A cataract is a clouding of the natural lens of the eye. The lens is the size of a chocolate M&M, and should be as clear as glass. The most common cause of cataracts is aging. As the lens ages it changes to an opal or brown color (termed a nuclear sclerotic cataract).
These changes often also cause a change in eyeglass prescription. As it ages further cloudy areas develop in the lens, and clear vision is no longer possible. Another form of cataract is a posterior subcapsular cataract (abbreviated PSC). With this the back surface of the lens has the appearance of frost on glass. Just like frost on a windshield in the sunlight, these cataracts cause a lot of glare problems. Not only aging, but injuries, familial predisposition, other illnesses and medications can cause cataracts.
Do I need to have my cataract removed?
Most of the time the only reason to remove the cataract is to improve your vision - so if your vision is adequate to do everything you need to do - then no, you don't need your cataract removed. Many people have some degree of cataract formation that is not bad enough to affect the vision.
Your doctor should suggest cataract surgery only if he or she believes it would benefit you, not just because there is a cataract. However, many cataracts come on slowly, and the person doesn't realize how poor their vision has become. Often people come to have cataract surgery when they can't pass their driver's license - even though they thought they were seeing well! After having the cataract removed, they then realize how poorly they were seeing. Most of the time people are aware they don't see well and want their vision improved.
Sometimes a cataract is removed not to improve the vision but because it is causing another problem such as glaucoma, or because it interferes with another treatment the eye requires, such as laser surgery for diabetic retinal problems. Sometimes a cataract is not removed because there is something else the matter with the eye and removing the cataract would not help the situation.
How big are my cataracts?
Although your lens does enlarge as you age, it is not the size of the lens that affects the vision, but rather the loss of clarity. Therefore, size is essentially irrelevant.
What is the treatment for cataracts?
Early on, a change in glasses or the use of sunglasses may restore good vision. Eventually, the cataracts tend to get worse and must be removed from the eye to allow clear vision. The cataract is replaced with an artificial lens called an intraocular lens, or IOL, (also called an implant) made of plexiglass, silicone or acrylic.
Do I really need an Implant?
In the vast majority of cases yes. If an implant (IOL) is not used the eye will have no lens, and just like a camera without a lens things will be very blurry. You would need to wear a contact lens or very thick glasses to see clearly. Implants may not be recommended for people who are severely nearsighted prior to surgery.
What is the implant made out of?
Three materials are currently commonly used to manufacture implants: polymethylmethacrylate (PMMA), silicone and acrylic. PMMA has been used the longest - it is similar to the plastic in crazy glue. Silicone and acrylic lenses are flexible and can be rolled up so they can be placed in the eye through a smaller opening. Once in the eye they unroll and are placed in their proper location. In contrast, PMMA lenses are stiff, and require a larger opening in the eye to introduce the implant.
Does the implant stay in my eye? Will it fall out?
The implant is seated in the eye so that it will remain in place.
How long is it good for?
The rest of your life.
What is a Multifocal (RLE) Refractive Lens Exchange IOL and what should I expect?
Your ophthalmologist has recommended you have cataract surgery. In the course of that surgery, s/he will be removing your natural lens and inserting a replacement intra-ocular lens (IOL). You have an opportunity at this time to consider having a multi-focal IOL implanted instead of a standard IOL. These premium lenses are intended to provide near, intermediate and distance vision without, in many patients, the need for eyeglasses or contact lenses following surgery
A Multifocal IOL corrects nearsightedness and farsightedness using an intraocular lens implant. A Multifocal IOL may be the lens of choice for patients who are too nearsighted, too farsighted, or have corneas that are too thin for laser vision correction. It is also a viable alternative for those over the age of 40 and for those individuals who may be showing signs of developing cataracts.
Millions of eyes have received intraocular lens implants when undergoing cataract surgery. RLE uses the same highly successful surgical techniques. The primary difference between cataract surgery and RLE is that cataract surgery is performed to remove a patient's cloudy lens, and Refractive Lens Exchange is performed to reduce one's dependence on glasses or contact lenses. Cataract patients are also candidates for RLE. For more information click here.
Performed as an outpatient procedure, the natural lens is removed using ultrasonic vibrations through a very small micro-incision and replaced through that same incision with an intraocular lens. You will remain comfortable as the eye is completely anesthetized. Everyone heals differently, but many patients report improvement in their vision almost immediately, and most resume their normal activities within a day or two. One eye is done at a time and the second eye is usually done in a week or two.
Will my insurane cover the Multifocal IOL?
Medicare and most commercial insurance companies will not pay for premium lenses as they are an optional treatment for presbyopia that can otherwise be addressed by eyeglasses. Low monthly financing options are available if you are interested.
Who is not a candidate for a Multifocal IOL?
Patients with the following conditions are usually not the best candidates for premium lens implants or keratorefractive surgery:
Patients who are perfectionists
Patients with certain pre-existing eye diseases, including but not limited to macular degeneration, glaucoma, poor blood flow to the retina, severe dry eye syndrome, and corneal scarring
Will I need glasses or any other procedure after recieving the Multifocal IOL?
If you are electing a Multifocal IOL, you need to be particularly aware of the following: Despite the advances in lens implant technology and the improvement in many patients' overall visual acuity, no procedure(s) can turn back the clock and allow patients to see well at all distances and in all lighting conditions. Also, the following information deserves special attention:
All patients heal at different rates after cataract surgery. Slower healing times can be seen in the elderly, especially if they have medical conditions such as heart disease, diabetes, dry eye syndrome, etc. Also, because each eye must be operated upon on two different days (sometimes several weeks apart), the overall healing of the visual system is delayed further. The visual performance of the ocular system is further refined over time by a prcess termed "binocular summation" or "neuro adaptation." These termes describe the brain's ability to adapt to the new vision. It may take up to a year for optimal visual acuity to be achieved.
Some patients may require a keratorefractive surgery such as LASIK to "fine tune" their best vision without glasses. This may occur if the patient has residual nearsightedness, farsightedness, or astigmatism that may be limiting their vision. Any of these karatorefractive procedures would be discussed with their doctor to help the patient make an informed decision based on the risks and potential benefits. These additional procedures may not be covered by the premium IOL fee and entail extra charges. Keratorefractive procedures are not covered by insurance.
If a patient requires a keratorefractive surgery after cataract surgery, a minimum interval of two to three months after surgery is needed for the eyes to heal.
All cataract patients develop scar tissue around the lens implant as part of the normal healing process. Sometimes this scarring can decrease the visual acuity, requiring a YAG laser procedure, which is usually covered by insurance. Patients with premium lens implants may be more likely to require this procedure. The cost of the YAG laser procedure is not included in the cataract or premium IOL fee. The cost of a YAG procedure should be covered by insurance.
Having a premium lens implant with or without keratorefractive surgery does not protect the eye from disease in the future.
As we get older, good lighting is very important to see well.
Calculation of the proper IOL power in patients who have had previous eye surgery, especially refractive surgery such as LASIK or RK, is not as accurate as in previously unoperated eyes. This makes it more likely that touch up refractive surgery may be required after the cataract surgery.
If you have more questions, please contact our refractive coordinatior, Kathy-Lyn Allen, (719)-295-1820.
Cataract Surgery 
What is a cataract?