A cataract is a clouding of the normally clear lens of the eye. It can be compared to a window that is frosted or "fogged" with steam. There are many misconceptions about cataract.
The amount and pattern of cloudiness within the lens can vary. If the cloudiness is not near the center of the lens, you may not be aware that a cataract is present.
The most common type of cataract is related to aging of the eye. Other causes of cataract include:
A thorough eye examination by your Ophthalmologist (medical eye doctor) can detect the presence and extent of a cataract, as well as any other conditions that may be causing blurred vision. There may be other reasons for visual loss in addition to the cataract, particularly problems involving the retina or optic nerve. If these problems are present, perfect vision may not return after cataract removal. If such conditions are severe, removal of the cataract may not result in any improvement in the vision. Your Ophthalmologist can tell you how much visual improvement is likely.
How quickly the cataract develops varies among individuals, and may vary even between the two eyes. Most cataracts associated with aging progress gradually over a period of years. Other cataracts, especially in younger people and people with diabetes, may progress rapidly over a few months and cause vision to worsen. It is not possible to predict exactly how fast cataracts will develop in any given person.
Surgery is the only way your Ophthalmologist can remove the cataract. However, if symptoms from a cataract are mild, a change of glasses may be all that is needed for you to function more comfortably. There are no medications, dietary supplements, exercises or optical devices that have been shown to prevent or cure cataracts. However, protection from excessive sunlight may help prevent or slow the progression of cataracts. Sunglasses that screen out ultraviolet (UV) light rays or regular eyeglasses with a clear, anti-UV coating offer this protection.
Cataract surgery should be considered when cataracts cause enough loss of vision to interfere with daily activities. It is not true that cataracts need to be "ripe" before they can be removed. Cataract surgery can be performed when your visual needs require it. You must decide if you can see to do your job and drive safely, if you can read and watch TV in comfort. Can you perform daily tasks, such as cooking, shopping, yard work or taking medications without difficulty? Based on your symptoms, you and your Ophthalmologist should decide together when surgery is appropriate.
Over 1.4 million people have cataract surgery each year in the United States, 95% without complications. Dr. Yohai has a complication rate of less than 1 percent. During cataract surgery, which is usually performed under eyedrop anesthesia as an outpatient procedure, the cloudy lens is removed from the eye.
In most cases, the focusing power of the natural lens is restored by replacing it with a permanent intraocular lens implant. Dr. Yohai performs this delicate surgery using a microscope, miniature instruments and the latest small incision techniques to allow the fastest possible healing. Although it is a common misconception, lasers are not used to remove cataracts.
In approximately one-fourth of people having cataract surgery, the natural capsule that supports the intraocular lens will become cloudy at some time after cataract surgery. Laser surgery is used to open this cloudy capsule, restoring the clear vision. After cataract surgery, you may return almost immediately to all but the most strenuous activities.
You will have to take eye drops as your Ophthalmologist directs. Several postoperative visits are needed to check on the progress of the eye as it heals. Cataract surgery is a highly successful procedure. Improved vision is the result in over 95% of cases, unless there is a problem with the cornea, retina or optic nerve.
It is important to understand that complications can occur during or after the surgery, some severe enough to limit vision. As with any surgery, a good result cannot be guaranteed.
There are basically two types of lens implants used in cataract surgery: monofocal and multifocal. Monofocal lenses provide clear vision at one distance, usually far away. Glasses are then used for reading. Some patients choose the reverse - reading without glasses, but then they must wear glasses to drive. This type of lens is fully approved and covered by Medicare and most insurances.
Multifocal lens implants will allow most patients to see at near and far without glasses. They do this by having concentric zones of near and far focus, thus providing near and far vision. Multifocal lenses, are considered premium lenses because they not only correct the blur caused by cataracts, but also provide near vision without glasses. 94% of patients with multifocal lenses see at distance and near without glasses.
These lenses are Medicare and insurance approved, but not fully covered. Therefore there is some out of pocket cost for patients choosing these lenses.
The other type of premium lens is a special type of monofocal lens that corrects astigmatism. This is called a toric lens. With this lens we can provide sharper vision at either distance OR near without glasses.
The last type of premium lens is the True Accommodating Lens Implant. We are still awaiting designs that will actually provide accommodation. Current lenses (the Crystal lens) attempt to do this with varying success. Accommodation is what our youthful natural lens does: change power to allow focusing from far to near.
Astigmatism is a distortion of vision. It is usually caused by an irregularly shaped cornea. The visual distortion of astigmatism persists after the cataract is removed. Traditionally, this was (and still is) corrected with glasses.
Surgical options for correcting astigmatism include Limbal Relaxing incisions (LSI)(also known as Astigmatic Keratotomy) and TORIC Intraocular Lens Implants.
Limbal Relaxing Incisions involve making pairs of incisions in the cornea to reduce the irregularity. LRI's can treat small to moderate amounts of astigmatism. While some surgeons perform them at the time of surgery, I feel that the results are more accurate one month postoperatively, as an office procedure.
Toric Lens implants are a special type of lens that correct larger amounts of astigmatism: VIDEO
Toric lenses and LRI can be combined for even more correction.
Cataracts are a common cause of poor vision, particularly for the elderly, but they are treatable.
Dr. Yohai is an expert in the treatment of cataracts and can tell you whether cataract or some other problem is the cause of vision loss or discomfort.
After a complete evaluation, he can help you decide if cataract surgery is appropriate for you. If you are having difficulty with your eyesight, call Dr. Yohai at (707) 544-7044 for an appointment.