Cataract Center

A cataract is a clouding of the lens in the eye that affects vision. Most cataracts are related to aging. Cataracts are very common in older people. By age 80, more than half of all Americans either have a cataract or have had cataract surgery. A cataract can occur in either or both eyes. It cannot spread from one eye to the other.

Are there other types of Cataract?

Yes. Although most cataracts are related to aging, there are other types of cataract:

• Secondary cataract. Cataracts can form after surgery for other eye problems, such as glaucoma. Cataracts also can develop in people who have other health problems, such as diabetes. Cataracts are sometimes linked to steroid use.
• Traumatic cataract. Cataracts can develop after an eye injury, sometimes years later.
• Congenital cataract. Some babies are born with cataracts or develop them in childhood, often in both eyes. These cataracts may be so small that they do not affect vision. If they do, the lenses may need to be removed.
• Radiation cataract. Cataracts can develop after exposure to some types of radiation.

Causes and Risk Factors

What causes Cataracts?

The lens lies behind the iris and the pupil (see diagram). It works much like a camera lens. It focuses light onto the retina at the back of the eye, where an image is recorded. The lens also adjusts the eye's focus, letting us see things clearly both up close and far away. The lens is made of mostly water and protein. The protein is arranged in a precise way that keeps the lens clear and lets light pass through it. But as we age, some of the protein may clump together and start to cloud a small area of the lens. This is a cataract. Over time, the cataract may grow larger and cloud more of the lens, making it harder to see. Researchers suspect that there are several causes of cataract, such as smoking and diabetes. Or, it may be that the protein in the lens just changes from the wear and tear it takes over the years.

How can Cataracts affect my vision?

Age-related cataracts can affect your vision in two ways:

1. Clumps of protein reduce the sharpness of the image reaching the retina. The lens consists mostly of water and protein. When the protein clumps up, it clouds the lens and reduces the light that reaches the retina. The clouding may become severe enough to cause blurred vision. Most age-related cataracts develop from protein clumpings.
   
   When a cataract is small, the cloudiness affects only a small part of the lens. You may not notice any changes in your vision. Cataracts tend to "grow" slowly, so vision gets worse gradually. Over time, the cloudy area in the lens may get larger, and the cataract may increase in size. Seeing may become more difficult. Your vision may get duller or blurrier.
2. The clear lens slowly changes to a yellowish/brownish color, adding a brownish tint to vision.
   
   As the clear lens slowly colors with age, your vision gradually may acquire a brownish shade. At first, the amount of tinting may be small and may not cause a vision problem. Over time, increased tinting may make it more difficult to read and perform other routine activities. This gradual change in the amount of tinting does not affect the sharpness of the image transmitted to the retina.
   
   If you have advanced lens discoloration, you may not be able to identify blues and purples. You may be wearing what you believe to be a pair of black socks, only to find out from friends that you are wearing purple socks.

When are you most likely to have a Cataract?

The term "age-related" is a little misleading. You don't have to be a senior citizen to get this type of cataract. In fact, people can have an age-related cataract in their 40s and 50s. But during middle age, most cataracts are small and do not affect vision. It is after age 60 that most cataracts steal vision.

Who is at risk for a Cataract?

The risk of cataract increases as you get older. Other risk factors for cataract include:

• Certain diseases such as diabetes.
• Personal behavior such as smoking and alcohol use.
• The environment such as prolonged exposure to sunlight.

What can I do to protect my vision?

Wearing sunglasses and a hat with a brim to block ultraviolet sunlight may help to delay cataract. If you smoke, stop. Researchers also believe good nutrition can help reduce the risk of age-related cataract. They recommend eating green leafy vegetables, fruit, and other foods with antioxidants.

If you are age 60 or older, you should have a comprehensive dilated eye exam at least once every two years. In addition to cataract, your eye care professional can check for signs of age-related macular degeneration, glaucoma, and other vision disorders. Early treatment for many eye diseases may save your sight.

Symptoms and Detection

What are the symptoms of a Cataract?

The most common symptoms of a cataract are:

• Cloudy or blurry vision.
• Colors seem faded.
• Glare. Headlights, lamps, or sunlight may appear too bright. A halo may appear around lights.
• Poor night vision.
• Double vision or multiple images in one eye. (This symptom may clear as the cataract gets larger.)
• Frequent prescription changes in your eyeglasses or contact lenses.

