Cataracts
Now offering LASER ASSISTED CATARACT SURGERY with the VICTUS Laser
If you have been told that you have a cataract, or scheduled for cataract surgery, please click on the below links to learn more about cataracts and all of the surgical options that are available to you
What are Cataracts?
A cataract is a clouding of the normally clear and transparent lens of the eye which is located behind the pupil. When the lens becomes cloudy from age, injury or a birth defect, less focused light reaches the interior of the eye and vision gradually fails.
Symptoms of cataracts range from a barely noticeable loss of vision to virtual blindness. The first symptom may be difficulty in performing routine tasks. Fuzzy or blurred vision, frequent changes in glasses, double vision in one eye, problems reading, decreased color perception and poor night vision are common symptoms. Night driving may be a particular problem. Vision may fluctuate from normal to almost complete blindness under bright light or glare conditions.
There are many misconceptions regarding cataracts. Cataracts are not a film over the eye, they are not caused by overusing the eye, they are not a cancer. They cannot spread from one eye to the other and they are not a cause of irreversible blindness.
There are many causes of cataracts. The most common cause of cataract is related to aging. Other causes of cataracts include family history of cataract, diabetes, injury to the eye, oral steroid medications, previous eye surgery and long-term unprotected exposure to the sun.
Most cataracts that are associated with aging progress slowly. Some patients do not notice the extent of their visual loss because of the slow onset.
Other cataracts, especially in younger people and patients with systemic disease such as diabetes, progress rapidly over a few months and vision deteriorates quickly. It is not possible to predict exactly how fast cataracts will progress in any given patient.
There may be other reasons for visual loss in addition to the cataract, particularly problems involving the retina or optic nerve. If these problems are present, perfect vision may not return after cataract removal. If such conditions are severe, removal of the cataract may not result in any improvement of vision. Your ophthalmologist can tell you how much visual improvement is likely.
Surgery is the only way your ophthalmologist can remove the cataract. However, if symptoms from a cataract are mild, a change of glasses may be all that is needed to for you to function more comfortably.
Cataract surgery can be performed when your visual needs require it. You must decide if you can see to do your job and drive safely, if you can read and watch TV in comfort. Can you perform daily tasks, such as cooking, shopping, yard work or taking medications without difficulty?
Based on your symptoms, you and your ophthalmologist should decide together when surgery is appropriate. Over 1.4 million people have cataract each year in the United States, 95% without complications.
If you have questions about cataracts or are searching for a Board-Certified Cataract Surgeon, we encourage you to contact us here at Ophthalmology Associates- The Cornea and Laser Vision Institute. With three locations in the Central Eastern Missouri region, we are proud to serve the surrounding communities of St. Louis, St. Peters and Sullivan.
Limbal Relaxing Incisions (LRIs)
The outer layer of the eye can be divided into three areas: the cornea, the sclera and the limbus. The cornea is the clear part, or the window, that covers the iris and the pupil. The sclera is the white part of the eye. The limbus is the thin area that connects the cornea and the sclera.
Limbal relaxing incisions (LRIs) treat low to moderate degrees of astigmatism. Astigmatism is when the cornea is elliptical rather than spherical. Slight astigmatism can cause blurred vision while strong astigmatism can cause headaches and eyestrain at all distances. As the name suggests, our cornea surgeon makes small relaxing incisions in the limbus, which allows the cornea to become more rounded when it heals. LRIs are placed at the very edge of the cornea (in the limbus) on the steepest meridians.
Limbal Relaxing Incisions are for those:
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who have astigmatism
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want to reduce or eliminate their dependence on glasses or contacts
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have no health issues affecting their eyes
These incisions are usually made at the time of cataract surgery to reduce or eliminate the astigmatism and thus increase the chances for better vision without eyeglasses. A near prescription will usually still be necessary to read and do close work. Our doctors will discuss the options that make the best sense for you. Some patients that need a limbal relaxing incision after cataract surgery may have this procedure done in the office!
TORIC IOL
In traditional cataract surgery, the surgeon implants a monofocal artificial lens, commonly called an “intraocular lens” (IOL). If you have astigmatism however, you may still experience blurred and distorted vision because a standard IOL cannot correct corneal astigmatism. In January 2007, Medicare approved a new monofocal IOL called the Toric IOL for patients with cataracts and astigmatism. The Toric corrects for both conditions (cataracts and astigmatism) simultaneously.
The Toric IOL is a foldable, single piece lens that is implanted during cataract surgery to replace the clouded lens. The unique design of the Toric IOL makes it possible to reduce or eliminate corneal astigmatism and significantly improve uncorrected distance vision. Toric lens provide QUALITY distance vision, independent of eyeglasses and contact lenses.
