What Are Cataracts?
Vision problems with cataracts
If your vision has become blurry, cloudy or dim, or things you see are not as bright or colorful as they used to be, a cataract may have developed in one or both of your eyes. Many people say that their vision with cataracts is similar to the effect of looking through a dirty car windshield.
As a cataract slowly begins to develop, you may not notice any changes in your vision at first. But as the cataract progresses, you may begin to find that it interferes with your daily activities. Performing a complete eye exam, your ophthalmologist (Eye M.D.) can tell you whether cataract or another problem is the cause of your vision loss.
While cataracts are one of the most common causes of vision loss, especially as we age, they are treatable with cataract surgery. Since most cataracts are part of the normal aging process, they cannot be reversed. There are no medications or eye drops that will make cataracts go away—surgery is the only treatment.
The top lens is clear. The bottom lens shows clouding by cataract.
A cataract may not need to be removed right away if your lifestyle isn't significantly affected. In some cases, simply changing your eyeglass prescription may help to improve your vision. Contrary to popular belief, a cataract does not have to be "ripe" to be removed. However, once you are diagnosed with a cataract, your ophthalmologist needs to monitor your vision regularly for any changes.
Cataract surgery for clearer vision
When a cataract causes bothersome vision problems that interfere with your daily activities, your ophthalmologist may recommend surgery to remove the cataract. With cataract surgery, your eye's cloudy natural lens is removed and replaced with a clear artificial lens implant (called an intraocular lens or IOL).
You and your ophthalmologist can discuss the cataract surgery procedure, preparation for and recovery after surgery, benefits and possible complications of cataract surgery, cataract surgery costs and other important information. Together, you can decide if cataract surgery is appropriate for you.
Pre-operative tests for cataract surgery
Before surgery, the length of your eye will be measured in what is called an A-scan, and the curve of your cornea will be measured in a technique called keratometry. These measurements help your Eye M.D. select the proper lens implant for your eye. You will also discuss the various lens options available to you.
If you have had previous LASIK or other laser vision correction, you can still have cataract surgery. In planning for cataract surgery, provide your Eye M.D. with the vision correction prescription you had before LASIK, if possible. This information will help your Eye M.D. calculate the correct IOL prescription for you. Previous refractive surgery can make determination of the correct IOL more difficult and your vision prescription prior to refractive surgery can help the surgeon calculate the correct IOL power.
Medications and cataract surgery
If you are having cataract surgery, be sure to tell your ophthalmologist about all medications and nutritional supplements you are taking. If you currently use or have ever used alpha-blocker drugs for prostate problems, such as Flomax®, Hytrin®, Cadura® or Uroxatral® , tell your Eye M.D. These medications may prevent your pupil from dilating properly during surgery, leading to possible complications. If your surgeon is aware that you have had these drugs, he or she can adjust their surgical technique to adapt as needed, allowing for a successful cataract removal procedure. You should also tell your Eye M.D. about any other sedative medications you are taking.
To reduce the risk of infection from surgery, your ophthalmologist may prescribe antibiotic eyedrops for you to use one or two days before surgery.
With phacoemulsification cataract surgery, an ultrasound instrument breaks up the center of the cloudy lens and suctions it out.
The cataract surgery procedure
The most common procedure used for removing cataracts is called phacoemulsification. A small incision is made in the side of the cornea (the front part of your eye), where your Eye M.D. inserts a tiny instrument that uses high-frequency ultrasound to break up the center of the cloudy lens and carefully suction it out.
After the cloudy lens has been removed, the surgeon will replace it with an intraocular lens (IOL) implant made of plastic, silicone or acrylic. This new, clear lens allows light to pass through and focus properly on the retina. The IOL becomes a permanent part of your eye. In most cases, the IOL is inserted behind the iris, the colored part of your eye, and is called a posterior chamber lens. Sometimes, the IOL must be placed in front of the iris. This is called an anterior chamber lens. When the IOL is in place, the surgeon closes the incision. Stitches may or may not be used. After the surgery, your Eye M.D. usually places a protective shield over your eye.
Cataract surgery recovery
You will spend a short period of time resting in the outpatient recovery area before you are ready to go home. You will need to have someone drive you home.
Following your surgery, it is very important to put in the eye drops exactly as prescribed by your ophthalmologist to promote healing. You will also need to take care to protect your eye by wearing the eye shield whenever you sleep, and by wearing special wraparound sunglasses in bright light. Be sure not to rub your eye.
During the first week of your recovery, you must avoid strenuous activity such as exercise or bending and heavy lifting (including anything over 25 pounds). You will also need to avoid getting any water, dirt or dust in your eye, which can lead to infection.
You may have some blurry vision a few days to weeks after surgery procedure. If you experience any pain or loss of vision, be sure to call your ophthalmologist.
Cataract surgery risks and complications
As with any surgical procedure, there are risks associated with cataract surgery. Risks and complications can include:
Bleeding inside the eye
Increased pressure inside the eye (glaucoma)
Swelling of the retina
Swelling of the cornea
Loss of vision (partially or completely)
In some cases, the part of the lens covering that supports the IOL (called the capsule) can become cloudy several months or years after the first cataract was removed. This is called an "after cataract" or "secondary cataract." If this occurs and blurs your vision, your Eye M.D. will make an opening in the center of the cloudy capsule with a laser to allow light to pass through the lens properly again. This procedure, called a posterior capsulotomy, takes about five minutes in the doctor's office and requires no recovery period.
Most people who wear bifocals or reading glasses for near vision may still need to wear glasses after cataract surgery for reading, and, in some cases, even for distance. If you choose to have a multifocal or accommodative IOL, your dependence on glasses may be minimized or, in some cases, eliminated completely.
Cataract surgery costs
Cataract surgery costs are generally covered by Medicare (if you are Medicare eligible) as well as by most private insurance plans.
Your cataract surgery costs will be covered by Medicare as long as your vision tests at a certain level of acuity or clarity. If you have a private insurance plan, they too may have similar vision requirements that you must meet in order to have your surgery covered. Even if Medicare or private insurance covers your cataract surgery, there may be some costs you would still be responsible for, such as having a special enhanced type of intraocular lens (IOL) implanted instead of a standard IOL, or choosing to have cataract surgery before your vision has deteriorated enough to be eligible for Medicare or insurance coverage.
In certain cases, it might be possible to get insurance or Medicare coverage for cataract removal before you meet the age or visual acuity eligibility requirements. Talk with your ophthalmologist if you are considering having early cataract surgery.
If you don't have Medicare or private insurance coverage, you may still be able to reduce and manage the cost of cataract surgery through other means, such as payment plans through your doctor's office or with a flexible spending account through your employer. Your Eye M.D. can help you learn more about costs of cataract surgery and discuss your options for affording the procedure.
For more information, visit GetEyeSmart.com