Cataract Surgery: Frequently Asked Questions
What is a cataract?
The majority of cataracts develop due to the natural aging of the eye. As we age, proteins in the lens of the eye clump together forming opage clusters. Over time, these protein clusters will eventually cloud the lens allowing less light to pass through and distorting vision.
Cataracts cannot be treated with corrective glasses or prescription eye drops. The only treatment for a cataract is surgical removal. Click here to learn more about cataracts.
How do you get cataracts?
The most common type of cataracts typically develop due to the natural aging of the eye. As the eye ages, proteins in the lens begin to clump together, forming opaque clusters. Over time, these protein clumps will eventually cloud the lens, allowing less light to pass through thereby distorting vision. This type of cataract is an age-related cataract and normally begins developing after age 60.
Non age-related and less common types of cataracts include:
- Congenital or developmental cataracts: These cataracts can occur in children. They may be hereditary or can be associated with some birth defects and some occur without any obvious cause. Eye Care Specialists pediatric ophthalmologist, Dr. Linn Mangano, treats this type of cataract.
- Secondary cataracts: Formation of secondary cataracts are caused by other eye diseases or previous eye surgery and may be accelerated by a chronic disease, such as diabetes, or excessive use of steroid medications.
- Traumatic cataracts: Traumatic cataracts may appear immediately following an eye injury, or develop several months or even years later.
What are the symptoms of a cataract?
Cataracts tend to develop slowly and painlessly. Many patients do not even realize they have a cataract or that vision is changing. Patients often describe having a cataract as looking through a cloudy lens or like trying to see through a frosty or foggy window. Most age-related cataracts develop gradually and therefore vision changes may not be immediate but very gradual. Cataracts can be diagnosed through a dilated eye exam.
The following symptoms may be noticed if a cataract goes untreated:
- Painless clouded, blurry, or dim vision
- Increased difficulty seeing at night or in low light
- Sensitivity to light and glare, seeing halos around lights
- Faded, dull, or yellowed colors
- The need for brighter light for reading and other activities
- Frequent changes in eyeglass or contact lens prescription
- Double vision in one eye
How is a cataract removed?
The most common procedure for removing cataracts is phacoemulsification. A small incision is made in the side of the cornea (the front part of your eye). A tiny instrument is inserted through the incision and high-frequency ultrasound is used to break up the center of the cloudy lens and suction it out.
After the cloudy lens has been removed, an intraocular lens (IOL) implant made of plastic, silicone, or acrylic, is inserted which permanently replaces the clouded natural lens. This new lens allows light to pass through and focus on the retina. The power and type of the lens implant is selected based on your prescription and lifestyle. In most cases, the IOL is inserted behind the iris, the colored part of your eye, and is called a posterior chamber lens. Sometimes, the IOL must be placed in front of the iris. This is called an anterior chamber lens. When the IOL is in place, the incision is closed, typically no stitches are required.
Click here to learn more about the cataract procedure process.
If I have a cataract, why would I wait to remove it?
A cataract develops gradually and sometimes blurry vision caused by a cataract can be improved by a change in prescription. If the cataract is not significantly interfering with your vision and lifestyle, you may want to wait to have it removed. Not all cataracts reach the stage where they should be removed. Regular visits to your eye doctor will help monitor the progress of a cataract and determine when surgery might be indicated.
If you have been diagnosed with a cataract by your regular eye doctor, he or she may refer you to a surgeon to discuss removal of the cataract. Medicare and insurance companies have stipulations on how badly the cataract must affect your vision before removing the clouded lens. If you have a cataract and increasing the prescription on your glasses or contacts still improves your vision, you may be able to postpone cataract surgery. However, the decision is ultimately up to you and if cataracts are keeping you from performing your daily tasks, it is likely time to proceed with surgery.
"A person should consider cataract surgery when their decreased vision is affecting their daily activities. When activities such as reading road signs, glare with headlights, and difficulty reading books becomes bothersome, that is the time to consider removing your cataract to improve your quality of living."
