CATARACT...

The transparent human lens, like the lens of a camera, focuses light rays onto the retina (camera "film"). A cataract is any opacity in the lens that interferes with light transmission through the eye. Clinically, this is manifested as "blurred vision", "cloudiness of vision", 'poor night vision", etc.

What causes cataracts? How does one get them?

Most cataracts develop as part of the aging process. Everybody will develop cataracts if people lived long enough. The pace of progression varies from individual to individual and is influenced by environmental factors (e.g. long term exposure to UV rays seen more in tropical countries). Other causes of cataract include certain medical conditions like diabetes, or intake of certain drugs like steroids. There are congenital and juvenile cataracts. Infections, inflammations and injuries can likewise cause cataracts.

What are the symptoms of cataracts?

In addition to painless blurring of vision, patients complain of cloudy vision, poor night vision, glare, light sensitivity, and yellowing or drab shade of colors. In some patients, the progression of the cataractous lens acts like a "reading lens" and may temporarily give some patients better near vision, a phenomenon called "second sight". This "improvement in vision" of course, is only temporary as the vision later worsens with further cataract progression.

Do I have to wait for my cataracts to "ripen"?

A product of the old-school, one of the persistent myths about cataract surgery nowadays is that one needs to wait for a cataract to "ripen". Different people have different visual needs depending on their profession and way of life. Once the cataract (even in its early stages) is significant enough to interfere with one's activities, then one may be a candidate for cataract surgery. With the advent of modern day techniques of cataract surgery, more and more cataracts are being operated on in their early stages.

What are my options for treatment?

Although so-called "anti-cataract" eyedrops from reputable pharmaceutical companies are available in drugstores (not wanting are herbal remedies or "cleansing diets" for cataract treatment), there is still no convincing evidence that medical therapy works to reverse the process of cataract progression. The only scientifically proven method of treating cataracts is surgery. Until recently, cataract surgery involved a very large incision in the globe to remove the lens in toto (intracapsular cataract extraction or ICCE), or leaving the posterior capsule behind to support an intraocular lens or IOL (extracapsular cataract extraction or ECCE). Both techniques require several sutures to close the wound, and are performed under general anesthesia or retrobulbar anesthesia (injection behind the globe), taking anywhere from 30minutes to an hour to perform. In ICCE, hardly performed in developed countries today, patients need to wear very thick glasses after surgery to compensate for the natural lens that was removed. In ECCE, a biometer uses ultrasound technology to calculate the IOL required for a certain desired predicted target of refraction after surgery. Most ophthalmologists in the country today perform cataract surgery via ECCE. However, state-of-the-art cataract surgery, as it is exactly performed in developed countries today, involves a very small incision (less than 1/8th of an inch) in the cornea wherein a probe is inserted with the purpose of breaking up the cataract and removing the pieces by vacuum. This procedure is called phacoemulsification, or no-stitch/stitchless cataract surgery, and is performed at the American Eye Center using the remarkable Alcon Infinity Phacoemulsification System. Phacoemulsification is the procedure that most lay people erroneously call "laser surgery", mistakenly referring to LASIK refractive surgery. Actual laser removal of cataracts is not yet commercially available and is still considered by most experts to be in its experimental stages. As the small incision in phacoemulsification is self-sealing, no sutures are needed. A relatively recent technological advancement, the "foldable" IOL" is inserted through this incision, preserving the small size and self-sealing nature of the wound. The whole process is done under "eyedrop anesthesia" and is typically over in 15-20 minutes or less. In qualified hands, cataract surgery nowadays is more than 99% successful.

What are the preparations before cataract surgery?

Generally, most ophthalmologists will require a cardio-pulmonary clearance from any internist of your choice for patients over 40 years old. Antibiotic eyedrops are instilled in the eye 1-3 days before the scheduled surgery. Some pre-operative measurements will be performed in order to calculate for the IOL power to be implanted in the eye. Most eye centers/clinics have a machine, the biometer that performs this measurement. At the American Eye Center, this crucial test is performed using the IOL Master biometer (see below).

