Frequently Asked Questions

Cataracts

What is a cataract?
What causes cataracts?
Is there a way to prevent cataracts?
When do I need surgery?
What are some of the problems with delayed surgery?
Where is cataract surgery done?
How is the surgery done?
How long before I can resume normal activities?
Will I need glasses after surgery?
What are the complications of surgery?
How will I see after surgery?
What about new lenses that give good near and far vision?
How many cataract operations have you done?
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What is a cataract?
Cataract is the clouding of the lens inside the eye. The effect is similar to that of looking through a ground glass. Things look fuzzy and reading is difficult. There may be glare while driving at night. Characteristically, these changes start slowly and progress over months or years.

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What causes cataracts?
There are many causes of cataracts. The most common cause is aging of the eye. Both eyes are usually affected but often to a different degree.

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Is there a way to prevent cataracts?
There is no way to consistently prevent cataract development. Several vitamins have been shown to reduce cataract formation but their protective effect is very limited. Avoiding excessive exposure to UV light by using glasses and sunglasses with UV filters may help a little.

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When do I need surgery?
Generally, you need surgery when the cataracts have advanced to a point where your vision interferes with your life style. Many patients with cataracts do not need immediate surgery. To our patients with cataracts we provide written information about when surgery can safely be avoided and when surgery should be done (see below). A copy of this discussion is available to anyone, whether or not they are our patients. Call us about it and we will mail it to you at no charge

Deciding about having cataract surgery.

1. Can I read, watch TV, and work on hobbies (essentially, do things I like to do)?
2. Can I see stair steps, small toys on the floor, uneven ground, etc. to avoid falls and injuries such as a hip fracture?
3. Can I see well enough to avoid injuries in the kitchen, or with power tools?
4. Can I drive safely, with no excessive glare from oncoming traffic at nighttime?
5. Am I reasonably satisfied with my vision?

Early cataracts.
If you answered "Yes" to every question, you do not need surgery. You need close follow up, usually every 6-12 months. If cataracts progress, you will need new prescription glasses. If changes in prescription become too frequent, you may reconsider surgery.

Some rare types of cataracts cause glaucoma. If you have this type we will let you know and suggest early surgery. Otherwise, the vast majority of cataracts left in place will not harm your eyes (they will become harder to remove - see Advanced Cataracts below).

Intermediate cataracts.
If you answered "No" to any of the above questions you should consider surgery, because of:

• Lifestyle improvement (you may again be able to do things you like to do)
• Increased safety (less chances of falls, driving accidents, work related-injury)
• Surgery can usually be done with a small incision with no need for stitches.
• Complications of surgery are less likely than with advanced cataracts
• You gain nothing by waiting; you just delay enjoying useful vision
• Waiting too long may lead to advanced cataracts (see below).

Advanced cataracts.
With advanced cataracts surgical complications are more frequent and, sometimes, the final vision is less satisfactory. Ideally you should have surgery before you reach this stage.

A cataract left in place for too long becomes hard. More force is needed to break it up and the hard fragments may damage nearby structures. Occasionally, the lens cannot be broken and it has to be removed as a single large piece. This requires a larger cut in the cornea which has to be closed with stitches.

Even though the post-operative course is sometimes stormier, nearly all patients end with greatly improved vision and, in over 90%, the results are excellent.

If your cataracts are already in the advanced stage we still recommend strongly that you have surgery. Your loss of vision was so gradual that you may not be aware of how much vision you have lost. You have a lot to gain by surgery since in over 90% of patients the results are excellent. You are likely to be pleasantly surprised with your new vision.

What are some of the problems with delayed surgery?
Because of your cataracts, you may not clearly see steps, toys or similar objects on the floor. You are much more likely to misstep, fall and suffer serious injuries from the fall, including hip fracture.

Excessive delay of surgery causes the cataract to harden. Fragmenting the hard cataract with ultrasound may be difficult, increasing the chance of complications. Sometimes the incision has to be enlarged and the benefits of the modern "Small incision - No stitch" surgery are lost.