––Shawn Parker, MD, FACS, Corneal and Refractive Specialist
What is an IOL or lens implant?
Through cataract surgery, your natural lens is replaced with an IOL or intraocular lens implant. IOLs are artificial lenses your surgeon surgically implants in your eye to regain the ability to focus. Which lens is right for you depends on your vision needs and prescription. Monofocal IOLs are standard lenses based on one vision distance such as close-up or far away. Other lenses, known as premium IOLs, can correct multiple distances and a corneal astigmatism. Click here to learn more about different types of IOLs.
How do I choose an IOL or lens implant?
Until recently, nearly all cataract patients received the same type of replacement intraocular lens (IOL), a standard monofocal lens. These basic IOLs are designed to replace the cloudy lens and deliver excellent distance vision. However, advancements in IOL technologies allow patients to recover their vision, and reduce – or even eliminate – their need for glasses. Today, there are many more IOL options than in past years.
The two most important factors to consider are lifestyle and cost. If you have an active lifestyle and are hindered by glasses, bi-focals, or contacts, you may want to consider a "premium" IOL. You'll also need to think about cost. Cataract surgery with a standard IOL is covered by Medicare and most health insurance plans, however, cataract surgery with a premium IOL is not fully covered and include some out-of-pocket costs. Weigh these additional costs against what you pay for multi-focal glasses or contacts and determine which is more economical for your budget. Not everyone is a candidate for a premium IOL. Dr. Stuckenschneider and Dr. Parker's years of experience will help ensure your lens best meets your needs.
Click here to learn more about the IOLs offered at Eye Care Specialists.
What is the difference between accommodative and multifocal IOLs?
While both are presbyopia-correcting lenses, the multifocal and accommodating lenses achieve focusing ability in different ways. Both aim to do the same job of providing vision at near, intermediate, and at a distance lessening dependence on glasses.
A multifocal IOL utilizes concentric rings giving multiple viewing areas. Much like a bifocal or trifocal pair of glasses, the multifocal IOL allows patients to see different distances through the different "rings" or areas of the lens.
The Crystalens accommodating IOL utilizes "hinges" that work with the eye muscles to bend the IOL forward and backward or "accommodate" the lens to focus, performing much like the natural lens of the eye.
Click here for more information on lens implants.
What is presbyopia?
Daily activities such as reading, watching television, or working at the computer, constantly cause the eyes to change focus on objects at varying distances. This ability to quickly change focus between near, intermediate, and far distances is called accommodation. During mid-to-late 40s, everyone eventually develops a condition known as presbyopia. Presbyopia is the decreased ability to focus at near. This progressive loss of the accommodative (focusing) ability of the lens is due to the natural processes of aging and is commonly corrected by the use of reading glasses or bifocals.
Advancements in technology through presbyopia-correcting lens implants, such as multifocal and accommodative IOLs, have made it possible to cure cataracts and treat presbyopia.
Will I still need glasses after cataract surgery?
Most patients do not need glasses or contacts for distance vision following cataract surgery with a standard monofocal IOL, but still rely on reading glasses for near vision. However, the need for glasses after cataract surgery partly depends on which type of intraocular lens you choose. The goal of premium IOLs is to greatly lessen or eliminate the need for vision correction. IOLs, such as the AcrySof RESTOR Multifocal IOL or Crystalens Accommodative IOL, give clear vision at near, intermediate, and a distance. The AcrySof Toric IOL allows your surgeon to correct for astigmatism and a cataract at the same time lessening a patient's dependence on glasses to correct blurriness from astigmatism.
How long do IOL or lens implants last?
Intraocular lens (IOL) implants are made of plastic, silicone, or acrylic which are not subject to deterioration and should last a lifetime. However, your vision may naturally change as you age causing a change in prescription.
Is cataract surgery safe?