What is the recovery time after surgery? Any physical limitations?

In the past, patients had to stay overnight in a hospital for cataract surgery. Fortunately, modern day cataract surgery should not have to be that way. The American Eye Center is a fully-equipped world class operating room suite that can rival the best surgical suites in developed countries. The cataract surgery is performed on an out-patient basis. Whereas in ICCE and ECCE where patients had several physical limitations after surgery (limited coughing, sneezing, straining, bending over, etc.), patients undergoing phacoemulsification literally get up from the operating table immediately after surgery, walk to the recovery room, and are ready to go home in a few minutes with only a transparent eyeshield as evidence of the surgery. Most patients already notice a significant improvement in vision a few hours after surgery, and it is expected to be 'optimal' by the next day. In some patients, this may take slightly longer depending on many factors which your doctor will discuss with you. Most regular physical activities are resumed the next day. . Though vision is good enough (legally at least) to drive a car the following day, the performance of this, as well as other special activities will depend on one's confidence/capabilities, and should be discussed in detail with your doctor. Water getting into the eye is avoided for 1-2 weeks to minimize the risk of infection. An eyeshield to keep the eye from being pressed or rubbed during sleep is optional.

Will I still wear glasses after cataract surgery?

As mentioned earlier, a biometer is performed before the surgery to determine the power of the IOL to be implanted for a certain desired target of refraction. As the human lens is replaced with an artificial lens, focusing power is lost. Therefore if the end result is that one's vision is good for distance after surgery, no glasses may be needed for distance, and only reading glasses are needed for near work (perfect scenario for, say, a golfer). Similarly, if the end result is that the patient is near-sighted after surgery (e.g. a lawyer who spends 10 hours a day reading), reading glasses may not be needed for near work but distance glasses will be required. In some patients, bifocals may still be needed after surgery. In most patients, the IOL calculation is targeted for distance, as most of our activities (driving, shopping, sports) require good distance vision. These issues should be discussed with your doctor before the surgery. Some patients request for one eye to be targeted for distance, and the other eye for near! (to eliminate the need for glasses altogther---as long as it works for them). In conclusion, one can say that the IOL calculations, for all their science, is basically just a guess or an estimate, albeit a good scientific guess. At the American Eye Center, the IOL Master biometer (the first and currently one of only two in the country), recognized and acknowledged as the most advanced and accurate machine of its kind in the world, is utilized for this purpose. Using this machine, we have seen a level of accuracy in IOL calculations never previously possible in the local setting. However, one's visual needs and expectations should be fully discussed with your doctor in planning the outcome of surgery.

Do I need to come back after surgery?

As with any surgery, follow-up care is very important. One is usually asked to come back for follow-up a day after surgery, at one week, and then at one month after surgery, during which time the post-op eyedrops are slowly tapered. By one month, one's vision and refraction should be stable enough to be able to get the final refraction if glasses are needed at all.

What are the complications of cataract surgery?

As one of the most successful procedures performed today, cataract surgery should be more than 99% successful in qualified centers. One should realize however, that blurred vision in the elderly does not always result from cataract alone, and may be the result of problems in the retina or optic nerve. In an otherwise "healthy" eye with cataract, successful cataract surgery should fully restore the vision without any problems. The risks of serious complications (such as bleeding, infection, corneal decomposition, macular edema, retinal detachment, etc.) are not common, and individual statistics on these may be discussed with your doctor thoroughly.

Do cataracts come back after surgery?

The IOL implanted in the eye should theoretically last a lifetime and is not removed due to "wearing out" or "rejection". Occasionally, a thin fibrous tissue develops behind the implant in a condition called "after-cataract". This is NOT a recurrence of the cataract. It requires a simple 5-minute laser procedure that creates a window through this tissue opacity to restore the vision.