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Cataract Q&A

In honor of Cataract Awareness Month, YourSightMatters.com interviewed cataract specialist Dr. James Pinke for helpful information including surgical options, common misconceptions and the latest research.

 

Cataract Q&A

What is a cataract?

cataract is a clouding of the lens of the eye due to changes in proteins that make up the lens. Certain factors can cause cataracts to develop more quickly such as ultraviolet radiation (UV rays) smoking, diabetes, steroids and nutrition deficiency. Even the most healthy and active individuals will likely develop cataracts at some point in their lives.

How often should patients get a comprehensive eye exam?

The interval of time between eye exams greatly depends on the health of the eye. For children and even adults in their 20s and 30s, it is usually sufficient to get a comprehensive eye exam every few years. Once patients reach the age of 50, I suggest an annual comprehensive eye exam.

There are instances where patients may need to have multiple eye exams per year to monitor and treat specific eye diseases. Patients who have eye disease, including conditions such as macular degeneration, glaucoma, diabetic eye disease, glaucoma or cataracts may need to be examined more often.

What are signs and symptoms of cataracts?

Some of the signs and symptoms of cataracts are cloudy or blurred vision, sensitivity to glare, seeing halos around lights, colors appearing faded or yellowed and double vision. Cataracts can make daily activities like reading, watching television, driving, distance vision and night vision more difficult.

Can cataracts be treated?

Cataracts are one of the most treatable eye diseases. This is good news because most people will start developing cataracts in their late 50s or early 60s. Most adults will not have their cataracts removed until they are in their late 60s or early 70s but it is generally just a matter of time. The cloudy human lens can be surgically removed and replaced with an artificial lens made out of acrylic or silicone.

What are some common myths and misconceptions about cataracts?

There are many misconceptions about cataracts. One common incorrect belief is that some people think that their doctor will take out their eyeball, remove the cataract and put the eye back in the socket. This is not how cataract surgery is performed. Cataract surgery involves a tiny incision of 2.2-2.5 mm in length and removing the cataract, which is behind the colored part of the eye. The cataract is replaced with an intraocular lens implant (IOL).

Another myth of cataract removal is that that the cataract is scraped off the surface of the eye. As noted above, the cataract is the cloudy lens behind the colored part of the eye, the iris.

Some people might think that their cataracts may be too advanced and are inoperable. Even the most advanced cataracts can be removed with restoration of excellent vision.

Another misconception is that people who have other eye diseases, such as glaucoma, diabetes or macular degeneration, cannot be helped by cataract surgery; however, cataracts can be removed regardless of other diseases. Often, vision can be improved dramatically despite these other conditions.

What are some common questions that patients have about cataract surgery?

I encourage my patients ask questions so they can have a full understanding of the cataract surgery procedure. Here are some of the most common questions I receive from patients and their answers:

  • Is cataract surgery inpatient or outpatient surgery? All cataract surgeries are outpatient, same-day surgery.
  • Will I be asleep for the surgery? Patients may fall asleep, but we do not use general anesthesia for cataract surgery. The anesthesiologist at the surgery center uses intravenous sedation to help patients feel relaxed and comfortable.
  • Is cataract surgery painful? No. Patients feel water on their eye and sometimes feel a slight pressure. Patients will see a bright light from the microscope.
  • How long does the surgery take? For me, the surgery takes less than ten minutes. On average, the entire time you spend at the center will be less than two hours. The preparation for surgery takes the majority of the time.
  • Can I drive myself home? You cannot drive yourself home, but most patients can drive within one to two days of surgery.
  • What restrictions will I have after surgery? I tell my patients that, barring complications, they have almost no restrictions after I see them the day after surgery.
  • Will I have stitches in my eye/eyes after surgery? Most patients do not need stitches during cataract surgery, because the tiny incision is usually self-sealing.

What new research and products are available for cataracts?

