Cataracts Information

Cataracts

A cataract is a cloudiness that develops in the normally clear lens of the eye. The lens, about the size of an aspirin, is the transparent fine focusing part of the eye located behind the pupil. It is comprised of a strong, transparent outer covering or capsule filled with a clear gel material. When the gel becomes cloudy, the incoming light rays are distorted or blocked before reaching the retina at the back of the eye. As the cataract develops, vision is increasingly reduced. Your family optometrist will usually discover developing cataracts in the course of routine eye exams. If you have cataracts that are causing visual difficulties, your doctor will usually recommend surgery, the only known cure for cataracts.

Causes of cataract development

Cataracts are most commonly caused by age. In fact, almost everyone who lives long enough will develop cataracts. Age-related cataracts are brought about by chemical changes within the lens of the eye. These changes result in the lens hardening and becoming cloudy.

Cataracts can also be caused by severe injuries to the eye, reactions to certain drugs, exposure to harmful chemicals or radiation, and some eye diseases and physicial conditions such as diabetes. Smoking and exposure to high amounts of sunlight have been shown to increase the onset of cataract formation. Babies can also be born with congenital cataracts.

Cataract symptoms

Cataracts vary in the way they develop, but generally, people experience one or more of these common symptoms:

Gradual loss of color vision.
Increased haziness, blurring, distortion and yellowed vision.
Dark spots or shadows that move with the eye.
Need for more light to read or see clearly.
Night glare, halos or colored rings around lights.
Becoming more nearsighted and not needing reading glasses.
Double vision.
Being able to see better without glasses.
In advanced stages, a white or yellow pupil.

Cataract solution

Unfortunately, there is no way to prevent or reverse the development of cataracts. Although there is evidence that anti-oxidants such as vitamin A, C and E may delay their development, there is no known way to prevent cataracts or to make the cloudy lens clear again.

If there are no other serious problems with the eye, an experienced cataract surgeon can restore vision in over 99% of the cases. In fact, cataract surgery is one of the most successful surgeries being performed.

The surgery involves two main parts: First, the cloudy lens must be removed and secondly, the focusing power must be replaced.

Removing the cloudy lens

Instead of removing the entire lens and capsule, the most modern treatment involves the surgeon making a small opening in the front of the clear covering to remove the cloudy gel inside the capsule. The rest of the capsule is left intact to provide a sac for holding the new artificial lens.

The most ideal method of removing the gel from the lens is to use an ultrasound probe which vibrates at 40,000 times per second. This procedure, known as phacoemulsification, causes the least amount of trauma to the eye when performed by an experienced surgeon. Reaching into the capsule with the ultrasonic probe, the surgeon uses the controlled vibrations of the tip to break up the hardened, cloudy gel and suction it out of the eye.

Replacing the focusing power

In removing the lens of the eye, the natural focusing ability is also removed during cataract surgery. To replace it, a tiny artificial lens implant, usually made of plexiglass, can be inserted into the original lens capsule. This lens implant is held securely in place by gentle, flexible loops. Artificial lens implants are available in all ranges of power so patients can often achieve better vision than they have ever experienced. Although clear vision can be restored almost immediately, glasses still may be needed for some activities such as driving or reading.

Cataract surgery risk

As with any surgery, there are risks involved with cataract surgery, though serious problems are very rare. Problems that do occur can generally be resolved so vision is not permanently lost. Under the care of an experienced surgeon, there is usually nothing to worry about.

After-surgery care

When a skilled surgeon performs surgery, patients may return to their family optometrist for the after-surgery care. During this follow-up period, the surgeon and optometrist work closely to monitor vision and the healing process. The commitment of these two eye doctors working together provides the patient with the best care. After-surgery clouding

After-surgery clouding

In about a third of cataract surgery cases, the clear capsule that holds the new plastic lens becomes cloudy or frosted over. Again, vision is reduced. Some people think their cataract has returned, but it can be easily treated with the laser. In a short office visit, the beam of laser light is used to make a small opening in the back of the cloudy capsule to restore clear vision.

