A cataract is simply a clouding of the lens usually brought on by age. In order to see something, light rays pass through the pupil and focus through the lens onto the retina (a layer of light-sensitive cells at the back of the eye.) The lens is made of mostly water and protein. The protein is arranged in a precise way that keeps the lens clear. Aging can cause some of the protein to clump together and start to cloud a portion of the lens.
Age-related cataracts generally develop gradually, so you may not notice any changes in your sight at first.
To determine if cataracts are the problem, you must have a dilated eye exam (where your pupil is widened with eye drops.) The test allows your ophthalmologist a clear look at your eye’s lens to detect early signs of cataract development.
It’s important to get a baseline exam at age 40 when early signs of disease and vision changes may develop. Your ophthalmologist will let you know how often you should return for an exam. At any point, if you have symptoms, see your cataract surgeon. Risk for cataract and other eye diseases increase with age. Since early detection and treatment of cataracts is critical to preserving sight, you should see your ophthalmologist once a year beginning at age 65.
Performing a complete eye exam is the only way your ophthalmologist can determine if your vision loss is a cataract or another problem. There are no medications or drops that will remove the cataract, but they can be easily treated with surgery. It’s not always necessary to remove the cataract immediately as long as it is not affecting your lifestyle. Changing your eyeglass prescription may be enough for the present. It is imperative that your ophthalmologist monitor your vision regularly for changes.
When a cataract becomes bothersome and interferes with your daily activities, it may be time to consider surgery. During the procedure, the eye’s cloudy lens will be removed and replaced with a clear artificial lens implant called an intraocular lens or IOL. Your ophthalmologist can discuss the surgery with you and answer any of your questions.
During a dilated eye exam, the doctor will examine and test your eyes to determine if a diagnosis is needed.
In this exam, your ophthalmologist will be able to find any abnormalities by viewing your eye in small detailed sections. The test will include examining the eye’s cornea, iris, lens and space between the iris and cornea.
Your Eye M.D. will examine the back of your eyes while they are dilated. Using a slit lamp and/or an ophthalmoscope, he will look for signs of cataract, glaucoma and other potential problems with the retina and optic nerve.
This test assesses the sharpness and clarity of your vision. Each eye is tested individually for the ability to see letters of varying sizes.
We have a variety of Intraocular Lens options available that can open up your world in a whole new way.
Cataracts can only be removed from the eye by surgery. Medication or other minor procedures cannot remove them.
The concept of waiting for a cataract to "ripen" is outdated. Generally, ophthalmologists recommend cataract surgery to patients when they feel that their quality of life is adversely affected by a cataract.
Cataract surgery is a quick and painless procedure. The surgery itself takes no longer than 30 minutes. Upon arrival at the eye surgery center, the staff will wash and clean the area around your eyes. Then, drops are inserted to dilate your pupils. The anesthetic eye drops will numb your eye, so you should not feel any pain. In most cases, you will be awake throughout the procedure. You may be given medication to help you relax. A tiny incision will allow your eye surgeon to enter the eye. The incisions are made with a laser or blade near the corneal edge. In the next step, the clouded natural lens will be removed from your eye and replaced by an intraocular lens (IOL). The tiny incisions usually heal on their own without stitches.
During the first 24 hours, your eye will be covered to protect it. You will be prescribed eye drops at regular intervals for several weeks. This will allow your eyes to heal and prevent any infection. It is essential to follow post-operative guidelines provided by your doctor.
Simulate Vision With Premium Lenses
Monofocal lenses are often referred to as the standard lens because they can correct vision at a single distance. During cataract surgery, this lens is the only one that Medicare will usually cover.
Because it's a basic intraocular lens, it does not correct astigmatism, and patients will need to wear glasses after cataract surgery. This is to ensure that they can see at other distances that the monofocal lens can't correct.
TECNIS, TECNIS Eyhance, Envista, AcrySof
The monovision process allows the patient to be independent from glasses by focusing one eye at a time for each distance. One eye is set to see distance, while the other eye is set to see near. It's best for those who are used to wearing contact lenses, as it can interfere with their depth perception.
TECNIS, TECNIS Eyhance, Envista, AcrySof
Toric lenses share some similarities with monofocal lenses, but they are specifically designed to correct astigmatism. This allows patients with astigmatism to see well at a distance or far away.
