Cataracts

The function of your eye can be compared to the workings of a camera.
Just as the camera

focuses light rays onto film to register a picture,
the lens of your eye focuses light onto your retina to form an image.
If the camera lens is scratched or dirty, your picture will not be perfectly clear. Similarly, abnormalities of the lens of your eye
(such as a cataract) will affect how well you can see.

A cataract is a clouding of the natural clear lens located inside the eye in front of the retina. As a cataract progresses and grows cloudier, it blocks the retina’s ability to receive images, colors and light. This condition is most commonly caused by the aging process. Just as aging changes occur in other parts of the body (such as an increase in wrinkles and age spots), changes occur in the lens of the eye.

Thus, a cataract is not a “film” or “skin” on the outside of the eye, but rather a natural breakdown in the chemical makeup of the lens inside the eye. Cataracts may also occasionally result from injury, disease, heredity, drugs or birth defects.

Cataracts are the leading cause of treatable visual problems in the U.S. Six out of 10 people
over age 60 have some form of cataract,
and almost everyone over age 80 has cataracts.
At present, the only effective cure is surgical removal of the lens—diets, drugs and eye exercises have not been shown to retard or prevent the development of cataracts. Today, this type of operation is far easier, safer, and more frequently successful than in the past.
Approximately two million Americans undergo cataract surgery each year.

Problems with your eyesight may occur at any time during the development of a cataract. Usually, you will first notice a slight fogginess. There is no pain or discomfort. As the cataract progresses, your vision will become blurry and dim. Occasionally, some people temporarily experience “second sight,” or the ability to suddenly be able to read up close without glasses. However, once the cataract progresses, vision for distance and close will become cloudy.

Depending on the type of cataract, the clouding of your lens may take years or just weeks to months to progress. The following symptoms may indicate that you have a cataract:

	Hazy, fuzzy and blurred vision
	Double vision in one eye
	Sensitivity to light and glare
	A “starburst” effect around headlights and streetlights
	Difficulty driving at night
	Frequent lens prescription changes
	Color changes of the pupil from black to yellowish or white
	Holding objects closer in order to read or to do close-up work
	Loss of color brightness

If you notice one or more of these signs, you should arrange for a proper evaluation of your condition.

A complete eye examination is necessary to evaluate the condition of your cataract and to determine whether treatment would be beneficial. At Eye Care Specialists, the following instruments and tests may be used.

Although it is no longer necessary to wait until a cataract is so “ripe” or dense that almost all vision is blocked, its mere presence does not necessarily warrant surgery. Occasionally, however, a cataract may

require removal for medical reasons—such as to permit evaluation and laser treatment in patients with diabetic eye disease.

Generally, the right time to remove a cataract is dependent upon your personal needs. When visual impairment interferes with your daily tasks or job, surgery may be beneficial. If so, the following criteria should be met (with occasional exceptions):

The goal of cataract removal is to improve eyesight and quality of life. You are the only one who, with your physician’s counseling, should decide if and when cataract surgery should be performed.

Cataract surgery is a highly successful procedure. The overwhelming majority of patients enjoy a marked improvement in vision—as long as there are no underlying problems or other conditions affecting the health of the rest of their eye and, therefore, the ability to see clearly.

Cataract removal is considered one of the safest operations in this country. As with any procedure, however, complications can occur. In rare cases, glaucoma, retinal detachment, bleeding, inflammation and other diseases or conditions may develop, and there is even an extremely remote chance of losing vision in the operated eye. Fortunately, however, the probability of success greatly exceeds the very small chance of complications.

Advanced techniques and new equipment have made cataract surgery one of the most commonly performed and successful operations in medicine.

Cataract surgery is almost always performed on an outpatient basis using local anesthesia. It is rare for patients to experience any discomfort. Local anesthesia is faster, simpler and safer than general anesthesia, especially for very elderly patients.

At Eye Care Specialists, the anesthesia process has been further simplified so that, in the majority of cases, eye drops alone are used to numb the eye—eliminating the need for needles or injections.

We also perform almost all of our cases at our own outpatient surgery center, the Eye Surgery & Laser Center of Wisconsin. Located in Milwaukee County Research Park , this 10,000-square-foot facility has four surgical suites, a laser room, and the most advanced technology available—all for performing only eye surgery. Nurses with an average of 20 years of experience and a specialization in eyes attend to patient questions and needs. And, to reduce anxiety, the center offers a relaxed atmosphere that allows patients to wear their own clothes during surgery and to rejoin family or friends for a snack just minutes afterward.

If a patient has certain health insurance restrictions, surgery may be performed at a hospital or other outpatient facility. No matter where surgery is done, however, patients are happy to be finished and back home within only about three hours.

Many people think lasers are used to perform cataract surgery. This is NOT true. Cataract surgery requires making an opening in the eye and then removing the cloudy lens (cataract). At Eye Care Specialists, our surgeons use phacoemulsification, the most advanced and sophisticated technique for cataract removal. Phacoemulsification (phaco=lens, emulsification=dissolving) uses high frequency ultrasound to break up the cataract and gently vacuum out the particles through a tiny incision (about 1/8 inch). Phacoemulsification requires additional training, equipment and expertise to perform, and is especially advantageous for most patients. Because the phacoemulsification incision is tinier than that used for other removal methods, it reduces surgical time and offers more rapid recovery. Most patients are good candidates for phacoemulsification. Rarely, however, pre-operative tests show degeneration of the cornea or other conditions that make using a larger incision method of removal more preferable.

