the need for stitches or an eye patch. After your surgery, you will rest in a comfortable reclining chair and they will offer you some refreshments. They will ask your family members to join you as review your follow-up care and schedule. The entire outpatient cataract surgery visit at the Ambulatory Surgery Center will take less than 2 hours.
Following your eye surgery you will be able to return home and continue your normal activities. The eye surgeon or their staff will call you later in the day to make sure that you are comfortable and to check on your progress. In general, you will be able to return to your normal daily activities almost immediately. They will have you come in to see your eye surgeon one to two days following your surgery day.
What Should I Expect to See After My Eye Surgery?
Most patients who have cataract surgery are amazed at how well they see the first morning after surgery. You can expect to continue all of your normal daily activities within a day or two. In most cases, by the end of the first week after cataract surgery, your vision should be bright and clear. Your eye care provider will examine your eyes according to a set of scheduled visits to make sure that your vision is progressing normally and that you achieve the best possible results.
Will The Eye Surgeon Use a Laser To Remove my Cataract?
Despite popular belief, most cataracts are not removed by lasers. Sometimes months or even years after your initial cataract surgery, the membrane which is left in place to support the Intraocular Lens (IOL) may become cloudy. To restore your normal vision, your eye surgeon will use a YAG laser to create a tiny opening in the membrane. This takes only a few minutes, is painless and does not require any incisions.
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