The Surgery Experience

When you arrive at Pacific Eyecare, you are treated as a special guest. Patient counselors verify your insurance and answer billing questions. After technicians check the quality of your vision and take precise measurements, the physician examines your eyes.

On the day of your surgery, nurses review your medical history, play a video from the surgeon and answer any questions you may have. The kind staff and home-like atmosphere provide a soothing touch of assurance. You feel calm and relaxed, and unlike most other surgery, cataract treatment at Pacific Eyecare will not disrupt your lifestyle. There is no need to stop normal medications or miss any meals.

Before entering the surgical suite, your clothes are covered with a light gown. Your eye is gently numbed so that you can stay alert through the procedure without discomfort.

Within a few minutes the operation is completed. oftentimes, no patch is used. As you leave the operating room, nurses gently tend to the smallest details of your comfort. Once you receive after-surgery instructions, you are free to go home or return to your hotel.

The next morning you come back to Pacific Eyecare for a quick check up.

The magic of the experience at Pacific Eyecare is more than skillful surgery. There is an atmosphere of care and compassion from the Doctors and Staff. Pacific Eyecare surgeons have performed thousands of cataract surgeries.

The Story of Lens Implants

In modern cataract surgery removal of the clouded lens is only the first part of the procedure. The second half involves placing a tiny lens implant called an intraocular lens, inside the eye to replace the eye's original lens. The development of artificial lenses revolutionized cataract surgery.

Early attempts

At first, efforts to solve the visual problem after cataract removal were unsophisticated and oftentimes useless. Even when a cataract was successfully removed, the patient's vision remained very poor. Without the natural lens in the eye, light rays could not focus to give clear vision. For light to properly focus in the eye, some type of external or internal focusing lens was needed to restore sharp, clear vision.

Before the technology for eyeglasses was developed, people who had cataract surgery could see only light and shadows and large objects. After the invention of glasses, patients were given thick spectacles to wear called cataract glasses. Though it was possible to function with these glasses, vision was not normal. The view with these cumbersome glasses was like looking through a moving magnifying glass of dizzy distortions. The search for good vision after cataract surgery continued.

Around the turn of the nineteenth century, an Italian surgeon decided to implant a glass lens inside the eye at the time of cataract surgery. However, due to the weight of the glass, it immediately sank to the bottom of the eye. For the next 150 years, surgeons tried unsuccessfully to find some type of material that the eye could tolerate. It seemed that everything they tried was toxic to the eye and many surgeons gave up the idea of implanting an artificial lens in the eye. Yet they still believed this offered the best opportunity for good vision after cataract surgery.

20th century developments

By the 1930s, technological advances made possible the development of plastic. During World War II, a British surgeon named Harold Ridley, discovered that particles of plexiglas, a tough plastic called polymethyl methacrylate (PMMA), from shattered aircraft canopies did not cause any harmful reactions in the eyes of pilots. Dr. Ridley used this discovery to create a small lens from PMMA to fit inside the eye.

The first plastic lens implanted during surgery was performed in 1949. The patient was able to see quite well without glasses. Within a few years, hundreds of PMMA lenses were implanted. The exciting news was that these tiny lenses eliminated the need for heavy cataract glasses and thick contact lenses. Also, they lasted indefinitely and were maintenance free. But sadly, early complications halted the use of these pioneer lenses.

The lens implant revolution

Inspite of the complications, many of Dr. Ridley's lenses worked well. A group of Dutch surgeons decided to redesign his original lens implant. They made it smaller and lighter and corrected the earlier problems. By the late 1970s, the overwhelming success of these new plastic lenses created an implant revolution throughout Europe and North America.

Today, lens implants are manufactured in many sizes, shapes and materials - some rigid, some soft, some foldable, some expandable, and some multi-focus. The most common lens implant is a clear, round plastic lens with two tiny flexible nylon loops or feet. The gentle tension of these loops against the wall of the capsular sac holds the feather-light lens in place. Other styles of lenses can be placed in front of the iris behind the cornea.

Conclusion

Now, modern advances in implant surgery have made it a common procedure. Surgeons at Pacific Eyecare have performed thousands of cataract surgeries using tiny plastic lens implants. The surgeon's goal is to select a lens implant power that will minimize the patient's need for glasses after surgery.