These symptoms also can be a sign of other eye problems. If you have any of these symptoms, check with your eye care professional.

How is a Cataract detected?

Cataract is detected through a comprehensive eye exam that includes:

• Visual acuity test. This eye chart test measures how well you see at various distances.
• Dilated eye exam. Drops are placed in your eyes to widen, or dilate, the pupils. Your eye care professional uses a special magnifying lens to examine your retina and optic nerve for signs of damage and other eye problems. After the exam, your close-up vision may remain blurred for several hours.
• Tonometry. An instrument measures the pressure inside the eye. Numbing drops may be applied to your eye for this test.

Your eye care professional also may do other tests to learn more about the structure and health of your eye. National Eye Institute

How is a Cataract treated?

The symptoms of early cataract may be improved with new eyeglasses, brighter lighting, anti-glare sunglasses, or magnifying lenses. If these measures do not help, surgery is the only effective treatment. Surgery involves removing the cloudy lens and replacing it with an artificial lens.

A cataract needs to be removed only when vision loss interferes with your everyday activities, such as driving, reading, or watching TV. You and your eye care professional can make this decision together. Once you understand the benefits and risks of surgery, you can make an informed decision about whether cataract surgery is right for you. In most cases, delaying cataract surgery will not cause long-term damage to your eye or make the surgery more difficult. You do not have to rush into surgery.

Sometimes a cataract should be removed even if it does not cause problems with your vision. For example, a cataract should be removed if it prevents examination or treatment of another eye problem, such as age-related macular degeneration or diabetic retinopathy. If your eye care professional finds a cataract, you may not need cataract surgery for several years. In fact, you might never need cataract surgery. By having your vision tested regularly, you and your eye care professional can discuss if and when you might need treatment.

If you choose surgery, your eye care professional may refer you to a specialist to remove the cataract.

If you have cataracts in both eyes that require surgery, the surgery will be performed on each eye at separate times, usually four to eight weeks apart.

Cataract Surgery

Cataract surgery is an outpatient procedure that will only take a few hours. When you arrive, your eyes may be treated with eye drops and anesthetic to minimize any discomfort during the operation.

During this routine operation, a small incision is made in the eye. Your surgeon will use a tiny instrument (about the size of a pen tip) to remove your clouded lens. This can be done with either an AquaLase®* device, which uses gentle pulses of fluid to wash away your cloudy lens, or an ultrasonic instrument that breaks up and gently removes your cloudy lens (called phacoemulsification).

Phacoemulsification: Also called "phaco," this cataract surgery procedure involves using a device with a vibrating, ultrasonic tip to gently break up the cataract and remove it from the eye.

Many people who need cataract surgery also have other eye conditions, such as age-related macular degeneration or glaucoma. If you have other eye conditions in addition to cataract, talk with your doctor. Learn about the risks, benefits, alternatives, and expected results of cataract surgery.  The information was provided by the National Eye Institute

Lens Options: Standard and Premium

If you are considering cataract surgery, there are many exciting new lens technologies available. Cataract surgery involves removal of the natural lens of the eye and replacement with an artifical intraocular lens (IOL).

Standard IOLs, which have been used for the past 30 years, are single-focus. For instance, people who elect to have their vision focused for distance without glasses will still need reading glasses.

New advances in IOL design now allow people to achieve distance and near vision without glasses. Eye Associates of New Mexico is pleased to offer this new technology with the Alcon Acrysof ReSTOR IOL and the Eyeonics Crystalens IOL.

There are 3 distances which people typically see. Distance (driving) intermediate (computer) and near (reading).

The ReSTOR IOL uses a special optical design to allow a distance and near focus. This lens tends to work well for distance vision and near vision without glasses.

The Crystalens IOL flexes inside the eye, similar to the action of the natural human lens. It can achieve distance, intermediate, and some near vision without glasses.

For people with astigmatism, there is exciting new IOL technology as well. The Alcon Acrysof Toric IOL has astigmatism correction built into the lens itself, and corrects mild to moderate amounts of astigmatism. It is a single-focus IOL.

