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A Definitive Guide to Cataract Surgery (Updated 2016)

17/11/2016
by Milan Eye Center

Myopia or Nearsightedness

If you’re over the age of 50, you might have noticed a few changes in your eyesight in recent years. (Source: National Eye Institute)

Maybe your vision has become blurry…

Maybe you’ve become sensitive to light and glare…

Or maybe none of the above have happened, but you’re aware there’s a good chance in the future.

If that’s you, then you might be considering cataract surgery.

Like any surgical procedure, there’s a lot to consider. And reading resource after resource might have left you feeling overwhelmed and confused about what advice to follow.

You might be asking yourself:

  • “What is cataract surgery?”
  • “How much does cataract surgery cost?”
  • “When should I have cataract surgery”
  • “Does Medicare cover cataract surgery?”

Today, you can rest easy, because all that’s about to change. In this comprehensive article, we’ll walk you through everything you need to know about cataract surgery, and whether it’s right for you.

Let’s get started.

Part 1: Overview

In Part 1, we’ll discuss what cataracts are, the science behind how they form and the consequences of not getting them treated.

What Is a Cataract?

A cataract is a clouding of the eye’s natural lens which causes reduced vision.

According to AllAboutVision, cataracts affects more than 22 million Americans age 40 and older…

…and that number is expected to exceed 50 million by 2050:

projections-for-cataract-in-2030-and-2050

Source: National Eye Institute.

What Causes Cataracts?

To understand the cause of cataracts, we first need to understand how the eye enables us to see, and what role the eye’s natural crystalline lens plays in the process.

The eye is comprised of the retina, the pupil, and the lens.

Eye Diagram

Source: National Eye Institute

Situated behind the iris and the pupil is the eye’s natural, crystalline lens.

When light enters the eye (through the pupil), the lens shortens and lengthens its width, and focuses it onto the retina where a clear, sharp image is recorded.

Myopia or Nearsightedness

Source: VisionAware.org.

This image is transformed into electrical impulses which are then transmitted through millions of nerve fibers to the optic nerve.

The lens, itself, is comprised of mostly water-soluble protein and is transparent enough to let light easily pass through. (Source: Hoehenwarter, W., Klose, J. & Jungblut, P.)

As we age, lens protein can degrade and “clump” together, reducing the clarity of the image reaching the retina.

Over time, the cataract may grow larger and cloud the lens further, affecting your vision.

Contrary to popular belief, a cataract can’t spread from one eye to another, nor can it be caused by overusing your eyes. (Source: National Eye Institute)

What Are the Different Types of Cataract?

There are three primary types of age-related cataracts:

  1. Nuclear sclerotic cataracts
  2. Cortical cataracts
  3. Posterior subcapsular cataracts

Let’s discuss each briefly.

1. Nuclear sclerotic (also known as “nuclear cataracts”)

Nuclear sclerosis occurs when the center of the eye (or “nucleus”) goes hard (or “sclerotic”) due to compression of older lens fibers in the nucleus by new fiber formation.

As the nucleus hardens, it becomes cloudy (or “opacifies”) and affects your vision.

Mature Cataract

(Source: American Academy of Ophthalmology)

Nuclear sclerosis is the most common of the three. (Source: American Academy of Ophthalmology)

2. Cortical cataracts (also known as “white cataracts”)

Cortical cataracts occur when the outer layer of the lens (or lens cortex) becomes opaque.

Over time, the clouding moves from the periphery of the lens cortex to the center, much like the spokes in a wheel.

Cortical Cataracts or White Cataracts

(Source: Medscape)

People with diabetes are at more risk of developing cortical cataracts. (Source: Javadi, M.A., Zarei-Ghanavati, S.)

3. Posterior subcapsular cataracts

Posterior subcapsular cataracts are caused by opacities in the most posterior cortical layer, directly under the lens capsule.

Posterior subcapsular cataracts

(Source: Orlando Eye Institute)

These cataracts are more common in younger age groups and tend to form faster than cortical or nuclear sclerotic cataracts (with symptoms surfacing within a few months of it first beginning). (Source: M. Edward Wilson)

Studies have also found that people taking steroids, have diabetes, or suffer from extreme nearsightedness and/or retinitis pigmentosa, are more prone to developing this type of cataract. (Source: Jobling A., Augusteyn R.C.)

What Are Symptoms of Cataracts?

In the beginning of their formation, most age-related cataracts have little effect on your vision. Subsequently, you may not notice signs or changes in your vision right away when cataracts first develop.

