Hazy, Blurry and Dim: An In-Depth Look at Cataracts, Part II - Treatments
Last week, we discussed the definition of cataracts, the symptoms they present, and what causes them. If you missed last week’s article or need a refresher, click here: Hazy, Blurry and Dim: An In-Depth Look at Cataracts, Part I (The EYE Digest).
This week we will talk about how we treat cataracts and the amazing technologies that go into cataract surgery and implant lenses.
How do you know when it is time for cataract surgery?
Ultimately, this is a decision that will be made with the help of your eye doctor during an eye examination or consultation. Often, symptoms such as blurry vision, hazy vision, trouble with nighttime driving, glare or halos around lights at night, or disruption in color vision are indicators that an individual may be ready for cataract surgery. If cataract surgery is deemed necessary, a referral will be given for surgery.
The decision to send a patient out for cataract surgery depends on certain criteria. Traditionally, the rule of thumb was that a best-corrected visual acuity of 20/40 or worse was the qualification for cataract surgery. However, these days that criteria is not frequently used.
We now evaluate cataract surgery necessity based on quality of life (QoL) and how the cataract affects activities of daily living (ADL). The reason for this is that cataracts may start to have a profound effect on an individual’s life through symptoms such as glare, halos around lights, or distortions, but not necessarily have an effect on visual acuity.
Cataract surgery has come a long way since it was first attempted in the late 1700s. Advanced medical technologies allow astounding levels of automation, precision, and safety in the cataract surgery procedure. This enables a safer experience, better outcome, and quicker procedure time.
How is cataract surgery performed?
There are a few ways that cataract surgery can be performed, but for the sake of simplicity, we will go over the most common method in the US. First, the patient is often placed under twilight anesthesia (or a similar sort of sedation). Twilight anesthesia enables the patient to stay awake but have nearly no recollection of the events of the surgery. The eye itself is also numbed.
Next, small incisions are made in order for the surgeon to enter the eye. Following this, devices are inserted into the eye and the crystalline lens afflicted with a cataract is broken up into many pieces via a process called phacoemulsification, which involves the use of an ultrasonic handpiece. These tiny pieces are then vacuumed out of the eye.
Following this, an intraocular lens (IOL) is implanted into the space and sack that the natural lens used to occupy. The patient then goes into recovery.
The entire procedure (not including surgery preparation) takes between 15-30 minutes per eye. Often, one eye has the surgery performed on it first, and then a week to a few weeks is given until the other eye is operated on. This is to gauge progress of the first eye and see if any adjustment are needed when performing surgery on the second eye.
So what is this "IOL" that is inserted into the eye?
The IOL, or intraocular lens, is a fantastic piece of innovation that replaces the natural lens of the eye during cataracts surgery. Recently, there have been many advances in IOL technology. The standard IOL that is most often used corrects distance vision up to a certain degree and normally allows an
individual to live their life without distance correction. The standard IOL can also be used in a way that corrects one eye for distance and the other eye for near with a modality called monovision.
Exciting new technologies have enabled the IOL to help with even more. Toric IOLs allow individuals to have their astigmatism corrected so that they do not glasses or contact lenses afterwards. Additionally, multifocal IOLs (sometimes referred to as premium IOLs) allow individuals to see both distance and up close by using different points of focus.
If you have any other questions about cataract surgery or if you need a workup to see if you may be a candidate, do not hesitate to contact us!
-Dr. Aaron Neufeld