Cataracts

The rapid changes in surgical technology leave all of us with too many choices and not enough information to make the right decision.  Ophthalmic Partners is committed to working with each patient and an individual.  We will identify the significant issues, educate you about options, and help you choose what will work best for you.  The physicians of Ophthalmic Partners perform an average of 3,000 cataract surgeries each year. In addition, Dr. Stephen Lichtenstein and Dr. Richard Tipperman focus predominantly on cataract surgery, with an emphasis on higher risk eyes and the management of complications.

WHAT IS A CATARACT?
Just like a camera, the eye has a lens that is responsible for focusing light.  The term “CATARACT” is used to describe a cloudy lens that can no longer focus properly.  Cataract affects about 1 in every 6 people over the age of 40 and by age 80 over half of all Americans have cataracts.  Cataract is a progressive disease.  With age, the lens increases in thickness and weight eventually changing the transparency of the lens.  A cataract is considered a normal part of the aging process.

WHAT ARE THE RISK FACTORS FOR CATARACTS
The most common risk factors include diabetes mellitus, long term corticosteroid use and prior intraocular surgery.  The incidence of cataracts is higher in certain chronic diseases associated with inflammation.  There is also an association with smoking and lifetime exposure to ultraviolet-B radiation.

CAN CATARACTS BE PREVENTED OR DELAYED?
There is no conclusive evidence that nutritional or vitamin supplementation can delay the onset or progression of cataracts, and there are no proven pharmacological treatments.  Management of a visually significant cataract is surgical.

WHEN IS CATARACT SURGERY INDICATED?
The impact of a cataract can be subjectively assessed by how it affects your activities of daily living.  In addition to progressive blurred vision and glare, cataracts can also cause impaired color vision and even double vision.  A major concern is loss of depth perception.
Often, cataract progression occurs so slowly (especially if both eyes are changing at the same rate) that patients adapt to their visual impairment and fail to notice.  Testing can measure your compromised vision and the impact of glare, and in the early stages changing your glasses may provide some improvement
Cataract surgery is most often indicated when your visual function no longer meets your needs and your eye exam, combined with the results of diagnostic testing, suggests the likelihood of improved vision if the cataract is removed.  In a small percentage of patients, surgery is indicated for the health of the eye or to facilitate diagnosis and management of another ocular problem.

THE IMPACT OF CATARACT SURGERY
The loss of visual function in the elderly is associated with a decline in physical and mental functioning, as well as independence in activities of daily living such as driving, reading, social and community activities, and household tasks.  Visual function plays an important role in terms of mobility and is a significant factor in falls and hip fractures, which often lead to nursing home placement.  Up to 90% of patients undergoing cataract surgery note improvement in functional status and satisfaction with vision after surgery in the first eye, with a significant reduction in the rate of falling and hip fracture. Similar improvement following surgery in the second eye has also been confirmed.  Drivers with visually significant cataracts are two to three times more likely to have an at-fault motor vehicle crash.
Numerous studies show that physical function, mental health, emotional well-being, safety and overall quality of life can be enhanced when visual function is restored by cataract extraction.

INTRAOCULAR LENSES
Cataract surgery removes the cloudy focusing lens from the eye. Virtually every operation is combined with the placement of a new focusing lens called an intraocular lens implant or IOL. This lens is designed to remain in the eye forever. Surgeons can choose from a wide variety of IOLs to address the patient’s needs and desires. The strength or power of the IOL is calculated from measurements obtained at the time of your evaluation.

CAN MY CATARACT BE REMOVED USING A LASER?
There are many surgical options to remove a cataract. In the United States most include the use of “phacoemulsification” where ultrasound is used to break up the densest parts of the cataract so they can be removed through a small incision.  The “femtosecond laser” is the newest advancement in cataract surgery and adds additional precision and control when utilized for astigmatism reduction.  Click here for additional information on the femtosecond laser.

INTRAOCULAR LENS FOCUSING TECHNOLOGY OPTIONS
MONOFOCAL IOLs are calculated to focus light at one distance.  You and your surgeon can decide to aim for good distance vision, good intermediate vision, or good near vision without glasses. In addition to the patient’s desires the most important issue is to choose an IOL so that both eyes work together without too much of an imbalance.  Glasses are usually necessary after surgery to provide a full range of vision since the monofocal only corrects one range. 

• Blended vision/Monovision is a condition in which one eye is corrected for distance and the fellow eye is corrected for intermediate or near vision. This requires the brain to shift into the clearer focused eye while suppressing the blurred image in the fellow eye. Many patients tolerate this well and are able to function uncorrected for most activities.

TORIC IOLs are a type of monofocal designed to maximize uncorrected vision quantity and quality by neutralizing pre-existing astigmatism that is present in greater than 30% of patients.

PRESBYOPIA (loss of near vision with aging) correcting IOLs are designed to reduce dependence on glasses by providing a greater range of vision uncorrected from distance to near, at the very least reducing the need for glasses and ideally providing independence from glasses for many activities.

• Multifocal IOLs divide the light that enters the eye, improving both uncorrected distance and near vision compared to monofocals.
• Accommodative IOLs are designed to change position or shape in the eye to provide a greater focusing range.
  WHAT IS “PREMIUM CATARACT SURGERY”?

Premium cataract surgery refers to astigmatism reduction and/or multifocal/accommodatiove IOL surgery to reduce dependence on glasses. Additional testing and surgical planning are required, and these options are associated with an additional cost not covered by insurance.  These decisions can only be finalized after a detailed discussion with your surgeon.