Your doctor can determine if you would be a good candidate for any of these specialty IOLs.  This can help evaluate which IOL will suit your lifestyle. Additional costs associated with these IOLs are not covered by medical insurance. Eye Associates of New Mexico offers various financing options.

Multifocal IOL vs. Monofocal IOL

Choosing The Right Lens Option For You!

Until recently cataract patients received monofocal lens implants that had only a single power. This meant you had a choice of correction for either far or near vision. If you suffer from presbyopia like many people over the age 50 this would mean that you still need glasses for either reading or for distance vision. The FDA has now approved several multifocal lens implants for use by certified ophthalmologists. The multifocal IOL lens can increase your chances for a life free of dependence on glasses or contacts after cataract surgery for near, far, and intermediate vision. If you have worn glasses for 30 years this might be an opportunity for you to eliminate this hassle from your life.

The implantation procedure is the same for both types of IOLs. The main point of differentiation between the IOLs is in the type of vision they provide.

*Compared with monofocal IOLs, multifocal and accommodating lenses may reduce the need for glasses in activities like reading, or viewing text on a computer screen

• Multifocal Lens Implants (ReSTOR)
• Toric Lens Implants
• Accomodating IOL (Crystalens)
• Monovision
• Premium Lens Self Evaluation Test
• Financing Options

One other option available for focusing at more than one distance involves something called Monovision. This technique has long been used by some contact lens wearers to focus one eye for distance and one eye for near. This same effect can be achieved with cataract surgery using Standard or Toric lens implants. Monovision requires extra testing and planning before surgery, but does help patients achieve greater freedom from glasses after cataract surgery.

These Specialty lenses and procedures have additional costs that are not covered by medical insurance. Our office can explain those costs to you and help you with a variety of financing options.

Frequently Asked Questions About Cataract Surgery

Is cataract surgery performed with a laser?

Most ophthalmic surgeons today use ultrasound vibrations to break apart the cataract and remove it. This process is called phacoemulsification. Once all of the cataract material has been removed, and assuming that the lens capsule which was opened at the beginning of the surgery remains strong enough to support the lens implant, a folded intraocular lens specifically chosen by the surgeon to suit your individual needs is then inserted through the original incision and maneuvered into the lens capsule and then centered. The lens will remain inside your eye in this location without moving. Intraocular lenses cannot be felt or sensed in any way by the patient.

Is recovery from cataract surgery quick?

Today’s surgeries are performed with the smallest possible incision to speed the recovery of vision and reduce the restrictions on your activities after surgery. An incision of 2.5 to 3 millimeters in length is then created at the junction of the cornea (the clear domed structure on the front of the eye) and the sclera (the white part of the eye).

Do you provide financing for the procedures?

Yes, we work with Care Credit to offer our patients flexible and affordable financing plans. Please click here to learn more about our financing options.

What if my medical history or current medication prevents me from considering an injection of local anesthesia?

Today, anesthesia may also be administered topically. This means no injection is required, and the medication numbs the eye without entering the bloodstream.

How soon after surgery will I be able to see?

In some instances, you will be able to see immediately following surgery, although most people experience clearer vision the day following surgery.

If I wear corrective eyeglasses or contact lenses before cataract surgery, can I expect improved vision and restored sight?

Today’s cataract surgery is safer, and the visual outcomes better, than ever before. This is due to developments such as smaller incisions, refractive surgery to correct vision at the same time of cataract removal and the precise matching of the IOL to the eye. Today’s cataract surgery also offers MULTIFOCAL VISION allowing patients to enjoy a better quality of life with independence from glasses in most situations — distance, near and everything in between.

What is the cost of cataract surgery?

Medicare benefits generally apply to cataract surgery for people 65 or older. Other insurance policies may provide coverage as well. To find out about your coverage, you should contact Medicare, your insurance company and/or your doctor.

If I want independence from glasses after cataract surgery what are my options?

You can elect to upgrade from a monofocal IOL to a multifocal IOL (additional costs apply) These multifocal IOLs offer a great opportunity to be spectacle FREE after cataract surgery. At this moment the ReSTOR® Lens is the best choice. Please SEE our webpages pertaining to these lenses