Many patients now have more alternatives thanks to advancements in cataract surgery, including the opportunity to be “spectacle-free.”
Any ophthalmologist will tell you that cataracts are a typical side effect of aging. Most people who live long enough will eventually acquire this disorder, characterized by a clouding of the typically clear eye lens in one or both eyes.
According to Yale Medicine ophthalmologist Vicente Diaz, MD, MBA, cataracts have existed for as long as there have been humans. “The aim was to remove the cataract without causing blindness for thousands of years.
Fortunately, advances have been made in cataract surgery. Due to scientific improvements, patients now have many alternatives, including laser-assisted surgery and an expanding selection of artificial replacement lenses that help treat other visual issues. It is incredibly safe.
As an ophthalmologist at Yale Medicine, Yvonne Wang, MD, explains, “What’s fantastic about cataract surgery now is that we not only remove the cataract, but we can restore patients’ eyesight.” “They could have worn glasses or contacts with prescriptions for many years. Their new lens may now be customized with a prescription, giving them superior eyesight than before.
Deciding on what type of surgery or lens is best for you may seem difficult given the number of options available. To answer frequent questions, we met with cataract surgeons from Yale Medicine.
What are Cataracts
It is helpful to first comprehend a cataract and its development.
We’ll begin with the lens, a part of your eye that directs light toward your retina to create a sharp image. The cloudiness of the lens prevents light from flowing through. “At that point, it becomes a cataract. The proteins in your lenses are beginning to break down while one is formed. You can no longer retain clarity because they become inconsistent, claims Dr. Wang.
The early symptoms, she continues, are usually blurry vision and the need to constantly adjust the prescription for your glasses or contacts. Halos, glare, and sensitivity surrounding lights are among additional symptoms that might occur, especially at night when driving. Or, if a restaurant’s lighting is dark, you can have difficulty seeing the menu, according to Dr. Wang.
The most frequent cause of a cataract is old age. It can occur at various ages. It may start for some patients in their 50s. The majority of cataract surgeries, however, are performed on patients in their 70s, according to the expert.
In addition to becoming older, Dr. Wang notes that exposure to light and UV rays can make lenses foggy. In rare circumstances, you can be born with a cataract. Other risk factors for cataracts include trauma, drugs, steroids, certain illnesses, such as diabetes, and certain disorders.
How is a cataract identified?
Cataracts are identified by ophthalmologists during an eye exam.
I enlarge the patient’s pupils and look at them under a microscope. According to Dr. Wang, the cataract will have a yellow, milky, or foggy appearance.
Most individuals can see better with an update to their glasses or contact prescription when a cataract is only starting to form and is not too significant.
But as cataracts deteriorate with time, patients can discover that their prescription needs to be changed every year or even more frequently than that—or the prescription doesn’t properly fix it, according to Dr. Wang. “At that time, cataract surgery is the sole option for therapy.”
What cataract surgery choices do I have?
Once you’ve decided to have cataract surgery, discuss the various surgical techniques and the type of intraocular lens (IOL)—a synesthetic lens—you want to employ to replace the cataract with your ophthalmologist.
There are two kinds of surgery:
One of the most popular forms of surgery worldwide is basic cataract surgery. It entails creating a tiny incision in the eye, using ultrasound to separate the cataract into fragments, and then removing those pieces. The IOL is subsequently inserted into the lens capsule by the surgeon. (More on what to anticipate during surgery is provided below.)
Yale physicians also provide cataract surgery using a femtosecond laser, which employs concentrated, high-energy light beams with pulse rates measured in “femtoseconds,” or trillionths of a second. The cataract can be made easier to remove by making incisions and softening it with the laser. Compared to traditional surgery, using a laser enables accurate incisions to be made in less time with the potential for more precise vision correction.
For those who opt for a particular IOL type, such as a multifocal or extended depth of focus lens, laser surgery may be advised (explained below). The laser can also treat astigmatism during surgery (a condition in which the front surface of the lens is curved differently, leading to blurry vision).
What are my options for lenses?
Every IOL will offer crystal-clear vision. After your cataracts are removed, you can choose an IOL that will improve your ability to see up close, far away, or in between, or you can elect to have your vision corrected. If you were nearsighted before surgery, for example, you could choose a lens that will keep you nearsighted after surgery. In other words, the IOL has a prescription, much like contact lenses or a pair of glasses.