Patients will still most likely have to wear over the counter reading glasses for up close. Insurance, Medicare, and secondary insurances do not cover this lens, so there is an out-of-pocket expense. Many advanced lens implants will have a toric component. This enables an extended range of vision as well as astigmatism correction.
TECNIS Toric, TECNIS Eyhance Toric, EnVista Toric, AcrySof Toric
The trifocal lens provides clear vision up-close, far away, and at intermediate distances. Intermediate tasks include things like shaving, applying makeup, and working on a computer. Up-close tasks include sewing, writing, and reading.
This lens provides patients with good distance, computer, and reading vision. Some patients may see halos or starbursts in certain light conditions. There is an out-of-pocket expense for this premium lens.
Panoptix, Panoptix Toric
No, it’s typically an outpatient procedure. You will be there for about 2-3 hours total but the actual procedure takes less than 15 minutes.
It’s twilight sleep, where you receive intravenous sedation but you do not have general anesthesia. With general anesthesia, a tube is placed to control your breathing and administer anesthetic gas, and the recovery is longer. With cataract surgery, topical anesthetic is placed before we start, and additional medication is placed in the eye, while the sedation drugs go in through the IV. It is similar to the medication used in a colonoscopy.
Generally, yes. With so many different policies, our billing coordinator will speak with you on the day you schedule your appointment so you will know what your out of pocket expenses will be. Medicare covers the hospital portion and 80% of the allowable fee for the surgeon, as well as 80% of the allowable costs for the anesthesia professional. Some new technology lens implants are associated with extra costs. If the new lenses are appropriate for you, we will thoroughly discuss the cost and benefit with you. Insurance can be confusing, but we’ll walk you through it.
No, an eyelid retractor is used to create enough exposure to get at the cataract. Don’t worry, you won’t feel it. Once the retractor is removed you’ll be able to blink normally since we don’t use injections around the eye or lids.
Because there are no injections around the eye, and no incisions through tissues that contain blood vessels, cataract surgery with topical numbing agents and IV sedation is bloodless. There is no need to stop your blood thinners, even warfarin (Coumadin). We have done hundreds of cases for people on all kinds of blood thinners (anticoagulants), and it is not a problem.
Cataract surgery is considered “clean” surgery by the infectious disease specialists and prophylactic antibiotics are not considered necessary.
Yes. You should not drive for 24 hours after your surgery and this includes the day of surgery.
There are few limitations. On the day of your surgery, you should not drive. Also, do not swim for at least two weeks after surgery. We recommend limiting bending at the waist and lifting objects greater than 10lbs for one week. We also recommend that you shield the operated eye for three days after surgery when sleeping.
Most people have no pain and very little light sensitivity. In some cases, patients have noted some mild discomfort, often describing it as “something in my eye”. The morning after surgery, most people are very comfortable. We typically don’t prescribe pain medication after surgery because in our experience, most people don’t experience major discomfort that would require medication.
Your current glasses prescription will no longer be accurate after the surgery. If needed, we will have our opticians temporarily remove the lens from your current glasses on the surgery side. Medicare will cover a large portion of the frames and lenses after each eye surgery. We will update your glasses a few weeks after surgery.
Colors and contrast are noticeably better by the morning after surgery. You should continue to see improvement over the next couple days.
We recommend avoiding showering until we see you for the one-day post-op visit. After that appointment, you can shower.
Risk of infection, (currently estimated at 1:3000 to 1:8000 cases) while it is highly unlikely to occur, can cause vision loss. Therefore, prevention is key. We guard against infection by: asking you to use a disinfectant eye scrub three days before surgery; use an antibiotic eye drop one day before and for 10 days after surgery; not rubbing the eye. We also use a standard solution of povidone-iodine prep in the operating room (OR) before your surgery, both in and around the eye. At the end of surgery, an antibiotic solution is placed within the eye itself. Our track record for avoiding infection and that of our ORs is outstanding. The most common sight-threatening complication is retinal detachment, 1.5% of cases overall but more common in younger patients, nearsighted patients (longer eyes), and males. Retinal detachment might require additional surgery for repair.