Experience the Life-Changing Effects of
Cataract Surgery

A cataract is an opacification of the natural lens that causes blurry, cloudy, or distorted vision. The human lens is located just behind the iris, or the colored part of the eye. A healthy lens is clear and flexible, allowing us to see focused images. As a part of the normal aging process, the proteins in the lens oxidize, which leads to a loss of clarity and hardening. Left untreated, a cataract can become so dense that it causes blindness and a white appearance to the pupil. In fact, cataracts are the leading cause of blindness in the world. There are multiple types of cataracts, and even within the same type, there are a range of symptoms a person can experience.

Everybody who lives long enough develops cataracts, so they are considered a normal part of the aging process, similar to graying hair and aging skin. There are no known medicines to stop or reverse this change. Certain factors can speed up cataract formation, such as diabetes, steroid use, trauma, smoking, alcohol, and excessive sunlight or radiation exposure. In rare cases, cataracts are present at birth and are genetic or caused by a problem during development. Cataracts are present in 50% of people by the age of 65 and in 95% by the age of 75. More than 3 million cataract surgeries are performed in the U.S. each year. Cataract surgery has an overall success rate of 97 percent or greater in the US.

Age-related cataracts develop very slowly and painlessly. In fact, many people discover they have a cataract only when they visit their eye doctor for new glasses. Early in the course of cataract formation, changes in glasses or contact lens prescription can improve vision to some extent. Eventually, a new prescription does not allow for "satisfactory" vision. "Satisfactory vision" may differ from patient to patient and depends on factors such as occupation, hobbies, driving needs, and personality. Many people believe that cataracts have to be "ripe" or in a highly advanced stage before they can be removed. This is no longer true. Today, cataract surgery is a routine procedure that can be typically performed as soon as you and your physician feel your vision interferes with the quality of your life.

Surgery is the only definitive treatment. Cataract surgery involves removing the damaged natural lens through a small incision, typically less than 3 millimeters or a tenth of an inch. Phacoemulsification (ultrasound), sometimes with femtosecond laser-assist, can safely break up the cataract. The lens has a natural coating, called the "capsular bag", that is preserved and polished to make it clear. The intraocular lens implant (or "IOL") is usually placed through the same incision and into the capsular bag. The lens unfolds, fills the capsular bag, and stabilizes without the need for glue or stitches. Most patients have significantly improved vision after the procedure.

A fast-pulsed laser can be used to create the incisions (corneal and capsulotomy), treat astigmatism (laser arcuate incisions), and begin the breakup of the cataract. This method adds an additional step which takes only a few minutes but may allow a more precise result by using 3-D imaging intraoperatively to exactly center the IOL, make the incisions, and treat astigmatism. There is an additional charge for FLACS since it is not covered by insurance.

An IOL is a manufactured artificial lens implant made from silicone, acrylic, or plastic. IOLs are available in different powers, just like contact lenses. The power is chosen specifically for each eye, based on measurements by your doctor. IOLs are made of safe, durable materials and you can expect that the implant will last your lifetime without need for replacement or maintenance.

A standard IOL is monofocal. This means the IOL only focuses at one distance. If an IOL is set for distance vision, then the eye typically needs glasses to read. Alternatively, the IOL can be set for intermediate or reading vision, but the eye will need glasses for distance vision. For someone who does not mind wearing glasses after cataract surgery, a monofocal lens can provide an excellent result.

IOL technology is progressing rapidly. You now have the option to choose from a selection of "premium" IOLs. This allows you to fix or reduce your presbyopia (loss of reading vision) or your astigmatism. Premium lenses are ideal for those with active lifestyles who are annoyed by glasses. They allow you to turn a potentially negative condition, cataracts, into an opportunity to improve your vision. Because they are optional, premium lenses and the associated services are not covered by insurance and are an out-of-pocket investment in your vision.

A toric IOL is a premium IOL that makes it possible to not only treat the cataract but also to correct corneal astigmatism. Corneal astigmatism occurs when the cornea is not perfectly spherical, causing blurry vision at all distances. If you have astigmatism and choose a standard IOL, you will still have blurry vision unless you wear glasses. A toric IOL has the correction for astigmatism built in and is an excellent option for someone who wishes to spend much of their time without glasses.

Cataract surgery is usually done on an outpatient basis; the actual surgery is 15 to 20 minutes long. Upon arrival at the facility, you will be given eye drops to dilate your pupils and a sedative to help you relax. A local or topical anesthetic will make the operation painless. Under an operating microscope, very small incisions are made through which micro instruments are used to remove your cataract. The IOL will be rolled up and injected into the capsule and placed in the eye where it will unfold. Even though the operation itself usually takes less than 20 minutes, you should plan to spend 3 hours at the surgery center.

Experiencing pain would be unusual. Most patients feel some occasional mild eye pressure and a lot of cool fluid. Most patients are surprised when we tell them "Your surgery is over!" You are typically very relaxed from the sedation, and you may even doze during the operation.

When you get home after the surgery, just take it easy and rest. During at least the first week, avoid strenuous activity and heavy lifting (nothing over 40 pounds), water that might splash into your eye, swimming or hot tubs for at least two weeks, dust or infection-causing contaminants, and eye makeup. Vision on the day of surgery is usually blurry. You usually experience your best vision two to four weeks post-operatively. Dry eye is a common side effect that may require additional treatment.

Once you have had successful cataract surgery, you will never need to have cataract surgery again. Occasionally, several months or years later, your vision may start to become cloudy again. This is sometimes called a secondary cataract and refers to the clouding of the capsular bag that surrounds the implant. There is a simple cure called a YAG Laser Capsulotomy which quickly and painlessly breaks up the membrane in the office.

Medicare and commercial insurance companies cover most of the cost of cataract surgery; however, they do not pay for everything. The goal of minimizing glasses is considered optional. Premium lenses and the associated services are not covered by insurance and are an out-of-pocket investment. Our cataract specialist team will review your insurance coverage and out-of-pocket expenses with you prior to your surgery.

Rarely, complications occur that can permanently affect vision. Some important ones include infection, bleeding, posterior capsular rupture, and vitreous loss. All of these conditions occur in less than 1% of cases at GOA. Other risks include peripheral shadows, dry eye, a cloudy cornea, eyelid drooping, and floaters. Most of these symptoms resolve or improve with time. Cataract surgery has an overall success rate of 97 percent or greater.