Details are as follows:
The most popular kind of lenses used during cataract surgery is mono-focal lenses. One of the following “focusing” distances are available: up close, medium distance, or distance vision. Most individuals opt to have reading glasses in addition to their distance prescription.
Another option is “monovision,” where one eye’s lens is adjusted to see “far” while the other eye’s lens is adjusted to see “close.” But with monovision, your binocular vision might not be as good because you’re utilizing one eye for distance and one for close-up items. You can also experience some loss of depth perception (the ability to judge how far away an object is). Some people will need to wear glasses if they want both eyes to observe the “distance” event when participating in “distance” activities like driving, watching TV, or traveling to a concert or sporting event.
According to Yale Medicine ophthalmologist Brian DeBroff, MD, monovision is unsuitable for everyone. Because they are aware of how it feels, he explains, “we often give it to folks who have previously experienced it with contacts.
- Multifocal Lenses: These are like bifocal or trifocal spectacles in that they contain correcting zones integrated into the lenses. You can see things up close and far away with multifocal lenses, and some of them can even correct intermediate vision. Although multifocal lenses may allow you to completely forgo using glasses or contacts for any activity, they have been linked to complaints of visual impairments, including halos and glare.
- Extended depth of focus (EDOF): These lenses have a single, lengthened focal point and a single correction zone. This enables eyesight at a distance and in the middle distance. While multifocal lenses are more likely to cause visual disturbances than EDOF lenses, you can still require glasses for “near” vision.
- Torus IOLs: Depending on your needs, these lenses come in a range of strengths with built-in astigmatism correction. They apply to platforms with monofocal, multifocal, and EDOF. Dr. Diaz finds it intriguing that cataract surgery may now treat astigmatism. To get fine-tuned outcomes, he explains, “We can utilize either the laser or an intraocular lens—or a mix of both.” Doctor DeBroff concurs. This is crucial since multifocal lenses won’t function properly if there’s existing astigmatism,” he says.
It’s vital to keep in mind that your insurance plan could not cover some solutions, such as multifocal, EDOF, and toric lenses, as well as laser surgery.
What does ORA stand for?
One of the most recent developments in cataract surgery is a technique known as ORA (Optiwave Refractive Analysis), a type of intraoperative aberrometry. With the help of this technology, surgeons can take refractive measurements inside the operating room in order to provide the best lens power and placement.
“This equipment takes an additional measurement of your eye during cataract surgery, allowing for a more exact measurement of the lens that is being inserted within it,” explains Dr. Wang. “Getting the greatest visual result depends heavily on having an exact measurement. The most recent lens designs provide clear reading and distant vision. But you need exact measurements to achieve those positive results.
According to Dr. Diaz, in the past, when someone was getting ready for cataract surgery, the surgeon would evaluate the size and shape of their eye to determine what kind of lens they would require. “However, cataracts can affect that measurement. ORA enables us to measure the eye once the cataract has been removed to position the lens correctly and provide clearer vision. This measurement is usually more precise because of this, the doctor explains.
How does a cataract operation go?
According to Dr. Wang, cataract surgery is a routine and safe treatment. Patients receive it in an outpatient setting and go home the same day. Patients usually get surgery on one eye first, then return a few weeks later for the second eye.
According to Dr. Wang, the entire cataract surgery process only lasts a few hours, but the actual operation only takes 15 to 20 minutes on average.
First, a local anesthetic is used to numb your eye (either eye drops or an injection). Dr. Wang notes that while you are awake throughout the surgery, a little sedative is administered via an IV to help you feel at ease and calm.
Dr. Wang claims that cataract surgery is a standard and safe procedure. The treatment is given in an outpatient environment, and patients return home the same day. Typically, patients have surgery on one eye, then return a few weeks later to have the second eye done.
The total cataract surgery procedure, according to Dr. Wang, only takes a few hours, but the actual surgery itself only takes 15 to 20 minutes on average.
First, your eye is numbed with a topical anesthetic (either eye drops or an injection). According to Dr. Wang, a small amount of sedative is given to you via an IV while you are awake throughout the procedure to make you feel comfortable and at rest.