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CATARACTS

If the lens becomes cloudy, the light reaching the retina is blurred and distorted, and your vision is affected. This clouded lens is called a cataract, and it must be removed before vision can be restored. A clouded lens can be compared to a window that is frosted or "fogged" with steam. Cataracts are not cancerous. They can be treated with a surgical procedure that has become a fairly common procedure in the United States.

The two most common types of cataracts are: the cortical cataract and a posterior subcapsular cataract. Depending on the type of cataract, a patient will experience different vision problems, but the most common cataract symptoms include:

  1. Blurring Vision.
  2. Sensitivity to light or glare.
  3. double Vision in one eye.
  4. poor night vision.
  5. needing brighter light to read.
  6. experiencing fading or yellowing of colors.

If the cloudiness is not near the center of the lens, you may not be aware that you have a cataract.

Age-Related Cataracts

Many cataracts take years to develop to the point where vision is seriously affected. Most occur as a result of the normal aging process. The types of age-related cataracts are usually described by their location in the lens. They are: nuclear cataracts, cortical cataracts and subcapsular cataracts.

Nuclear cataracts occur in the center of the lens and may induce other eye problems, such as myopia. A cortical cataract, which tends to occur more in persons with diabetes, begins at the outer portion of the lens, then slowly moves inward. Subcapsular cataracts develops under the capsule, often at the back of the lens. This type of cataract also occurs more in persons with diabetes, but it is also found in persons with high myopia, adults with retinitis pigmentosa and in people who take steroids.

Other Types of Cataracts

There are other kinds of cataracts not related to the aging process. Traumatic cataracts develop as a result of an eye injury. Others can develop from metabolic blood disorders, eye infections and inflammations and certain types of medications.

Another type, called congenital cataract, occurs at birth, particularly if the mother has had rubella (German measles) during pregnancy. A nuclear cataract occurs in the center of the lens.

Research continues to look for ways to prevent cataracts. Until then, useful vision can be restored in 98 percent of all patients who have normal, healthy eyes.

Treatment for Cataracts

Cataracts can be removed at any age. You no longer have to wait until the cataract "ripens" or until you lose your sight before surgery can be performed. In fact, the placement of an intraocular lens (IOL) implant to restore vision is best done in an eye when the cataract interferes with your daily activities or causes a decrease in vision.

In removing cataracts, the clouded lens (cataract) must be removed surgically. Cataracts cannot be removed via laser.A common surgical procedure used today is extracapsular cataract extraction. The surgeon makes an incision in the eye and the front (anterior) capsule of the lens to remove the clouded lens. The lens tissue within the capsule is removed. The sac-like capsule that surrounds the lens remains in place. This capsule is left intact for two reasons: to avoid disturbing the gel, or vitreous, that fills most of the eye, and to support an intraocular lens After the cataract has been removed, the incision is closed. Often the sutures, which are finer than human hair, do not need to be removed. Some patients, in fact, don't even need sutures, and the "no suture" surgery is popular today.

Another common type of extracapsular cataract extraction is phacoemulsification (often just called "phaco"), where the surgeon removes the cataract through an even smaller incision than the one used in conventional surgery. In this procedure, the surgeon uses a computerized instrument consisting of a needle about the size of a ballpoint pen tip which vibrates at about 40,000 times a second.

This ultrasonic vibration dissolves the cataract into fine particles, which are then vacuumed through an opening in the instrument.The benefits of the phaco approach include an early restoration of vision and return to normal activities. Phaco is well suited for patients with a less-advanced cataract, when an earlier return to activity is required or when increased physical activity is part of the convalescent period.

Cloudiness of the Capsule

In about 10 to 50 percent of patients who have a cataract removed, the capsule becomes cloudy several months or years after the original surgery. Often this condition is referred to as a "secondary cataract." However, this does not mean that the patient has another cataract; it is only the capsule — not the artificial lens — that has become cloudy.

If this cloudiness blurs your vision, a clear opening can be painlessly made in the center of the posterior capsule membrane with a YAG laser. This procedure is done on an outpatient basis in about 15 minutes, without injections. This is the only instance in which a laser can be used for a cataract-related treatment.

Restoring Sight After a Cataract is Removed

Because the clouded lens is removed in cataract surgery, some type of substitute or replacement lens is needed to restore vision. There are three ways of doing this:.

Intraocular Lens Implant

An intraocular lens implant, or IOL, is an artificial lens made of plastic, silicone, acrylic or other material that is implanted inside the eye during cataract surgery. The IOL is implanted within the capsule, which provides permanent support for the lens. This is the most natural and preferred way of restoring vision.