In a recent FDA study, 97% of patients who had the Toric lens implanted in both eyes reported freedom from their glasses for distance vision. It is important to understand that reading and computer glasses are still required with this lens, however; if a standard lens were used, bifocal glasses would be needed. The Toric IOL can treat both the cataract and astigmatism in one surgical out-patient procedure. If you are interested in learning more about Toric IOL’s, please contact Ophthalmology Associates
Multifocal and Accommodative IOL Surgery (ReSTOR® Lens, Crystalens®, TECNIS®, and Toric Lens)
Several new intraocular lenses (IOLs), called multifocal and/or accommodating IOLs, have been introduced in recent years that utilize advanced technology to achieve good distance, intermediate and near vision without glasses. One such lens is the AcrySof® IQ ReSTOR® lens, a breakthrough lens that uses apodized diffractive technology (similar to technology used in telescopes and microscopes) to give patients a full range of vision – near through distance – and to reduce dependency on reading glasses or bifocals following cataract surgery. This means that many patients can read the text on items such as prescription bottles, magazines, newspapers and computer screens, while also providing the ability to see items at a distance free from glasses or bifocals.
AcrySof® IQ ReSTOR® Intraocular Lens
As we perform daily activities such as reading, watching television or working at the computer, our eyes are constantly focusing on objects at varying distances – up close, far away and everything in-between. The ability to quickly change focus throughout this range of vision is called accommodation. Unfortunately, this ability diminishes as we grow older, causing us to become dependent on bifocals or reading glasses. Thankfully, by combining the strengths of apodized diffractive and refractive technologies, the AcrySof® IQ ReSTOR® IOL can now provide quality near, intermediate and distance vision, and increased independence from reading glasses or bifocals. And now, with the addition of proven aspheric technology, the AcrySof® IQ ReSTOR® IOL takes the advancements one step further, for a lens with enhanced image quality and clarity.
According to the AcrySof® IQ ReSTOR® IOL clinical studies, three out of four patients implanted in both eyes with the AcrySof® IQ ReSTOR® reported never wearing glasses following cataract surgery. Additionally, the AcrySof® IQ ReSTOR® IOL clinical studies indicate that over 95% of the study subjects were so satisfied with their new quality vision that they would have the AcrySof® IQ ReSTOR® IOL implanted again.
Multifocal IOLs have a slightly greater tendency to cause night vision complaints than other IOLs, so those who drive a great deal at night may wish to consider a different IOL. The vast majority of patients with these IOLs, however, are not bothered by night vision complaints. Additionally, multifocal lenses usually need to be implanted in both eyes before full adaptation can occur.
Crystalens® Accommodating Intraocular Lens
Crystalens® accommodating lens, unlike other lens technologies, uses 100% of the available light rays. Working in concert with the eye’s natural muscle, Crystalens® “flexes” to accommodate near, intermediate and distance subjects. Just as the human lens uses the Your browser may not support display of this image. ciliary muscle to move the lens thus allowing a person to focus on the subject at hand, the Crystalens® works in a similar way. The lens rests back in the eye to accommodate distance vision, then gently flexes forward to accommodate intermediate vision, and then flexes further forward for near vision. This movement is enabled by a flexible hinge within the lens.
Crystalens® is the first and only FDA-approved accommodating IOL. Your physician will perform a thorough eye exam to determine if you are a candidate and will fully inform you of any increased risk of complication.
TECNIS® Multifocal Intraocular Lens
Designed to give patients back their youthful vision, the TECNIS Multifocal Lens, provides patients with high-quality vision at any distance, and in any light condition — even in low light. Just introduced by Abbott Laboratories, the advanced TECNIS Multifocal is the only full-surface “diffractive aspheric” IOL. It enables patients to function comfortably without glasses at near, intermediate and far distances. Based upon initial studies, it’s the lens 94% of patients would choose again and nearly 9 out of 10 study patients did not require glasses after their cataract surgery.
If you are diagnosed with cataracts and are experiencing one or more of the following symptoms, you may be a candidate for the TECNIS Multifocal Lens:
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Difficulty reading
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Difficulty seeing close objects
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Difficulty seeing to drive, especially at night
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Changing glasses prescriptions
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Needing bifocals
Ask your doctor if the TECNIS Multifocal Lens is an option that is right for your lifestyle and eye health.
Before Surgery
You will need a medical clearance from your family physician within 30 days of surgery. This includes a history and physical, and possibly an EKG and chest X-ray (if you have had significant lung disease). You may be required to have additional diagnostic and lab tests at the discretion of your physician.
On the night before surgery, do NOT eat or drink after midnight. Postpone your diabetic medications until after surgery or reduce the dose if surgery is in the late morning or afternoon. Continue to take other medications prior to surgery, including aspirin. You may take your medications with a little bit of water.
