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Bradley D. Geller, M.D., F.A.A.O

Emerson Office

466 Old Hook Road Suite 24E

Emerson, NJ 07630

Ph / (201) 265-7515

Fx / (201) 265-8626

Cataracts

         
What are cataracts?
If your vision has become cloudy or things you see are not as bright as they used to be, a cataract may have developed in one or both of your eyes. A cataract is a clouding of the eye’s naturally clear lens. Your eye becomes like a window that is frosted or yellowed.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.

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What are the symptoms of cataracts?
The only way to know if you have cataracts for certain is when your ophthalmologist (Eye M.D.) does a dilated eye exam. Get a baseline exam at age 40, when early signs of disease and changes in vision may start to occur. Your Eye M.D. will let you know how often you should return for follow-up exams. At any point, if you have symptoms or risks for eye disease, see your Eye M.D.  Because your risk for cataracts and other eye diseases increases as you get older, starting at age 65 you should see your Eye M.D. every year.  A complete eye examination will rule out any other condition that may be causing blurred vision or eye problems.

Most age-related cataracts develop gradually. As a result, you may not immediately notice changes in your vision when cataracts first develop.
In time, you may have symptoms such as:
•    Painless clouded, blurry or dim vision;
•    Increasing difficulty seeing at night or in low light;
•    Sensitivity to light and glare, seeing halos around lights;
•    Colors seem faded or yellowed;
•    The need for brighter light for reading and other activities;
•    Frequent changes in eyeglass or contact lens prescription; or
•    Double vision within one eye

How are cataracts diagnosed?
During a comprehensive, dilated eye exam, your Eye M.D. uses several tests to check for cataracts:
Slit-lamp. This device allows your Eye M.D. to closely examine the eye’s cornea, iris, lens and the space between the iris and cornea. The doctor is able to examine the eye in small sections, making it easier to see abnormalities.
Retinal exam. When your eye is dilated, the pupils are wide open so the doctor can more clearly see the back of the eye. Using the slit lamp and/or an instrument called an ophthalmoscope, the doctor looks for signs of cataract and if present, the extent of the clouding. Your Eye M.D. will also look for signs of glaucoma and other potential problems with the retina and optic nerve.
Refraction and visual acuity test. This refers to the sharpness and clarity of your vision. Each eye is tested individually for the ability to see letters of varying sizes.           

Once I know I have cataracts, what should I do?
Have an eye exam every year if you’re older than 65, or every two years if younger.
Protect your eyes from UV light by wearing sunglasses that block at least 99 percent  UV and a hat.
If you smoke, quit; smoking can increase cataract progression.
Use brighter lights for reading and other activities; a magnifying glass may be useful, too.
Limit night driving once night vision, halos or glare become problems.
Take care of any other health problems, especially diabetes.
Get the right eyeglasses or contact lenses to correct your vision; when it becomes too difficult to complete your regular activities, consider cataract surgery.
        
    There are many misconceptions about cataract. A cataract is not:
•    A growth or film over the eye;
•    A cause of irreversible blindness;
•    A result of overusing the eyes;
•    A contagious disease spread from eye to eye or person to person.

    
There are many misconceptions about cataract. A cataract is not:
•    A growth or film over the eye;
•    A cause of irreversible blindness;
•    A result of overusing the eyes;
•    A contagious disease spread from eye to eye or person to person.

What causes cataracts?
The design of the human eye is much like that of a camera. Light rays are focused through the lens onto the retina, a layer of light-sensitive cells at the back of the eye that is similar to film. In a normal eye, light rays pass through a clear lens and are focused onto the retina. This produces a bright, clear image.
As the body ages, the lens continues to grow layers onto the existing surface. Over time the lens hardens and becomes cloudy, which often results in dull, cloudy or blurred vision. This condition, known as an age-related cataract, is normal and occurs eventually in most people.
If the clouding is mild or affects only a small area of the lens, your vision may be only slightly affected. If there is more clouding and it affects the entire lens, your vision will become severely limited.

What else causes cataracts?
Less common types of cataracts, not related to normal aging, include:
Congenital or developmental cataracts. Can occur in children. They may be hereditary or can be associated with some birth defects. Some occur without any obvious cause.

Secondary cataracts. Caused by other eye diseases or previous surgery within the eye. Formation of secondary cataracts may be accelerated by a chronic disease, such as diabetes, or excessive use of steroid medications.

Traumatic cataracts. Related directly to an eye injury. Traumatic cataracts may appear immediately following injury, or develop several months or even years later.