The History of Cataract Surgery

Cataract is a Greek word meaning "white water falling." Early Greeks thought the blurred vision of a cataract was like looking through a waterfall. For centuries, our ancestors struggled with the problem of cataracts. The evolution of how they dealt with them is a fascinating story.

Primitive "cures"

Throughout recorded history, various concoctions and eye drops were reputed to cure cataracts. But any resulting improvements in vision were simply the natural fluctuations of the developing cataract.

Reportedly,physicians in the ancient civilizations of Babylon and India were the first to use sharp instruments to go inside the eye and push away the hard, cloudy lens letting it fall to the bottom of the eye. This primitive surgerywas called couching. However, leaving the clouded lens in the eye often resulted in severe inflammation and eventual blindness.

Early cataract removal

For hundreds of years, couching was the only treatment for cataracts. But around 1700 surgeons made an incision in the eye and removed the lens instead of pushing it aside. These large incisions went halfway around the cornea, the clear front part of the eye. Healing was long and often fraught with infections and wound reopenings. In time, however, sutures were used to stitch the woundtogether and antibiotics eliminated many of the disastrous infections.

Intracapsular and extracapsular techniques

By the 20th century, cataract surgery had evolved into two basic methods - intracapsular and extracapsular. Intracapsular involved removing the entire lens and capsule around it. The extracapsular method, however, made an opening in the capsule to remove the lens and leave the empty capsule in the eye.

Although extracapsular surgery was considered the superior technique, it had an annoying drawback. Quite often the capsular sac left inside the eye became clouded and blurry. To the patient it was like looking through a cataract again, so it was called a secondary cataract. To restore clear vision, a second operation was required to make a hole in the back of the clouded capsule or remove the entire capsule.

Due to the frustrating problem of secondary cataracts, most surgeons performed intracapsular surgery by removing the lens and capsule together. But this technique often damaged the delicate structures in the eye.

Artificial lens implants

With the development of a clear acrylic known as plexiglas in the 1930s, British surgeon Harold Ridley used this material to design a tiny plastic lens to be placed inside the eye during cataract surgery. With the success of plastic lens implants after World War II, cataract surgery became a two part process - first the eye's cloudy lens was removed and secondly, a new plastic lens was implanted.

Ultrasound surgery

In 1968, American surgeon Charles Kelman developed an instrument that used high intensity sound waves called ultrasound to remove cataracts. This sophisticated procedure called phacoemulsification allowed surgeons to use the extracapsular method of cataract removal. This superior method of cataract surgery makes an opening in the front of the capsule membrane so the cataract can be removed.

With phacoemulsification, the delicate ultrasound instrument is inserted into the eye through a tiny incision so small it requires no sutures. The high intensity sound waves are used to break up the cloudy gel of the cataract and the fragments are gently suctioned away. When the cataract is removed, the clear capsular sac is left intact to hold the new artificial lens implant.

For most cataract surgeons today, phacoemulsification is the technique of choice. This ultrasound method allows patients to resume normal activities almost immediately following surgery. However, mastery of this technology requires a surgeon to perform the procedure regularly. Excellent ultrasound surgeons are usually found at busy surgery centers.

Now, if the capsular sac becomes clouded with a secondary cataract, it can be treated easily with the YAG laser. Without touching the eye, the lasersends a painless beam of light thatmakes an opening in the cloudy capsule to restore clear vision.

Conclusion

From the earliest method of couching to the high-tech of ultrasound, cataract surgery has developed into a very sophisticated procedure. Pacific Eyecare's surgeons have performed thousands of cataract surgeries and lens implants using the phacoemulsification method. Today, modern cataract surgery is considered one of the safest surgeries performed, enabling hundreds of thousands to regain clear vision.

For more information

These cataract information sites are sponsored by the American
Society of Cataract and Refractive Surgeons: http://www.ascrs.org/eye/ptguide.html
http://www.ascrs.org/eye/cataractquiz.html

Doctors

Paul A. Kremer, M.D.
Terrill C. Olsen , M.D.
David James Creagh O’Morchoe, M.D.
Martha Motuz Leen, M.D.
James Lin, M.D.