Much of the new research into cataracts has to do with the technology that is emerging to treat cataracts surgically. There are ongoing improvements in intraocular lens (IOL) design. We can now customize the type of lens that is inserted into the eye, providing patients a greater range of vision. Patients now have the option in many cases to get both near and distance vision to reduce or eliminate the need for glasses after surgery. We also have intraocular lenses that can reduce a significant amount of astigmatism. We expect to have new lens implants that correct both near vision and astigmatism in one lens.

Another exciting advancement involves new glaucoma procedures that can be done in conjunction with cataract surgery. These procedures have been successful in lowering eye pressure in glaucoma patients by inserting a tiny implant, such as the iStent, in the eye. This minimally invasive procedure also allows patients to resume their normal activities more quickly than many other glaucoma surgeries. Another quick procedure called ECP (endoscopic laser photocoagulation) uses laser at the conclusion of cataract surgery to reduce the pressure in the eye.

Who should consider getting cataract surgery?

Anyone with a cataract! I recommend surgery to anyone who is starting to have difficulty with the tasks of their daily life, including glare, halos, night vision and problems seeing the print on the TV screen. Consider cataract surgery if driving and reading signs is becoming more difficult. When my patients feel like cataracts are affecting their daily lives, I encourage them to consider surgery.

What are the benefits of cataract surgery?

The best benefit of cataract surgery is restoration of normal vision. It is one of the most common surgeries performed. Cataract surgery gives you back your "visual" life. It can also help prevent injury and actually keep you safe. The Journal of the American Medical Association released a study in 2012 detailing the reduced risk of hip fracture in seniors after cataract surgery. In essence, you are safer on your feet and safer behind the wheel when you see better.

What are the risks with cataract surgery?

There are few risks associated with cataract surgery, but all surgical procedures have some risk. My overall surgical complication rate is probably less than one percent. However, the risk of a severe complication, like the risk of infection inside the eye, is extremely rare. Most complications are minor and easy to deal with. Some common fleeting symptoms may include eye floaters, seeing flashing lights for a week or two, and feelings of scratchiness.

Some patients develop a cloudy, opacified capsule or “secondary cataract” months or years following cataract surgery. The cataract does not grow back, but the capsule that holds the intraocular lens in place may become cloudy over time causing blurred vision. When this happens, I can perform a 15 second laser procedure called YAG capsulotomy which makes a tiny hole in the capsule to restore the clear vision.

Will I need reading glasses after cataract surgery?

Every eye is different, which makes each patient a unique case. The basic IOL is a monofocal implant which provides either distance vision or reading vision, but not both. Premium multifocal implants are now commonly available and dramatically improve both distance and reading vision. Many people with these advanced technology implants don’t use glasses at all.

If I have astigmatism, what are my options with cataract surgery?

Astigmatism is a common eye condition characterized by an irregularly shaped cornea which results in blurred vision. There are several options for patients who have both cataracts and astigmatism. For patients with milder astigmatism, I may use a procedure called limbal relaxing incisions (LRI). LRI involves making small, partial thickness incisions in the peripheral cornea, which makes the cornea to be more rounded when it heals. LRI's only add a few minutes to the overall cataract surgery. LRI's reduce astigmatism and sharpen the vision.

Another treatment for patients with more pronounced astigmatism is use of a toric intraocular lens (IOL), which helps correct distortions due to the shape of the cornea. Toric implants are the best solution available for astigmatism correction in cataract patients.

What would you say to patients who are considering cataract surgery?

I always tell my patients about the benefits and risks of surgery, and I remind them that removing a cataract is their decision. 
The most important thing that I want my patients to keep in mind is to have realistic expectations. I cannot promise life-changing results, but almost everyone experiences marked improvement in vision after cataract surgery; however, cataract surgery does not correct other unrelated diseases such as glaucoma, diabetes or macular degeneration.


Dr. James Pinke attended Tufts University School of Medicine and has been practicing ophthalmology for 31 years. He specializes in but not limited to: No Stitch Cataract Surgery, IOL Implants including astigmatic and multifocal lenses, Laser Surgery, Glaucoma Surgery and Eyelid Plastic Surgery.