How are cataracts diagnosed?
During a comprehensive, dilated eye exam, your Eye M.D. uses several tests to check for cataracts:
Slit-lamp. This device allows your Eye M.D. to closely examine the eye’s cornea, iris, lens and the space between the iris and cornea. The doctor is able to examine the eye in small sections, making it easier to see abnormalities.

Retinal exam. When your eye is dilated, the pupils are wide open so the doctor can more clearly see the back of the eye. Using the slit lamp and/or an instrument called an ophthalmoscope, the doctor looks for signs of cataract and if present, the extent of the clouding. Your Eye M.D. will also look for signs of glaucoma and other potential problems with the retina and optic nerve.

Refraction and visual acuity test. This refers to the sharpness and clarity of your vision. Each eye is tested individually for the ability to see letters of varying sizes.           
 
Once I know I have cataracts, what should I do?

  • Have an eye exam every year if you’re older than 65, or every two years if younger.
  • Protect your eyes from UV light by wearing sunglasses that block at least 99 percent UV and a hat.
  • If you smoke, quit; smoking can increase cataract progression.
  • Use brighter lights for reading and other activities; a magnifying glass may be useful, too.
  • Limit night driving once night vision, halos or glare become problems.
  • Take care of any other health problems, especially diabetes.
  • Get the right eyeglasses or contact lenses to correct your vision; when it becomes too difficult to complete your regular activities, consider cataract surgery.


How are cataracts treated?
If your vision is only slightly blurry, a change in your eyeglass prescription may help for a while. However, if you are still not able to see well enough to do the things you like or need to do after the change in eyeglass prescription, cataract surgery should be considered.

Cataract surgery is often performed as an outpatient procedure and does not require an overnight stay. There are usually few restrictions, and you will be able to resume your normal activities almost immediately.

Before surgery, the length of your eye will be measured in what is called an A-scan, and the curve of your cornea will be measured in a technique called keratometry. These measurements help your Eye M.D. select the proper lens implant for your eye.

The most common procedure used for removing cataracts is called phacoemulsification.  A small incision is made in the side of the cornea (the front part of your eye). Your Eye M.D. inserts a tiny instrument through the incision that uses high-frequency ultrasound to break up the center of the cloudy lens and suction it out. The lens is removed in one piece, using a technique called extracapsular extraction.


After the cloudy lens has been removed, the surgeon will replace it with an intraocular lens (IOL) implant made of plastic, silicone or acrylic. This new lens allows light to pass through and focus on the retina. The IOL becomes a permanent part of your eye. 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 surgeon closes the incision. Stitches may or may not be used.


In some cases, the part of the lens covering that supports the IOL (called the capsule) can become cloudy several months or years after the first cataract was removed. This is called an “after cataract” or “secondary cataract.” If this occurs and blurs your vision, your Eye M.D. will make an opening in the center of the cloudy capsule with a laser to allow light to pass through the lens properly again. This procedure, called a posterior capsulotomy, takes about five minutes in the doctor’s office and requires no recovery period.


If you are having cataract surgery, be sure to tell your doctor if you are currently or have ever used alpha-blocker medications such as Flomax®, Uroxatral® or Cadura®. These medications affect the iris or pupil and can lead to complications during cataract surgery. You can still have a successful surgery if your surgeon knows that you have taken these drugs and appropriately adapts his or her surgical technique. You should also tell your Eye M.D. about any other sedative medications you are taking.


Before intraocular lenses (IOLs) were developed, people had to wear very thick eyeglasses or special contact lenses to be able to see after cataract surgery. Today several IOL types are available to help people enjoy improved vision. Discuss these options with your Eye M.D. to determine the IOL that best suits your vision needs and lifestyle.


How IOLs work
Like your eye’s natural lens an IOL focuses light as images, received from the cornea and pupil at the front of the eye, onto the retina, the sensitive tissue at the back of the eye that relays images through the optic nerve to the brain. Most IOLs are made of a flexible, foldable material and are about one-third of the size of a dime.  Like the lenses of prescription eyeglasses, your IOL will contain the appropriate prescription to give you the best vision possible. Read below to learn about how IOL types correct specific vision problems.


Which IOL is right for you?
Before surgery your eyes are measured to determine your IOL prescription, and you and your Eye M.D. decide which IOL type will be best for you, in part depending on how you feel about wearing glasses for reading and near vision.
The type of IOL implanted will affect how you see when not wearing eyeglasses. Glasses may still be needed by some people for some activities.
If you have astigmatism your Eye M.D. will discuss toric IOLs and related treatment options with you.

