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About Cataracts

Answers to Commonly Asked Questions

What is a Cataract?

A cataract is any clouding or opacity in the crystalline lens-normally transparent lens inside the eye. A cataract is not a tumor or growth of skin over the eye.  Also, when you have a cataract, it does not mean you will necessarily have to do anything about it or that you will eventually be blinded by it.

What Causes a Cataract?

Most cataracts occur as part of the aging process, from a change in the chemical composition of the lens. A cataract usually doesn’t become a problem until you are in your 60’s or 70’s. Some, but not all scientists feel that prolonged exposure (over years) to sunlight can damage the lens and plays a key role in cataract development.

Cataracts can also be caused by eye injuries, certain eye diseases and body conditions, hereditary or birth defects, and on occasion, some medications. They are not caused or made worse by using or “overusing” the eyes.

How Can I Tell if I have a Cataract?

You may notice a gradual blurring or dimming of vision. Some people see a “halo” or haze around lights, especially at night, or have hazy or double vision. At first, the symptoms may occur only in dim light or when you face a bright oncoming car with their headlights on; the glare may make night driving difficult. Pain, headaches and eye irritation are not usually symptoms of a cataract.

Is it Possible to have a Cataract and Not Notice It?

Yes, if the cataract is small, it may not disturb your vision or cause any symptoms at all. Even a dense cataract may not be noticed if the other eye is providing clear vision. In fact, you might not be aware of the blurred vision unless you happen to cover the normal eye. Unless it is very dense, a cataract is not visible to the naked eye of an observer.

Once a Cataract Begins, How Rapidly does it Progress?

Presently, the only effective treatment is surgical removal of the cloudy lens. This can be done in a hospital or as an out-patient. Some studies hint that the process can be slowed by vitamin C or aspirin, but other treatments, such as medications or exercises do not help at all. If the cataract is minimal, treatment may be delayed for a while by changing your eye glass prescription or by dilating (enlarging) your pupils.

How Successful is the Surgery in Restoring Sight?

Cataract surgery is one of the most effective and safest operations performed today and it usually has a 95% success rate. The high success rate is due to advances in microscope technique, high tech instruments, ultra fine needles and suture material, and the use of intraocular lenses.

What are the Complications of Surgery?

Though rare, infection, bleeding, glaucoma, corneal problems, chronic intraocular inflammation, and retinal detachment are possible. Most of these complications, if they do occur, are usually temporary or they can be treated successfully with medication. Rarely, they may require a second, surgical procedure.

When Should a Cataract be Removed?

When it interferes with your vision to a point where it is bothersome to you.  Since everyone’s visual needs are different, this point will differ from one person to another. It’s not necessary to wait until the cataract is “ripe” (totally opaque) to have it removed.

Who Makes the Decision about when a Cataract is to be Removed?

You as the patient, do. You will be advised that you are a candidate for the surgery and what kind of improvement you can expect from having the cataract removed, free of complications. Then you will have to decide if the cataract is causing you enough trouble to warrant surgery. There are rare circumstances that require cataract removal regardless of vision; if it becomes overly mature (“overripe”), if it begins to release chemicals that can damage the eye, if it contributes to glaucoma, or if it prevents observation or treatment of other eye diseases.

How is a Cataract Removed?

There are several procedures for removing the cloudy lens. In each, a small incision is made in the front of the eye and an instrument is inserted into the eye to remove the lens. Your eye remains in its normal position during the operation and is never removed from its’ socket.

With the intracapsular method, the entire lens is taken out in one piece with its capsule (the membrane enclosing the lens). With the extracapsular method, the front part of the capsule is opened and the lens taken out, leaving the back part of the capsule in its normal position.

The newest extracapsular techniques are referred to as “small incision” surgery. One of these involves phacoemulsification (fake-oh-ee-mull-sih-fuh-KAY-shun), in which a needle-like, ultrasonic instrument is introduced to the eye. It delivers high-frequency sound waves to break up the opaque lens into tiny pieces that are then gently suctioned out through the instrument’s hollow tubing.

Will I be Awake During the Operation?

The type of anesthesia you’ll have depends on your general health. If you are given a “local” so you may stay awake, you will be given sedatives and medication will be injected under the eye to paralyze the eye muscles and numb the nerves for pain. The injection is not painful; it produces a little discomfort and will cause vision to be dim for a few hours. The lids may also be injected with an anesthetic to keep you from squeezing them shut.

General anesthesia may be recommended if you are uncomfortable or frightened to stay awake during the procedure or if there is a chance you could not hold still. Children always need to have general anesthesia.

How Soon after Cataract Surgery can I Resume Normal Activity?

Most patients can be up and around on the same day as their surgery. Most return to their normal activities in a short time; as long as they don’t require heavy lifting or straining. It is safe to use your eyes for reading, watching TV and office work almost immediately. Depending on the procedure used and the size of the incision, you will be able to resume full, normal activity in a few days to a month or so.

What will my Vision be like after Surgery?

Cataract surgery removes the crystalline lens, a major focusing element of the eye. Without a lens, your vision would be poor. Good vision; however, depends on many factors. These factors include: how your vision will be corrected after surgery and how well your vision was before surgery and the eye’s overall health. You will see images that are normal in shape and size and your depth perception and side vision will be natural. You are still likely to require an eyeglass correction for reading and for sharp distance vision.

It may take several weeks before the operated eye is fully healed and vision is stabilized. If you have a special need for very sharp vision before then, you may need eyeglasses prescribed early on, so long as you understand that it may be necessary to have the prescription changed soon after.

If you are not having IOL, your vision will need to be restored by contact lenses or special cataract glasses. Neither of those options is ideal. Contact lenses must be handled, cared for and tolerated. Not everyone can wear them or even handle them easily. Cataract glasses used to be the most common way to restore vision after cataract removal, but they are thick and heavy and they magnify and distort your vision and create difficulty with side vision.

How do I care for an IOL?

An IOL is a permanent replacement for your natural lens. After is has been placed inside your eye with surgery, it requires no care. You can’t feel or see it and it’s not noticed by others. Today, almost all patients having cataract surgery safely choose an IOL as part of the procedure.

Are the Risks of Cataract Surgery Greater with an Implant?

There is a slight, increased risk of surgical complications, such as displacement of the IOL, but most people feel that the benefits outweigh the risks. Though no surgical results can ever be guaranteed, the odds are excellent that everything will be fine and you will see about as well after the operation as you did before the cataract developed.