Over time, though, as the cataract gets bigger, the clouding of the lens will diffract light entering your eye and your vision will deteriorate.

While symptoms are gradual, the symptoms you experience and how soon they occur depend on the type of cataract you have.

If you have a nuclear cataract, for example, you might notice a temporary improvement in your near vision, known as “second vision” (though this improvement will disappear as the cataract grows larger). (Source: AllAboutVision)

Common symptoms of cataracts include:

  • Clouded or blurry vision. Your vision may become hazy and blurry like you’re viewing the world through frosted glass.
  • Fading or yellowing of colors. If you notice colors fading and lacking the brightness they once did, you might need to have your eye examined.
  • Sensitivity to light and glare. This can be painful, particularly to those with posterior subcapsular cataracts (Source: Mayo Clinic)
  • Seeing “halos” around lights. This makes activities like driving at night especially dangerous. One Australian study found motorists suffering from cataracts were less capable of noticing and responding to potentially dangerous hazards on the road, and thus, more prone to getting into road accidents. (Source: Marrington S.A., Horswill M.S., Wood J.M.)
  • The need for brighter light for reading and other activities. If your vision at night becomes affected, you might be experiencing the beginning of a cataract.
  • Double vision or multiple images in one eye. Be aware as this symptom is known to clear as the cataract gets larger (Source: National Eye Institute)
  • Frequent prescription changes in your eyeglasses or contact lenses. If you wear glasses or contact lens, you may find the prescription weakens over time.

If you notice any changes in your vision or experience any of the symptoms listed above, it’s advised you book an appointment for an eye exam.

An ophthalmologist (eye doctor) will determine whether you have early signs of cataract development using what’s called a “dilated eye exam.” This is when a special magnifying lens is used to examine your retina and optic nerve for signs of damage and other eye problems.

What Happens If You Don’t Get Cataract Surgery?

As we learned before, a cataract is caused by clouding in the eye’s natural lens. When the cataract hardens, it becomes “ripe” or “mature”, affecting your vision.  And as the cataract grows larger, the entire lens may eventually become white.

In the past, you would have been advised to wait until your cataract was “ripe” before having surgery.

Today, though, it’s a different story.

With modern advances in cataract technology, it’s advised you have it removed sooner rather than later (when, exactly, we’ll discuss in the following section).

If a cataract is left untreated, it will gradually get worse and affect your eyesight to the point where you may no longer be able to perform daily activities such a driving or reading.

Furthermore, it may prevent your doctor from identifying other eye-related problems or operating in the future, should you need it. (Note: if a cataract becomes “hyper-mature”, surgical complications become far more likely.)

A common question we’re asked is, “Can cataracts cause blindness?” While outcomes like blindness are rare, it is possible (though legal blindness often comes a long way before total blindness).

When Should I Get Cataract Surgery?

You’re probably already aware that the only way to remove cataracts is cataract surgery.

But what you might not be aware of is when you need to have it done.

It’s important to mention here that a cataract should NOT be removed just because it’s present.

In fact, minor changes in your vision can often be improved with prescription glasses.

If, though, your vision deteriorates to the point where you’re no longer able to do everyday activities, then it’s advised you book an appointment with an ophthalmologist.

According to The American Academy of Ophthalmology, there are four questions you can ask yourself to help you determine whether you’re ready for cataract surgery:

  1. Are your cataracts impacting your daily or occupational activities?
  2. Are your cataracts affecting your ability to drive safely at night?
  3. Are your cataracts interfering with the outdoor activities you enjoy?
  4. Can you manage your cataracts in other ways?

As a final point, it’s important you understand that moving forward with cataract surgery is always your choice.

While a doctor can advise you based on your circumstances, the decision MUST always come from you.

Part 2: Cataract Surgery

Is Part 2, we’ll discuss everything you need to know about cataract surgery, including how much it costs, and the risks and benefits associated with the procedure.

What Is Cataract Surgery?

Cataract surgery involves removing the cloudy lens from the eye and replacing it with an artificial, intraocular lens implant (IOL) lens.

The procedure, generally performed by an ophthalmologist, uses local anesthesia in an outpatient setting (which means you can often go home the same day) and causes little to no harm to the patient (in fact, most patients are often surprised with how quick the procedure is).

With an overall success rate of 98 percent or higher in restoring vision and a turnaround time of about 20-25 minutes, cataract surgery is one of the safest, same-day procedures in the world. (Source: All About Vision)

Phacoemulsification Cataract Surgery (An Overview)

There are several types of cataract surgery (intracapsular, extracapsular, etc.) but the most common surgical technique is called phacoemulsification cataract surgery (otherwise known as small-incision surgery).

