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Cataracts, Part II

Part II of everything you need to know about this common condition.

You thought that you just needed a new pair of glasses, but during your annual eye exam you were told that you have cataracts. You have been told that you may need a surgery to help correct your vision, but what does that actually mean? Why can't a simple glasses prescription change help the problem, and what happens if you do not do the surgery? These are all common questions that I get from patients in this situation, and taking the time to discuss the options and any associated risks is important to help all patients make an informed decision.

I think you can just make my glasses a little stronger.....right??

The vision symptoms a person experiences with cataracts can range from a vague sense of increased glare and halos with bright lights all the way to a dramatic reduction in overall vision. When a cataract is forming, there is often an associated change in a patient's overall glasses prescription. For many patients these prescription adjustments can get their vision back to a decent level, but there often also comes a point when there is no amount of prescription adjustment that will make any noticeable improvement. I describe these type of cataracts to patients as a dirty or foggy window. You can see through it, but it can be a little hazy and streaky when trying to make out what is on the other side. The window in this case is the internal crystalline lens in the eye, and no amount of prescription adjustment will make it easier to see though it. In order to properly correct the problem, the window needs to be cleaned, and in this case the answer is to remove the cataract surgically.

Wait a minute.....they take out a part of my eye and replace it??

In short...yes. That is exactly what happens during a cataract surgery. The natural crystalline lens in the eye is removed, and it is replaced with an artificial lens. When I tell patients this, their first reaction is usually surprise followed by a sense that this sounds like something out a sci-fi movie. Cataract surgery is an extremely common, repeatable and safe procedure that has been perfected after decades of cases. Very precise measurements need to first be taken to accurately measure the dimensions of the eye in order to design the appropriate artificial lens to be placed in the eye. The exact measurements of the lens are unique to each individual person, and they are designed specifically to match that person's eye and vision needs. One aspect of cataract surgery that many patients do not know is that the artificial lens has the ability to correct for a patient's prescription, so after the surgery it is often possible for someone to not need glasses or contact lenses to correct their vision. Advancements in the artificial lens technology have made it possible to correct for both distance and near vision in such a way that someone who was used to wearing corrective lenses may be completely glasses free for all tasks after the surgery. It is very important for all patients to discuss with their eye care team exactly what their visual demands are in order to choose the best lens option for them. Some patients are used to taking their glasses off to read, or they are used to having really good computer range vision without glasses, or they are not bothered by wearing reading glasses, and the choice of the replacement lens needs to match the patient's goals and expectations for their vision.

I need the surgery.....and everything is what actually happens during the surgery?

Once all of the preliminary work has been done to prepare for the surgery, patients always want to know what happens during the actual procedure. In order to reach the crystalline lens in the eye, small incisions must first be made in the cornea. This allows the surgeon to enter the eye with the appropriate instruments to begin removing the cataract. The natural crystalline lens in the eye is suspended in a membrane behind the pupil. A very precise incision must next be made in order to finally reach the cataract through this membrane. The natural lens is then broken apart using a combination of mechanical forces from the surgeon and also a special technique called phacoemulsification. This process breaks apart the crystalline lens with ultrasonic energy and then removes the small broken up pieces of the lens to make room for the artificial lens. Once the natural lens is removed completely, the artificial lens is inserted into the eye though the corneal incision and is unfolded and aligned behind the pupil. The corneal incisions are then sealed. The amazing thing about this entire process is that it usually takes only about 10 minutes! After the surgery is completed, it is very important for patients to follow the appropriate post surgical protocol. This involves a series of eye drops to reduce the risk of infection and to also reduce inflammation inside the eye. A series of post surgical exams is also very important to ensure proper healing. Once surgery on the first eye in completed, a few weeks are allowed for healing before the second eye can be operated on. In the space of only a few weeks, a patient can then go from blurry hazy vision in both eyes even with glasses to clear vision in both eyes without the need for glasses! It is a pretty incredible prospect when you really think about it.

Any surgery can be scary for patients, but we try to give patients enough information to help them make the most informed decision that will work for their needs. The doctors at Optique work with trusted surgeons throughout the Austin area in order to always give our patients the best options for the best outcomes. If you are concerned about cataracts, have been told you have cataracts, or are beginning the process of discussing cataract surgery, please let us know, so we can answer any questions and make the process as easy as possible for you.

-Dr Z