Cataract removal is one of the most common operations performed in the United States. It also is one of the safest and most effective types of surgery. In about 90 percent of cases, people who have cataract surgery have better vision post-surgically.
As with any surgery, cataract surgery poses risks, such as infection and bleeding. Before cataract surgery, the surgery center may ask you to temporarily stop taking certain medications that increase the risk of bleeding during surgery. After surgery, it is important to keep your eye clean, wash your hands before touching your eye, and use the prescribed medication drops to minimize the risk of infection. Serious infection can result in loss of vision.
How long is the procedure? Is it painful?
Plan to be at the surgery center 1 1/2 to 2 hours. The actual surgery is typically 20 minutes. Cataract surgery is an outpatient procedure performed under topical or local anesthesia. Although you are awake for the procedure, you will feel no pain nor will you see the actual surgery.
What are the potential side effects of the cataract surgery?
All patients respond differently to surgery and most recovery times are minimal with little discomfort. However, the following symptoms may be experienced after cataract surgery:
- Mild discomfort or scratchiness
- Mild light sensitivity and blurring of vision
- Drooping of the eyelid
What if the surgery doesn't work?
If your vision is not as clear as you anticipated after cataract surgery, several options are available. Vision should stabilize three to four weeks after surgery. You may need to change your glasses or contacts or, depending on your age, laser vision correction may be able to enhance your prescription. To ensure proper healing, you will need to wait three months before having LASIK. A final option would be to replace the implant with a different type or prescription strength IOL. However, the IOL is intended to be permanent and never needs to be replaced under normal circumstances.
Some patients experience subsequent clouding of the membrane that holds the lens, called the capsule. This typically would occur years after surgery and the normal treatment is a capsulotomy, in which a laser beam is used to create a hole through the membrane, allowing a clear path for light. Capsulotomy is a quick and painless procedure.
What are my limitations after cataract surgery?
The day after surgery you may resume climbing stairs, watching TV, reading, and/or sewing for short periods of time; tub baths with assistance in and out of the tub, showers and shampooing (avoiding soap and water in the eyes); shaving and beauty shop appointments. For one week do not wear eye makeup, lift anything over 20 lbs., and avoid bending or straining. You may drive after a discussion with your doctor. Patients should not swim for four weeks after surgery.
For post-operative instructions for your surgeon, click on the link below:
Will I be awake for the procedure?
Cataract surgery is an outpatient procedure performed under topical or local anesthesia. Although you are awake for the procedure, you will feel no pain nor will you see the actual surgery. You may be given a medication prior to surgery to help you relax and be comfortable.
Do you have cataract surgery on both eyes at the same time?
Only one eye will be operated on at a time. All patients are different and heal at different rates, typically you would have surgery on the second eye two to three weeks after the first eye.
How soon can I see after surgery?
Every patient and eye is different. Most patients are seeing clearly the next day.
Is cataract surgery covered by Medicare or insurance?
Standard cataract surgery using a monofocal lens is covered by Medicare and most insurance providers. However, cataract surgery using a premium lens, such as the Crystalens® accommodating lens implant, Acrysoft RESTOR® multifocal lens, or Acrysoft Toric lens implant, is not covered.
Opting for a premium lens is considered an upgrade and the difference between the cost of a standard procedure and premium procedure would be paid out-of-pocket.
If you are a candidate for a multifocal, toric, or accommodating lens and determine that a premium lens will best suit your needs, Eye Care Specialists offers a variety of payment options, including financing through CareCredit.
- Cash, Check or Money Order
- Visa, MasterCard or Discover
- Monthly payments through a CareCredit Financing Plan
Should I stop any medications before cataract surgery?
The morning of your surgery, you may take your regular medications with a little sip of water. However, if you take diabetic medication, blood thinners or aspirin, you should discontinue these medications as instructed by your doctor and the surgery center.
For pre- and post-operative instructions for your surgeon, click on the link below: