A cataract is a clouding of the normally clear internal lens of the eye. You can see such changes occuring in the model eye located immediately to the left. This might look like the pupil is clouding, but it is the internal lens behind the pupil that is changing.
Located right behind the pupil(the black opening in the middle of the iris - colored part), this internal lens is responsible for changing focus (accommodating) in order to focus light coming from different distances, like a camera does. Changing focus to see far in the distance, down the road, TV, computer, reading, or even closer tasks, is only possible because of the internal lens.
If you wear glasses or contact lenses, these devices provide clear focus for seeing off in the distance. In order to change focus (accommodate), the internal lens is able to change its shape (becoming thicker or thinner) and to move a small amount forward or backward. These changes actually focus light very effectively. They happen automatically and rapidly, and without our awareness. By doing this, our vision usually changes so smoothly that we continue to see with clear focus, virtually all the time. We tend to take this focused vision for granted, but without a normally-functioning, clear and flexible internal lens, our eyes and our clear vision would be focused at only one distance.
As the eye matures, the internal lens gradually loses its flexibility and our reading vision starts to become blurred. This usually becomes noticeable around age 40, and then we need reading glasses, bifocals, trifocals, progressive trifocals, monovision contacts or some other solution to achieve
clear reading vision..
Then, by age 50, almost all of us will begin to show a little yellowish discoloration of the internal lens accompanied by some early clouding. This is the beginning of cataract formation. Progression of a cataract is determined by genetically inherited factors, and also by environmental influences including excessive exposure to sunlight, diseases like diabetes, medications like cortisone, presence of glaucoma or retinal disease, eye injuries, and more. Because of this, cataracts can develop at virtually any age, making it important to have an annual comprehensive eye exam to look for cataracts and other eye conditions.
Whatever your age, cataracts can effect your vision, early or later in life. However, early cataract presence does not usually significantly effect vision, and often does not mean cataract surgery right away. Eventually, however, cataract cloudiness prevents light from passing clearly through the internal lens to the back of the eye, or retina, and our vision becomes blurred and difficult. We might see halos or glare around lights at night making it difficult or even unsafe to drive at night.
Much like the lens of a camera focuses light on the camera's film, the internal lens of your eye focuses light on the eye's retina. If the front of your camera's lens becomes dirty or fogged, then the picture taken will be hazy or blurred. A cataract causes light focusing on the retina of your eye to be blurred in a similar manner. Modern cataract surgery involves removal of the cloudiness in the lens and replacing it with a new, clear artificial lens implant or IOL (Intraocular Lens Implant). There are many types of IOL's to fit all needs as you will see as you read further, and you can see examples of these in the column to the left.
There are lens implants fixed for one distance, usually either driving or reading, and this can be done so that one eye sees best off in the distance and the other eye can read; this is called Monovision or Blended Vision.
Also, there are newer, accommodating or multi-focal implants that can restore both distance and near vision in each eye quite effectively. One such accommodating lens implant is the Crystalens® HD, designed to move imperceptively forward and backward within the eye like the natural internal lens does. The Crystalens® HD made by Bausch & Lomb works because of its unique design allowing it to move and thus change focus. It offers the ability to focus for near and distance vision so that most patients can read, use a computer, watch TV and drive without having to use glasses for many patients. In fact, 80% of Crystalens® HD patients used no glasses after cataract with Crystalens® HD implantation surgery in its FDA Study.
Another new-generation multifocal lens implant is the AcrySof® ReSTOR® HD lens. This lens offers the ability to focus for near and distance vision so that most patients can read, use a computer, watch TV and drive without having to use glasses. Other multifocal lenses include the AMO ReZoom lens and the Technis IQ and Technis Multifocal implants.
Cataract Symptoms
You may notice problems with your vision at any time during the development of cataracts. Generally, as a cataract develops, there is a dimming or blurring of vision. This is sometimes first noticed as difficulty seeing while driving, particularly at night, or difficulty in reading small print or sewing. Glare or halos may appear to surround lights at night, and sometimes during day light. Colors can be difficult to see accurately. Many people feel as though a film is covering the eye. However, a cataract is not a growth or film on the outside of the eye, but a clouding within the lens inside the eye, so a cataract can only be removed surgically. These problems can ultimately become severe enough to prevent driving, working, reading and other important activities.
When such vision problems interfere with your lifestyle and your ability to safely live the way you want, cataract removal with lens implantation is usually indicated.
Once cataracts are removed, you should again be able to enjoy many of your necessary and favorite activities such as reading, driving, working, TV, shopping, using a computer, visiting friends and enjoying your grandchildrens smiles.
A: Surgery is done in our EYE SURGERY CENTER OF MIDDLE TENNESSEE. Located on the same floor, it is part of, and is owned by, the ARROWSMITH EYE INSTITUTE. It is a licensed and accredited Ambulatory Surgical Treatment Center (ASTC) first licensed in 1984.
Having your cataract surgery in a licensed and accredited outpatient surgery center saves you money! Most people don't realize that to have cataract surgery in a hospital, or in a hospital-owned surgery center, costs about twice as much as in a free-standing surgery center. Hospitals are allowed to add extra costs onto your bill in order to pay for the cost of running the hospital, which operates much less efficiently. This results in greater cost to you, the patient. If you think this doesn't sound fair, we agree.
A: Using only a little sedation (provided by our nurse anesthetist) and numbing drops, our cataract surgery is painless! The surgery itself takes only about 10 - 15 munutes, and there is setup and preparation time adding about another 10 minutes and providing plenty of time to double-check and tripple-check everything. We absolutely do not rush. You will always be treated as a valuable and special person, not just a number to be rushed through surgery. This way we can provide you with the best possible result, in the safest possible manner!
A: This is a very important question. We are fortunate to live in a time when catarct lens implants are incredibly advanced, and they can restore vision in a way never before available. The types of currently-available lens implants or IOL's are shown in the left hand column. There are others, but the combination of accommodating, multifocal, toric and monofocal implants shown here represents all of the different types of IOL's available.
Dr. Arrowsmith recommends the Crystalens® HD for most patients because the Crystalens® HD provides the best combination of crystal-sharp vision and the ability to see both far away, near and in between.
Cost varies. Cataract surgery and basic implants, such as the AcrySof® IQ Implant, are almost always covered by Medicare and other insurance plans since cataract represent a disease process in the eye, unlike LASIK which is not covered. Although, Medicare and insurances do not cover most of the cost of premium implants including the Crystalens® HD,ReSTOR® HD, and AcrySof® Toric, a number of very helpful 0% interest financing plans are provided to make these desirable implants easily affordable.
A: Cataract implants are designed to last for your lifetime. You will not need to remove, clean or replace your implant normally. So your investment in the best lens implant you can choose, is a one-time investment. Lens implants began development in the 1950's and have completely replaced the thick "coke bottle" magnifying glasses cataract patients used to require after surgery. This has been one of the most important developments in cataract surgery since IOL's restore vision that is often better than an individual has ever had!
A: We will definitely aim to help you get out of your glasses or contacts to the greatest extent possible with your cataract surgery. If you have had LASIK, cataract surgery will not undo the benefits you achieved with LASIK, RK or other refractive surgery. In fact, cataract and refractive surgery compliment each other and enhance each other and this is one important reason Dr. Arrowsmith offers both. This results in patients having the greatest opportunity to eliminate glasses and contacts. When planning for cataract surgery after LASIK, special calculations are used in determining lens implant power. Sometimes, after cataract surgery, it is desirable to perform LASIK, especially after premium IOL's where LASIK - if desirable - LASIK is provided at no addition charge.
A: You will usually begin to see immediately after surgery when you sit up on the table. From here, vision tends to continue to improve rapidly - even to a level that often permits reading on the same day, and driving the day after surgery. The final visual result is generally reached by the end of one month. Unlike past cataract patients, you may be active beginning the day after cataract surgery and you will have very few restrictions. Bending and lifting are not limited, you will need to wear goggles when you sleep, but you can sleep in any position that is comfortabe for you. You will need to keep you "new eyes" clean, dry and protected, especially during the first week after surgery. We will provide easy-to-follow, verbal and written instructions about this. And, you will be asked to simply enjoy your new vision.
A: No, your original cataract will not recur, but a second type of clouding can occur after cataract surgery in 10 - 20% of cases. This can occur when a cloudy membrane develops behind the lens implant. If this should occur, it is usually treated with a special YAG laser which permanently opens the membrane so it will not return. Done in a treatment room, it takes only about five minutes.
A: Your second eye can be treated once your first eye is reasonably stable. This usually requires from one to four weeks and varies from person to person.
