More About Cataracts and Cataract Surgery

Once adequate anesthesia has been achieved, the area around the operative eye will be cleansed for sterility and a surgical drape will be placed. A small device known as a speculum will then be placed to keep your eye open during the procedure. There will be no discomfort. A small incision is then made in the cornea, or clear window at the front of the eye, and a viscous gel is injected into the eye in order to maintain space and protect the other ocular structures during surgery.The “main” corneal incision is then carefully made using an extremely sharp and precise blade made of diamond. Next, a circular opening is created in the front of the thin membrane, or capsule, which surrounds the lens, and fluid is injected inside to separate the entire lens from its attachment to the capsule. The cataractous lens is then removed using phacoemulsification, the amazing technology behind modern cataract surgery. The phacoemulsification machine produces ultrasound waves within a tiny handpiece, pictured to the left, which is inserted into the eye. This causes the metal tip of the instrument to vibrate very rapidly, up to 40,000 times each second, dissolving the cataract material which is then aspirated out of the eye. Additional instruments are used to clean all the cataract from the lens capsule, which is then refilled with more viscous gel. An artificial, permanent lens implant, made of a type of plastic, is then inserted into the capsular “bag,” taking the place of your natural lens. This implant, which helps focus the incoming light on your retina, is held in place by two haptics, or curved arms. Once the implant is in place, the incisions are closed, usually without stitches, and the surgery is complete.

Prior to surgery, your eye will be carefully measured for the proper strength of lens implant. The implant can be chosen to focus your eye at any distance you desire. While most choose to focus at distance, some prefer to see most clearly at near, particularly if they have always been myopic, or nearsighted. At Fishkind, Bakewell Maltzman & Hunter we perform these measurements with the Zeiss IOL-Master, the most advanced, accurate device for this purpose, which uses a laser to scan the eye in just seconds. While these calculations are extremely accurate in most cases, the expected results are not always achieved. Most patients obtain vision good enough to drive without glasses. Rarely, the post-operative refraction (eyeglass prescription) will be significantly different than expected. In these unusual cases, additional surgery, including removal and replacement of the lens implant, may be required to achieve the desired result.

The majority of lens implants inserted during cataract surgery are considered ‘monofocal,’ meaning that they focus light at only one location, usually in the distance. This means that reading glasses will be required for close-up tasks such as reading- without them near vision will be blurred. Another option is the ‘multifocal’ lens implant. Such implants allow for clear vision at distance, as well as good vision at mid-range and near. Each type of lens has specific advantages and disadvantages. You can discuss these options with one of our physicians during your evaluation. Please click here to read in greater detail about lens implant options.

Astigmatism is a form of refractive error in which perpendicular lines are focused at different distances within the eye. Significant astigmatism occurs in as many as one in three people and can cause blurred vision, visual fatigue, and squinting if not corrected with glasses or contact lenses. In early life, most astigmatism is due to an irregular shape of the eye, in which the cornea is steeper in one meridian than the other. As we age, many develop astigmatism due to irregular thickening of the lens as cataracts develop. This latter form of astigmatism will disappear when a cataract is removed, however any remaining corneal astigmatism will blur vision, increasing the likelihood that glasses will be necessary for clear vision postoperatively.

Fortunately, for those who desire the best possible uncorrected distance vision after surgery, astigmatism can be reduced or eliminated surgically at the time of the cataract operation. This is performed in one of two ways, depending upon the amount of astigmatism present prior to surgery. For lesser degrees of irregularity, extra incisions called “limbal relaxing incisions” can be made in the cornea using a very precise diamond blade. These incisions serve to flatten the steeper meridian of the cornea, making it even in all directions. For larger amounts of correction, limbal relaxing incisions are not enough to overcome the irregularity. In such cases, a special lens implant known as a “toric IOL” can be placed in the eye. Like eyeglasses, which are crafted with cylindrical lenses placed in a specific axis to correct one’s particular degree of astigmatism, a toric implant with the correct cylindrical power is carefully rotated into the precise position within the eye to neutralize the corneal astigmatism.

Once removed, a cataract does not return. However, the back side of the lens capsule, which remains intact at the time of surgery in order to support the implant, can become cloudy over time. This opacification, sometimes referred to as a “secondary cataract,” can affect vision much the way the cataract once did. If this occurs, a brief, painless laser procedure performed in the office can clear the opacity from the implant. The capsular opacification does not recur once this is performed.

Modern cataract surgery is safe, effective, and capable of rapidly improving your vision. Don’t let poor vision slow you down. Call or contact us today to schedule an appointment with one of our doctors to find out if cataract surgery can help you.