After the lens (which is about the size of an aspirin) has been removed, an artificial lens is needed to once again focus light rays onto the retina. This lost focusing power is usually replaced by an intraocular lens implant (IOL). Because an IOL is placed inside the eye where the natural lens used to be, it provides full peripheral (side) vision and good depth perception. IOLs stay permanently in place and do not require maintenance. Each IOL is chosen for the shape and strength of vision needed. Most patients, however, still need to wear glasses for close-up tasks or fine-tuning their vision.

As just described, cataracts are removed surgically—NOT by a laser. The laser can be used, however, to restore vision in patients who experience cloudiness after cataract surgery. To explain, once a cataract is removed, it cannot grow back. Occasionally, however, months to years after surgery, the sac that was left behind (to protect the back of the eye) becomes cloudy through a process of normal cell regeneration, causing vision to blur. Through a quick, painless outpatient procedure, a “YAG” laser is then used to make an opening in the center of this cloudy capsule. Within minutes after sitting at the machine, most patients experience improved vision.

Eye Care Specialists' surgeons are proud to be on the cutting edge of new technologies and techniques, including:

This innovation involves removing a cataract through an incision made to heal on its own without the need for stitches. This is appropriate for most all patients.

As mentioned earlier, this exciting development enables eligible patients to enjoy having surgery with only eye drops (rather than injections) to numb the eye. "Topical" (eye drops on the surface) surgery requires advanced skill and training to perform. Patient benefits include a faster recovery and immediate (if no patch is used) return to vision.

Eye Care Specialists’ surgeons were the first in Wisconsin to use lens implants that can fold and fit through the tiny incision made during phacoemulsification removal. These lenses speed healing, recovery, and return to normal vision.

Standard or conventional lens implants (IOLs) are “mono-focal” or single-focus. They are like miniature internal contact lenses or glasses set for a single prescription power—usually to provide clear vision in the distance (for driving, watching TV, etc.). Most cataract patients, however, still need to wear reading glasses or bifocals to compensate for the effects of “presbyopia,” the decreased ability of the eye to focus on near objects, as you grow older.

Some newer IOLs, however, are “multi-focal”—providing multiple focusing zones for a full range of vision day and night, near and far. About 70% of patients with these IOLs can see to read, work on a computer, drive, play golf, or perform most any activity—with increased freedom from wearing glasses.

Realistic expectations, higher costs, potential night glare, and other concerns are reviewed with multi-focal IOL candidates.

Endoscopic Cyclo-Photocoagulation (ECP) is a breakthrough surgical laser procedure that has proven highly effective for controlling glaucoma and reducing (or eliminating) the need for glaucoma drops. During the 10-minute ECP procedure, a self-sealing micro-incision is made to insert a laser probe. This probe uses tiny optical fibers to illuminate, view and apply laser energy directly to the eye’s “ciliary body” to reduce its fluid production and thereby lower glaucoma pressure. Since the natural lens inside the eye blocks access of the ECP probe to the ciliary body, ECP can only be performed with or after cataract surgery—once the natural lens (cataract) has been removed.

Your Eye Care Specialists’ surgeon will analyze your individual health and lifestyle situation to determine if utilizing one of these or other new advances will make your cataract operation even more convenient, safe and beneficial.

After your operation, you will be taken to a recovery area and served a light snack. Following a short period of rest and observation, you will be free to go home and do most normal, non-strenuous activities. Because you are given medication to relax during surgery, you must have someone drive you home.

The day after surgery, you will be examined, and your course of treatment will be reviewed. You will wear a

protective shield at night and may be told to wear glasses or sunglasses during the day to prevent inadvertently touching your eye.

While your eye is healing, you may have blurring of vision. Now that the clouded cataract has been removed, you may also notice that things seem brighter. Both the blurriness and brightness are not unusual. It is also common to have a scratching sensation for a short period of time.

With the modern surgical techniques used by our practice, you can resume most daily activities almost immediately, including reading (although there may be some initial blurriness), watching television, using stairs, walking outdoors, cooking, cleaning, shopping, and driving. You should, however, avoid getting water in your eye, heavy lifting or exercise, and excessive stooping or bending. As your eye heals, you may be able to enjoy activities that were halted by your cataracts, such as needlepointing or golfing.

Many people notice significant improvement in vision within a few days. Results do, however, vary from patient to patient, and vision generally will not reach its optimal level until the end of the three- to four-week recovery period. At that time, a final check-up will be arranged to "fine-tune" your eyesight with a prescription for a new lens for your glasses.

The most satisfied patients are those who are educated, active partners in their own care.
As with any medical procedure, feel free to contact your doctor’s office with any questions or concerns. Also, it is extremely important that you keep your follow-up appointments.
Observation and counseling are essential to achieving the best possible final vision.

If you understand and accept the potential benefits and complications of cataract surgery, and elect to proceed with treatment, you can look forward to a new “outlook” on life. . . . Patients often comment about the simple joys of seeing faces clearly again, rediscovering the colors of a garden, following a golf ball through the sky, or renewing a driver’s license without dreading the eye exam. Many say that, had they known the positive noticeable difference, they would have had surgery sooner.

At Eye Care Specialists, we have had the privilege of enhancing the vision and lifestyles of tens of thousands of cataract patients. We’d like the opportunity to make a visible difference in your life.
Let us show you how.

If you would like a detailed color booklet with the information contained in this section and/or to schedule a comprehensive evaluation for cataracts, please feel free to contact Eye Care Specialists’ Communications & Education Department at 414-321-7035.