IOL types
Monofocal: This IOL type has been in use for several decades.
Monofocals are set to provide best corrected vision at near, intermediate or far distances.
Most people who choose monofocals have their IOLs set for distance vision and use reading glasses for near activities. On the other hand, a person whose IOLs were set to correct near vision would need glasses to see distant objects clearly.

Some who choose monofocals decide to have the IOL for one eye set for distance vision, and the other set for near vision, a strategy called “monovision.” The brain adapts and synthesizes the information from both eyes to provide vision at intermediate distances. Often this reduces the need for reading glasses. People who regularly use computers, PDAs or other digital devices may find this especially useful. Individuals considering monovision may have a trial with monovision contact lenses to learn how well they can adapt to monovision. Those who require crisp, detailed vision may decide monovision is not for them. People with appropriate vision prescriptions may find that monovision allows them see well at most distances with little or no need for eyeglasses.

Presbyopia is a condition that affects everyone at some point after age 40, when the eye’s lens becomes less flexible and makes near vision more difficult, especially in low light. Since presbyopia makes it difficult to see near objects clearly, even people without cataracts need reading glasses or an equivalent form of vision correction.
Multifocal or accommodative: These newer IOL types reduce or eliminate the need for glasses or contact lenses.


In the multifocal type, a series of focal zones or rings is designed into the IOL. Depending on where incoming light focuses through the zones, the person may be able to see both near and distant objects clearly.


The design of the accommodative lens allows the eye’s ciliary muscles to move the IOL forward and backward, thus allowing the focus to change much as it would with a natural lens and enabling near and distance vision.

The ability to read and perform other tasks without glasses varies from person to person but is generally best when multifocal or accommodative IOLs are placed in both eyes.

Usually 6 to 12 weeks are required after surgery on the second eye for the brain to adapt and for full visual improvement to be realized with either of these IOL types.
Considerations with multifocal or accommodative IOLs

For many people, these IOL types reduce but do not eliminate the need for glasses or contact lenses. For example, a person can read without glasses, but the words appear less clear than with glasses.

The effectiveness in a specific person may depend on the size of his/her pupils and other eye health factors. People with astigmatism can ask Dr. Geller about toric IOLs and related premium lenses such as Crystalens. The Crystalens® is implanted during standard outpatient cataract surgery. In the United States, on average over 8,000 cataract procedures are performed a day. The cataract procedure is quick, simple and allows for relatively fast healing. This safe and painless procedure typically starts with eye-numbing drops and a micro-seal being made at the edge of the cornea. The natural lens is gently washed away and Crystalens is implanted. Crystalens can be implanted quickly and without sensation. Most patients return for a follow-up visit with the physician the day after surgery. The recovery period is usually short. Most patients are able to pursue normal activities almost immediately after surgery. Patients usually have a follow-up visit scheduled with the surgeon to evaluate the patient's recovery. (Discuss with your doctor beforehand what to expect before, during, and after the procedure in terms of eye drops and office visits.) If you are like most patients who have Crystalens, you can expect to see sharper images than you have seen in years. 

Side effects such as glare or halos around lights, or decreased sharpness of vision (contrast sensitivity) may occur, especially at night or in dim light. Most people adapt and are not bothered by these effects, but those who frequently drive at night or need to focus on close-up work may be more satisfied with monofocal IOLs.

Toric: This is a monofocal IOL with astigmatism correction built into the lens.

Astigmatism: This eye condition distorts or blurs the ability to see both near and distant objects. With astigmatism the cornea (the clear front window of the eye) is not round and smooth (like a basketball), but instead is curved like a football. People with significant degrees of astigmatism are usually most satisfied with toric IOLs.

People who want to reduce (or possibly eliminate) the need for eyeglasses may opt for an additional treatment called limbal relaxing incisions, which may be done at the same time as cataract surgery or separately. These small incisions allow the cornea’s shape to be rounder or more symmetrical.

Protective filters: IOLs include filters to protect the eye’s retina from exposure to UV and other potentially damaging light radiation. Dr Geller selects the filters that will provide appropriate protection for the patient’s specific needs.

        Please talk to Dr Geller about your lens options at your next visit.

Member of the Cataract Surgeon Directory Network at www.aboutcataractsurgery.com providing information about Cataracts, Cataract Surgery and Intraocular Lens Implants (IOL)