How Does Phaco Surgery Work?

Before surgery, the length of your eye and the curve of your cornea will be measured using an “A-Scan” and a technique called “keratometry.” This will help the ophthalmologist determine the correct replacement lens for your surgery.

During the procedure, itself, your ophthalmologist will make one or more incisions in the front of your eye. Then, using a phaco probe—which transmits ultrasound waves—he or she will break up (emulsify) the cataract and remove the remaining fragments before placing the intraocular lens implant (IOL) lens into the remaining lens capsule.

If you have cataracts that affect your vision in both eyes, you’ll need two separate operations, usually carried out 2 weeks apart. (Source: National Health Service)

What Are The Benefits of Cataract Surgery?

With 3 million Americans going under the knife each year, cataract surgery is one of the most common and successful surgical procedures performed today. (Source: AllAboutVision)

Aside from the more obvious benefits of improved vision (e.g. seeing things in focus, being able to tell the difference between colors, etc.), cataract surgery has benefits that extend beyond eyesight, too.

A few of the most recent and exciting findings include:

  • Improved quality of life. Health and vision-related quality of life have been shown to improve after cataract surgery. A study published in 2013 found that quality of life for patients who had cataract surgery improved by 36 percent. (Source: Brown et al 2013)
  • Decreased risk of falling and fracturing bones. A common consequence of cataracts is falling more often (and with greater severity). A 2012 study found patients who had cataract surgery had lower odds of fracturing their hips within one year after surgery. (Source: Victoria et al 2012)
  • Improve your chance of living longer. One 2013 study—comparing people over the age of 49 years who had cataract-related vision loss and had cataract surgery—found that there was a 40 percent lower long-term mortality risk in those who had the surgery. (Source: Fong et al 2013)

What Are The Risks of Cataract Surgery?

While cataract surgery is extremely safe, as with any surgical procedure, there are risks (though most are rare and can be quickly and easily treated).

If, for example, you have another eye condition (e.g. glaucoma or macular degeneration) your risk of complicating the procedure becomes higher.

This is why it’s important to discuss any concerns you might have with your ophthalmologist before deciding whether to go ahead with cataract surgery.

The following are the most common risks you need to be aware of.

  • Posterior capsular opacification (PCO). One of the most common cataract surgery complications is a posterior capsule opacity (or PCO). This occurs when the thin clear membrane that surrounds the natural lens (called the lens capsule) becomes clouded, causing hazy vision. Treating PCO is fairly straightforward and normally requires creating an opening in the back the back of the lens capsule so that the light can once again pass directly to the retina.
  • Retinal detachment. This is when the retina (the neurosensory lining the back of our eye) becomes detached from the inner back wall of the eye, often months or even years after a successful cataract procedure. If you experience floaters (spots within your vision that move or “float” when you look around), flashes of light or curtain-like vision loss after surgery, make an appointment with your ophthalmologist, immediately. Failing to get retinal detachment treated can result in permanent loss of vision.

Other cataract surgery complications include infection (endophthalmitis), bleeding and swelling of the retina (cystoid macular edema), though these are less common.

As always, if you have any concerns about any of the risks of cataract surgery, ask your ophthalmologist.

How Much Does Cataract Surgery Cost?

A common question we’re asked is, “How much does cataract surgery cost?”

While most of the cost of cataract surgery will typically be covered by Medicare or private medical insurance (if, that is, you’re over the age of 65 and are a United States citizen), the amount insurance companies will provide for the procedure will vary on a number of factors (including the type of intraocular lens used for the procedure).

If you don’t have Medicare or private medical insurance, you’ll be  responsible for the entire cost of cataract surgery. The cost, itself, will vary depending on market conditions and the surgeon’s fee.

According to a 2015 report conducted by AllAboutVision, the average cost of cataract surgery with a standard IOL performed in the United States for someone without Medicare or private health insurance was $3,542 per eye. (Source: All About Vision)

Part 3: Life After Cataract Surgery

In Part 3, we’ll look at life, post-cataract surgery, and what you can expect after having a cataract successfully removed…

What Can I Expect After Surgery?

After completing the procedure, you’ll be given a protective eye shield or a pair of sunglasses. This is to prevent you from accidentally rubbing your eye at night and to reduce any discomfort you may experience from bright light on your journey home.

