by David Hibbard | Photography by Diana Matthews
For millions of older adults, the ability to see clearly can be compromised by the development of cataracts, a clouding of the natural lens inside the eye. It’s a common condition, but one that can be treated more effectively than ever, thanks to major advances in surgery and lens implant options in recent years.
While cataracts can develop at any age, most patients don’t begin to have vision problems until they reach their 60s. How will you know if cataracts are affecting your vision? John W. French, MD, a specialist in corneal and external diseases and small-incision cataract surgery at Carolina Eye Associates. has a simple analogy.
“Many patients state that they feel like their glasses are dirty, but cleaning their glasses does not improve their vision,” Dr. French says.
In addition to blurred vision that isn’t improved with glasses or contact lenses, other cataract symptoms include glare from headlights or sunlight, difficulty with night vision, clouding of vision or the sense that visual activities in general are becoming more difficult.
Early-stage cataracts can sometimes be treated with a change in eyeglasses, but eventually, surgery will be required to improve a patient’s vision. The first step in the surgical process is a comprehensive exam of the eye, typically two or three hours in length, which provides data unique to each patient’s eye.
“Ophthalmologists consider this evaluation as part of the surgical process,” says Anna F. Fakadej, MD, a specialist in refractive cataract surgery at Carolina Eye Associates, “because there is a lot of analysis that the surgeon must perform on this data to perform the surgery.”
The ability to make precise measurements has been one of the most important advancements in cataract surgery in the last 20 years, both physicians say.
“Measurements of the eye are crucial to the outcome,” Dr. Fakadej says. “We can also laser map the eye and create computer models of an individual eye to assess, analyze and improve outcomes.”
After this pre-surgical evaluation, the physician typically meets with the patient and family to discuss the various options available for surgery, which includes removal of the cataract and implantation of a replacement lens. Recent improvements in replacement lens options give patients and physicians more specialized choices. These lenses offer correction for up-close vision, distance vision, astigmatism, presbyopia (a progressive loss of the ability to focus on nearby objects), or a combination of conditions. It’s important to discuss these options with your physician to determine which is right for you. Medicare and private insurance normally only cover the basic, single vision replacement lens, so you should talk with your physician about the costs involved with advanced lenses.
“The newer advanced technology lenses have improved patient satisfaction with their cataract surgery,” Dr. Fakadej says. “Patients have more freedom from the distortions of glasses and have broader range with functional vision.”
Yet another advancement in cataract surgery in recent years has been the use of precision lasers.
“Laser cataract surgery makes incisional work on the eye (easier) and softens the cataract inside the eye before the removal in the operating room,” Dr. Fakadej explains. “This provides a less traumatic eye surgery for the patient and hastens recovery.”
On the day of surgery, the patient receives a general anesthetic as well as local anesthesia around the eye. Using a laser, the cataract is removed and the replacement lens is implanted. After a short recovery time of an hour or two, patients can go home. If cataract surgery is needed in both eyes, the procedures are usually scheduled a week or two apart.
“The recovery from cataract surgery is fairly minimal compared to other surgeries,” Dr. French says. “Patients can return to many activities within a day of surgery. The common restrictions include no heavy lifting, bending over or strenuous physical activity for one week following surgery.”
While vision in the surgically-repaired eye may initially be blurry, patients generally notice rapid improvement in their vision in the first 24 or 48 hours. It’s normal for the eye to be red and feel scratchy afterwards; physicians typically prescribe antibiotic and anti-inflammatory eye drops to be used several times daily in the weeks following surgery to help the eye heal.
While cataract surgery certainly has the benefit of improved eyesight-many patients are amazed at how well they can see after recovery-there may be other benefits as well.
“Cataract surgery, especially in both eyes, seems to have a benefit of decreasing accident rates and fall rates in older adults and may have a positive impact for patients with dementia,” Dr. Fakadej adds.
The idea of surgery can be unnerving, but Dr. French stresses that today’s technology, combined with a variety of lens implant options, makes cataract surgery a safe, reliable choice.
“Fortunately, cataract surgery is one of the safest surgeries and has one of the highest satisfaction rates in medicine.”