What to wear: Clean clothes, loose tops, short sleeve top, no dresses, no body suits, no turtlenecks. Do not wear eye makeup, facial moisturizer, perfume, cologne, or body mist.
Location: The Surgery Center (downstairs below the main office)
Arrival: The week before surgery, our office will send to you by mail your surgery time and will let you know what time to arrive. Upon arrival, you will complete surgical center registration forms. Bring insurance cards with you. Be prepared to pay co-pays or any other out of pocket expenses.
Length of stay: Count on being at the facility for one to two hours, possibly more. You will need someone to take you home. Friends and relatives may wait for you in the waiting room or in the café on the first floor of the surgery center.
The surgery center will NOT release you without a companion.
Surgery
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First, an anesthesiologist will provide a mild sedative to make your surgery more comfortable and to relax you.
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To remove the cataract, the cataract surgeon makes a microscopic incision and gently removes the cataract in a procedure called phacoemulsification.
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Next, the intraocular lens is inserted through the same microscopic incision and placed into the lens capsule of your eye where the natural lens was located. The procedure usually takes only 10 to 20 minutes.
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Today, cataract removal is generally performed as an outpatient procedure under topical anesthesia in over 99% of patients, and they leave the operating room without needing an eye patch.
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Because this procedure is performed through a microscopic incision, the eye usually seals itself without stitches.
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Following the procedure, most people return home within an hour or so. Vision is improved immediately in many cases. However, vision usually continues to improve in the weeks following the procedure until you achieve your best-possible vision.
After Surgery
Your eye will be examined the same or next day and then at intervals determined by your doctor.
You should have someone with you at home after surgery because of the medication you will receive.
Go home and rest.
After surgery you will be wearing an eye shield. Keep the shield on the entire first day except to place eye drops as instructed.
(If your eye is patched closed, don’t start your medications until seen by the doctor the next day.)
Eye drops: You started some of these drops a few days before surgery. The antibiotic drop you started will be continued for one week. The 2 other drops will be both used about four to six weeks, depending on your individual rate of healing.
*Restart any glaucoma drops or dry eye medications you were on prior to cataract surgery, including Restasis, AzaSite, and/or Oasis tears.
*Wait 3 minutes between each of your drops
*Bring all eye medications to all of your post-op appointments.
Back to work: You may be able to return to work the next day after surgery, depending on your occupation.
Exercise: You may resume some physical activities in as soon as one day depending on your surgery. Do not get sweat into your eyes.
Precautions:
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No heavy lifting over 30 pounds, no bending over, and no straining for one week.
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Do not ever rub or push your eye.
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Do not allow water to flow directly onto your face or directly at your eyes for 5 days after surgery.
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Do not wear makeup, moisturizer, perfume or cologne for 5 days.
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Do not swim or use jacuzzis or saunas for 2 weeks.
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Do not use hair chemicals (color treatments or harsh solutions) for 10 days.
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Wear the eye shield at night for one week.
Pets: Please be sure to wash linens after your surgery. Please do not sleep with pets. Their fine hair may get into your eyes.
Surgery on your second eye: If you need cataract surgery in both eyes, the second eye can be done two to four weeks later.
Glasses: If needed, glasses for standard cataract surgery will be prescribed by your doctor or your comanaging doctor about a week after medications are stopped.
Normal healing: You may experience: scratchiness, few areas of redness, foreign body sensation, mild tenderness to touch, and fluctuating vision.
Call the Office Immediately If:
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You have severe eye pain.
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Your vision becomes worse.
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The redness of your eye worsens.
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Your eyelids become swollen.
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You have flashes of light or sudden worsening of floaters.
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You have a curtain or cobweb in your vision.
A Posterior Capsulotomy is a surgical procedure that is sometimes necessary after cataract surgery. Cataract surgery removes the cloudy lens from the cellophane-like membrane called the lens capsule. Then a clear artificial lens implant is put in its place. In about half of all cataract surgery patients, the lens capsule, or “bag”, becomes cloudy or wrinkled. This cloudiness or haze is referred to as an “After-Cataract.” Patients start to experience symptoms similar to before the cataract surgery, including blurred vision or increased glare. It will seem as if the cataract has come back. These symptoms may begin anywhere from a few months to many years after cataract surgery.
The doctors at Ophthalmology Associates can perform a simple laser procedure which creates an opening in the lens capsule. The procedure takes only a few minutes and is painless, with no recovery time. Once the laser procedure is performed, it will never need to be done again. This procedure is commonly referred to as a “YAG”, which is the type of laser used to perform the procedure. If it seems that your vision is not as good as it was right after your cataract surgery, our doctors can evaluate you to see if you are a candidate for a Posterior Capsulotomy. Your doctor will be happy to discuss the benefits and risks associated with this laser procedure.