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Cataract Surgery

Cataract surgery is a procedure to remove the lens of your eye and, in most cases, replace it with an artificial lens. Normally, the lens of your eye is clear. A cataract causes the lens to become cloudy, which eventually affects your vision.

More than 50 percent of people over the age of 60 (and quite a few younger than that) suffer from cataracts. Almost everyone develops cataracts as they grow older. Cataract formations occur at different rates and can affect one or both eyes.

It is easiest to think of the eye like a camera. Just like a camera, the eye has parts that help focus the image. The cornea is the front covering (lens) of the eye. Inside the eye the iris acts like the aperture of the camera. Behind the iris is the natural lens.  When we are young, the natural lens is flexible (allowing for focus from far to near), as we get older the lens hardens and clouds (cataract). Behind the natural lens is the film of the eye, which is known as the retina. The image formed on the retina is then transported to the brain via the optic nerve.

Having cataracts can be like looking through a foggy or dusty car windshield. Things may look blurry, hazy, or less colorful. A cataract is a progressive clouding of the eye's natural lens. It interferes with light passing through the eye to the retina (camera film). Aging and other factors cause proteins in the eye's lens to clump together forming these cloudy areas. Early changes may not disturb vision and may be treated with a change in glasses, but over time cataracts typically result in blurred or fuzzy vision and sensitivity to light.

Symptoms of Cataracts

  • Decreasing vision with age
  • Difficulty distinguishing colors
  • Poor depth perception
  • Frequent prescription changes for glasses
  • Difficulty reading
  • Glare while driving especially at nigh or reading
  • Blurred or double vision
  • Seeing halos around bright lights
  • Difficulty seeing at night
  • Vision that worsens in sunlight 

Causes of Cataracts

  • Age
  • Eye trauma
  • Heredity
  • Diabetes
  • Some medications including long-term use of steroids
  • Ultraviolet radiation
  • Smoking
  • Certain metabolic conditions
     

In fact, cataracts are the leading cause of vision loss among people over age 55, and cataract surgery with an intraocular lens implant (IOL or artificial lens) is the most frequently performed operation in the United States. By removing the cataract and placing the IOL vision can be improved, though remember the amount of improvement does depend on the health of the other parts of the eve including the retina and cornea surface.

Currently there is no medical treatment to reverse or prevent the development of cataracts. Once they form, the only one way to achieve clear vision again is through cataract surgery.

In your parents' or grandparents' day, cataract surgery was considered risky, required a lengthy hospital stay and was usually postponed for as long as possible. Today, cataract surgery is performed on an outpatient basis and takes only a few minutes. It is now one of the most common and successful medical procedures performed.

During surgery your clouded lens is removed and replaced with an IOL. Your doctor will help you choose the correct IOL for you. Depending on the health of your eye and your needs, there are multiple IOL options that may be available to you.

These are single focus lenses that allow for vision at distance or near. Glasses are generally needed after surgery.

These IOLs correct for astigmatism in addition to correcting for either distance or near. Toric IOLs allow for clearer vision as a result of astigmatism correction. When the front surface of the eye is not shaped like a perfect ball but rather has different curves then one has astigmatism. Glasses and contacts can generally correct regular astigmatism. Toric IOLs allow for clearer vision without glasses when astigmatism is present.

These IOLs give a wider range of vision without glasses. In most cases, glasses will not be needed for driving, watching TV, or close-up vision, such as computers or reading. These lenses function somewhat like built-in bifocals, splitting the focused light between distance and near. Due to this light splitting these IOLs are not generally recommended in patients who have other ocular conditions.

EDOF IOLs, or extended range-of-vision are a relatively new technology in the treatment of presbyopia. The basic optical principle is to create a single-elongated focal point to enhance the depth of focus. EDOF IOLs provide excellent vision without glasses for distance (driving, watching TV) and intermediate visual tasks (computer work), and good vision quality at near distance (reading labels, cell phone) for most patients. The design of this new lens is also a leap forward in minimizing concerns about glare and halo that some patients experience after cataract surgery.

Like multifocal IOLs, accommodating IOLs are also designed to increase the range of vision without glasses for most daily activities. These lenses work by flexing, mimicking the natural focusing action of the eye.

The light adjusting IOL, or LAL, allows the surgeon and team to adjust your correction after surgery. This can be particularly useful in patients who have had prior refractive surgery. The complete process does require more time and effort, though the surgery is the same. Patients have to wear UV protecting glasses until all of the post-surgery light treatments are complete, which can take 6-8 weeks on average. 

Traditionally, cataract patients received monofocal lens implants that had only a single power. This meant you had a choice of correction for either distance or near vision but would need glasses for the opposite. Since about 2005, the FDA has approved several lifestyle intraocular lens implants for use by certified ophthalmologists. These lenses can increase your chances for a life free of dependence on glasses or contacts after cataract surgery for distance, intermediate, and near vision. Additionally, there are special lenses that can correct for astigmatism. If you wear glasses and have a cataract, this might be an opportunity to eliminate them altogether.

The implantation procedure is the same for lifestyle IOLs and monofocal IOLs. The main point of differentiation between the IOLs is in the type of vision they provide. 

All patients should know that one approach or IOL is not better than another, they are just different and dependent on the individual patient's situation. It is also important to know that there is no perfect solution – each lens technology has its pro’s and con’s. Our goal is to provide the safest and most effective cataract surgery for each one of our patients. All efforts will be made to personalize the cataract surgery approach and IOL choice for you so that you will be able to enjoy improved vision for years to come.
 

IOLs are placed at the time of cataract surgery to allow for the focusing of light. Generally, IOLs are very well tolerated and cause no problems. If the IOL is not placed correctly, intraocular lens decentration may occur. This also may happen if there is trauma to the eye. Symptoms of decentration include glares, halos, and reduced vision. If this occurs the intraocular lens must be repositioned surgically. Intraocular power miscalculation can also occur if the implanted lens is not sufficient to correct the patient’s vision. This can also require surgical replacement or laser vision correction.

Using a laser allows the surgeon to make precise incisions in less time. It can improve accuracy and consistency. In some cases, the laser can provide more correction than traditional surgery. The laser can reduce the amount of ultrasound energy needed to soften the lens prior to removal.

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Whether you need a routine eye exam or care for complex vision problems, the internationally respected ophthalmologists at the UCI Gavin Herbert Eye Institute will provide you with the highest quality of care to treat your vision problems. 

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The UCI Gavin Herbert Eye Institute has locations in Orange at the UCI Medical Center, and also in Irvine on the UCI Campus.