Because the IOL lies safely inside the eye, it is never handled or adjusted as one would for a contact lens. Most patients are good candidates for the implant.

Most patients have the device implanted during their surgery. Those who have had cataract surgery without the IOL implant, and who later discover they cannot tolerate contact lenses or cataract glasses, have to be evaluated very carefully before a second operation for a lens implant is recommended.

Contact Lenses

Contact lenses are another alternative to IOL implants. However, handling them is sometimes cumbersome, and not everyone is a good candidate. Patients with tremors, extreme nervousness, or dry eyes, for example, are not likely to wear contact lenses with much success.

Today, hard contact lenses, soft lenses and extended wear soft lenses are available for persons who have had cataract surgery.

Cataract Eyeglasses

Years ago, cataract eyeglasses were the only option for patients who required cataract surgery. They are still used today but seldomly because they are the least-preferred option. These are recommended only when a patient cannot have another IOL implant or when they cannot wear contact lenses.

Years ago, cataract eyeglasses were the only option for patients who required cataract surgery. They are still used today but seldomly because they are the least-preferred option. These are recommended only when a patient cannot have another IOL implant or when they cannot wear contact lenses.

A cataract glass is a thick magnifying glass that may provide perfect vision. However, the glass provides clear vision only through the center of the lens, magnifying everything to about one-third larger than normal. There are several disadvantages with cataract eyeglasses.Because of the thickness of the glass, you must turn your entire head ­ rather than just your eyes to see on either side.

If the vision in your other eye is good, you cannot wear a cataract eyeglass because both eyes will not be able to work together comfortably. This is because the magnification of the cataract lens will cause a difference in the size of the images you are looking at.Further, cataract eyeglasses are expensive, need expert adjustment for best vision and are difficult to adapt to.

Development of Intraocular Lens Implants

Intraocular lens implants (IOLs) have been used since 1949. Physicians at Wills Eye were the first in the United States to perform the implant procedure in 1952, and millions of these procedures have been performed since then.

Present-day IOLs have undergone many improvements and refinements over the years, and results have generally been excellent.

Research into new types of IOLs is ongoing. The latest versions include a soft, foldable lens that can fit through an even smaller incision, and the bifocal intraocular lens.

Your Cataract Surgery

Most patients can have their cataract surgery done through Wills Eye's Day Surgery program or at one of the Wills Eye Surgery Centers located throughout the region. On the day of the surgery you will be given medication to calm and relax you.The area surrounding your eye will be cleansed, and sterile drapes will be placed over you, exposing only the eye to be operated on.

You might have a local anesthetic, which involves small injections around your eye to keep the eye muscle relaxed during surgery and to numb the eye. Topical and general anesthesia are also available. The surgery is essentially painless.The surgeon will use a special microscope that magnifies your eye and helps to guide the surgical procedure.

Later in the day you will be released, and you can resume normal, moderate activity as soon as you feel up to it.When you return home, begin using your eyedrops as prescribed. Be sure to wear eyeglasses or a hard shield to protect your eye. When outdoors, use sunglasses. While sleeping, use a shield to avoid accidentally bumping the eye.

Convalescence

Following cataract surgery, most of the healing occurs within three months. During that time, it is important to visit your ophthalmologist and use the eyedrops as prescribed.

If you have had an intraocular lens implanted and have no complications, you will notice improved vision in a week, or even sooner.You can get temporary glasses shortly after the surgery, but your final eyeglass or contact lens will not be ordered until most of the healing is completed.

Complications of Surgery or Lens Implantation

Of the vast majority of patients who have cataract surgery, only a small number experience complications. Infection, bleeding and retinal swelling or detachment might occur. Also, glaucoma, corneal clouding or loss of an eye are some of the more serious, but rare complications.

Those most at risk for complications include alcoholics, substance abusers, diabetics, and people with glaucoma, high myopia or vascular disease. If your eye is healthy before the surgery, the likelihood is that the surgery will be successful.

Cataract Surgery at Wills Eye

Few hospitals in the world perform more cataract surgeries than Wills Eye and its Surgical Network. Many of the latest advances in cataract surgery, implants and instrumentation were developed at Wills Eye.

Until the time comes when there is a way to actually prevent the development of cataracts, it is our goal to provide you with the best care in managing this common condition. Click here for more information about the Cataract and Primary Eye Care Service at Wills Eye.