Due to the after effects of local anesthesia, you’ll probably feel slightly groggy after the procedure, and for that reason, might need to rest in the recovery area for approximately 10 minutes before it wears off.

While cataract surgery is a relatively straightforward procedure, you will want to arrange for a friend or family member to collect you and take you home, as driving is not recommended.

After leaving the surgical center, you’ll want to continue to use the antibiotic, steroid and anti-inflammatory eye drops for four weeks to prevent infection and reduce inflammation.

As for when to administer the eye drops, this will be explained at both your preoperative appointment as well as your follow-up appointments (more on that in, “What Happens in the Appointments That Follow?”).

How Long After Cataract Surgery Can I See?

Cataract surgery recovery time varies from person to person (or perhaps more fittingly, from eye to eye).

While many patients report noticeable improvements in their vision within a few hours or days (particularly with brightness in color), you may need as long as a week before your vision becomes very clear.

This is because the eye needs time to adjust to the removal of the cataract and adapt to the intraocular lens that has replaced it.

Don’t be alarmed if your eye is itchy or feels gritty for a couple of days after surgery—this is part of the healing process and will disappear after a few days.

Avoid rubbing or pushing on your eye and the discomfort will subside as your eye heals.

What Happens in Appointments That Follow?

After having cataract surgery, you will typically have three follow-up appointments with your optometrist. It’s important you attend all your appointments, even if you’re feeling well.

The first follow-up appointment is the day after your surgery. The purpose of this appointment is to check your vision and your eye pressure and to make sure there are no post-op complications.

At this appointment, your vision and eye pressure will be checked and your doctor will give you detailed instructions about your eye drops.

It is not uncommon to experience elevated eye pressure for the first few days after surgery, but if it is elevated, you may need to use additional eye drops to help lower the pressure.

As with any antibiotic, your eye drops are a crucial part of your recovery so make sure you use these eye drops exactly as prescribed.

If you don’t notice any improvement in your vision or you’re experiencing itchiness or discomfort in the days following this visit, report this to your doctor.

The second follow-up appointment usually takes place about one week after surgery. At this appointment, your eye may be dilated again (to allow a thorough retinal examination) and checked for any symptoms of infection. Furthermore, the schedule for your eye drops will be reviewed with you.

The third follow-up appointment happens around four weeks after the cataract surgery. At this appointment, you will be checked for a prescription for eyeglasses. Most patients at this appointment will be instructed to stop using all of the surgery-related eye drops as your eye will be completely healed.

What Not to Do After Cataract Surgery

One day after surgery, you might find yourself returning to everyday activities such as bathing, showering, washing your face and hair, etc. While this is perfectly acceptable, it’s important not to partake in any activities that could potentially cause infection or derail the healing process.

To make sure you enjoy a safe and speedy recovery, avoid the following activities:

  • Heavy lifting or strenuous activity for approximately two weeks after surgery (this includes lifting your grandchildren)
  • Bending over for approximately 2 weeks after surgery (this puts extra pressure on the eye)
  • Swimming (including hot tubs and saunas)
  • Irritants such as grime and dust
  • Rubbing your eye (this is especially important as this can increase the chance of infection)
  • Wearing eye makeup

As always, if you have any concerns or questions, discuss them with your  ophthalmologist or optometrist at your follow-up appointment.

Conclusion

Cataract surgery is one of the most common and effective surgical procedures performed in the United States.

And because of it, millions of people are enjoying greater vision—and the many perks that come with such gift.

If you have a cataract and are looking to have surgery, but don’t know where to start, we would love to hear from you.

To learn more about how the Milan Eye Center can help you with cataracts, call and speak to an expert at (678) 381-2020 or contact us for more information.

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“Seeing Dr. Sajja was very easy and efficient. He was very thorough and professional. He was also very honest in what he felt needed to be done. He also had a very good bedside manner and was caring, nothing was painful at all. The surgery was a quick procedure and I was in excellent care. I was amazed that Dr. Sajja himself called me two days after surgery to check-up on me!”
R.E.

“Dr. Milan Patel is an excellent, caring physician. From the initial exam through cataract surgery he was very patient with explaining the surgery and recovery process. I had both eyes replaced with new lenses and felt extremely comfortable through both procedures. I highly, highly recommend him!”
Anonymous

“I was scared of having my cataracts removed, but the doctor and all of the staff made me most comfortable. There was no pain & the recovery was short. I would recommend Dr. Desai to anyone who needs surgery. And the people who work there are just wonderful”
Deb Hallinyer

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