While you need not rush into surgery, you should not procrastinate just because of fear. When you think that you are not seeing as well as you would like, or as well as you think you should for your safety, it is time for surgery. Today, cataract surgery is very easy on you. It is painless, and the results are very satisfying.

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Where is cataract surgery done?
Most of our cataract surgery is done in the Southgate Ambulatory Surgery Center. The Surgery Center is highly efficient because it has been set up mainly for cataract surgery. An American Board Certified anesthesiologist is on the staff. Nurses and other support personnel have extensive experience in cataract surgery, assuring a smooth and safe process. To you this means less upheaval, less anxiety and a short stay in the Surgery Center. Most patients check in, undergo surgery and are home within two hours. Patients who had one eye operation at a hospital and the other at the Surgery Center, much prefer the Surgery Center.

We also operate in the Heritage and Wyandotte hospitals.


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How is the surgery done?
On the vast majority of patients we use the most current surgical method of cataract surgery. It is the "Clear cornea - Small incision - No stitch" method. There are no shots to the eye. After mild sedation, eye anesthesia is achieved with eyedrops. An ultrasound probe is introduced through a 1/8-inch, self-sealing puncture. The ultrasound breaks up the cataractous lens and the fragments are aspirated. Then, an artificial lens made of plastic or similar material is introduced into the eye through the same small incision. The lens is positioned and secured in place by the anatomical structures within the eye. No stitches are used to keep the lens in position or to close the incision through which the operation was done. Most patients do not even need an eye patch at the end of surgery. The operation is essentially painless and takes about 15 minutes.


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How long before I can resume normal activities?
Most patients leave the operating room without an eye patch and are able to see with the operated eye immediately. They are not allowed to drive until the next day. Most normal activities may be resumed one day after surgery. If any of your planned activities are unusual or physically intense and stressful, discuss your plans with us before engaging in such activity.We recommend that you plan to stay in the area for a couple of weeks. If this is not practical, let us know.

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Will I need glasses after surgery?

Yes, usually to read small print. Currently, nearly all lenses implanted in the USA are monofocal. This means they focus at only one particular distance (focusing distance depends on lens power). If your lens gives you perfect distance vision, you will have to use glasses to read. If your lens gives you perfect reading vision, you will have to use glasses to see clearly at distance. Many patients are happy with an in-between power that gives them adequate distance vision while allowing them to read larger print without glasses. We carefully measure the lens power and try to accommodate patient wishes. However, there are many variables in eye anatomy and surgery. Perfect results cannot be guaranteed. All medical insurances cover standard monofocal lenses.

What about new lenses that give good near and far vision?

Standard monofocal lenses do not correct astigmatism. There are currently available implants that may be able to correct astigmatism but there is no guaranty that the astigmatism will be corrected completely. The astigmatism-correcting lens is expensive and is not covered by insurance.

Bifocal, multifocal and accommodative lens implants are available. The goal is to provide good close and far vision, and eliminate the need for eyeglasses. Results are somewhat unpredictable. Not all patients are good candidates for these lenses. Further improvements are expected. The lenses are expensive and are not covered by insurance.

What are the complications of surgery?
The most serious complications are severe bleeding inside the eye and infection inside the eye. Severe intraocular bleeding is said to occur once in 500 operations. In my experience with the current small-incision surgical method bleeding is much rarer than that. Serious infection is said to occur once for each 1,000 operations. In my own experience it is closer to once in 2,500 operations. Less dramatic complications, with no major vision loss, are said to occur in about 3% of operations.

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How will I see after surgery?
The vast majority of patients notice great improvement in vision sharpness and in color perception. Years ago we did a study of 200 consecutive patients undergoing cataract surgery. All patients whose only eye problems were cataracts regained sufficient vision to allow them to resume driving. Patients who, in addition to cataracts, had diabetic eye problems or macular degeneration showed less complete vision recovery. The extent of improvement in these patients was limited by the vision loss caused by diabetes or macular degeneration.

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How many cataract operations have you done?
Over 15,000.

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