General Information

What is a cataract?
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 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.

It breaks up the cataract and the pieces are sucked up and out of the eye through the bore of the needle. (However, just to confuse the issue, in 1998 an experimental laser cataract machine was invented. It still uses a needle in the eye to suck out the pieces, but rather then using ultrasound to break up the cataract, laser energy passes down the needle to break up the cataract. The technique of removing the cataract with this is quite similar to the phacoemulsifier. The possible advantages are technical and the patient's experience with both machines would be essentially the same. This machine will not be in common use for quite a while).

Bending over - With modern cataract surgery bending over is fine. Bend your knees and crouch down rather than bending at the waist.

Lifting - Don't lift anything that would result in straining.

Work - Depends on the nature of your work. Office workers should be able to return in a day or two. If work involves a dirty environment, risk of injuring the eye, or heavy activity your doctor should advise you.

Sunlight - Bright light may be uncomfortable, and you may need to wear sunglasses while your eye recovers.

Bathing, showering - Avoid immersing your eye in water while it is healing. Do not direct a shower at the eye, otherwise please bathe.

Swimming - No swimming for a couple of weeks. Best to consult your doctor individually. Sex - Ok as long as there is no pressure on the eye or straining.

Getting my hair done, permanents - No problem. Might be a good idea to wear an eye shield while getting your hair done for a couple of weeks after the surgery, just as a precaution so it doesn't get bumped.

Sports - Consult your doctor. Make sure and wear eye protection while playing tennis, racket ball, hand ball, squash, hockey etc. Boxing is bad for your eyes in general, and should not be done for a long time after eye surgery if at all.

Reading - As soon as it is comfortable you can read. You may need some temporary glasses until your permanent ones are ready.

Computers - Same as for reading - see above.

What about possible complications?
Choose from the following links to read a brief summary of possible complications. Complications are rare. In competent hands 98% of cataract patients have an improvement in their vision. There is about a 1% chance the vision may not improve, and a 1% chance it may be worse. About 1 per thousand cataract operations will result in blindness or loss of the eye.

Capsular rupture/Vitreous loss
During removal of the cataract, the substance of the lens is removed and the capsule (or bag enclosing the lens) is left to hold the artificial lens (IOL). This capsule also keeps the jelly in the back of the eye from coming forwards and escaping from the eye. This capsule is very thin and can be broken, it looks like Saran Wrap, but is not as strong. If it breaks the vitreous may come forward. The surgeon needs to attend to that, and carefully remove the vitreous. If the vitreous is disrupted and comes out of the eye it is called "vitreous loss." This complication increases the chances of getting retinal detachments, swelling of the retina, infections, and the IOL coming out of place, among other problems. When the capsule is broken, pieces of the cataract may fall into the back of the eye. There they may cause inflammation. If pieces are left in the eye it may be necessary to perform another surgery to remove them. Sometimes the pieces can be left and they will gradually absorb. How often the surgeon breaks the capsule during cataract surgery is a good measure of his or her skill as a surgeon. In an otherwise uncomplicated case a competent surgeon should have a broken capsule less than 5% of the time.

Infection/Endophthalmitis
As with any surgery there is a risk of infection - an infection inside the eye is called endopthalmitis. It should happen no more than about 1 out of 1000 cases. It happens even in an otherwise perfect operation, but more commonly if there are other complications. It is a very serious medical emergency. There is usually increasing blurring, pain and redness if this happens. The physician needs to be contacted as an emergency and the eye examined by someone qualified to provide postoperative eye care (preferably your surgeon). Your family doctor is not qualified to diagnose or threat this condition. Depending on how much time passes from the beginning of the infection and what microorganism is infecting the eye, the eye may completely recover or the eye may be lost. Prompt treatment is extremely important. Treatment usually consists of an operation (vitrectomy) in which the inside of the eye is cleaned out and antibiotics are injected into the eye. Antibiotic drops, oral antibiotic and/or IV antibiotics may also be used - but they alone will not cure the infection. A vitrectomy and injection of antibiotic into the eye is necessary for a cure.

Astigmatism An eyeglass prescription that is different vertically than horizontally is called astigmatism. Modern small incision cataract surgery doesn't change the eyes astigmatism (except in the unusual case in which the astigmatism is in the cataract, where normally it is in the cornea). If a large incision is required, particularly if sutures are used, to remove the cataract, there may be a change in the eyes astigmatism. Pupil not round Information currently being updated. Swelling of the retina/CME Cystoid Macular Edema (CME) is a condition in which the very center of the retina - the macula - develops swelling and cyst. This results in a fuzzy spot in the center of the vision reducing the vision. It is a reaction of the eye to inflammation. This may rarely occur in uncomplicated cases - in which case it usually goes away after a few weeks. It is more common in diabetics and in eyes that were prone to inflammation prior to the surgery. It is one of the complications that can result from vitreous loss. Double Vision If as a result of cataract surgery the two eyes have a large difference in their eyeglass prescription, double vision may result. If the person has a strong eyeglass prescription and both eyes are to have cataracts removed, this may be a temporary problem between the time the first and second eyes are operated on. The other cause would be a misalignment of the eyes. Rarely after cataract surgery the eyes may not track together. Correction of the problem may require special glasses or surgery to realign the eyes. Droopy Eyelid This was quite common in the past with large incisions and sutures. It is rare in uncomplicated surgery. If there are problems, particularly with a lot of inflammation, the eyelid may droop. Implant Information Do I really need an implant? In the vast majority of cases yes. Only in people who are severely nearsighted before the surgery your doctor may not recommend an implant. 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. 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 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. Eye Glasses Information Will I need glasses after my cataract surgery? In most cases yes. See the other eyeglass questions for more answers. What will the surgery do to my eyeglass prescription? Because the surgery will replace the eye's natural lens with an artificial lens, it presents the opportunity to change the eye's eyeglass prescription. If you are farsighted or nearsighted the surgery can change that. If you have astigmatism the cataract surgery may or may not change this, please refer to the section on astigmatism. Before the surgery your eye will be measured to determine what the power of the artificial lens needs to be. The official name for this lens is Intraocular Lens, or IOL for short, also sometimes called an implant. Changing the power of the IOL will change where the eye is in focus without glasses. You and your doctor will need to consider a variety of options depending on your particular circumstances. These are some of the more common situations - the following assume there is not a lot of astigmatism: - In most cases, while the vision may be quite good without glasses, bifocal or trifocal glasses are worn to give the best distant and near vision. - Most commonly the eye is made to see best in the distance without glasses, therefore requiring glasses for reading. - Occasionally someone who likes to do a lot of near activities, such as reading, knitting, etc, asks that the eye be made (or left) nearsighted. Then they can perform these near activities without glasses, and would need glasses for distant vision - TV, driving, etc. - A good option for some is monovision. In this the dominant eye is set to see in the distance without glasses and the other eye is made nearsighted, so that it can see up close without glasses. Thus, without glasses it is possible to see both near and distance. Glasses can still be worn too, which would give better depth perception, as the eyes then focus together better. - Multifocal lens: The ARRAY lens is an IOL that has more than one focus point. It allows clear vision without glasses at distance and near by using essentially two lenses in one. Distance vision should be as good as that achieved with a traditional IOL. Typical reading vision would be regular newspaper print; however, smaller print such as want ads may require reading glasses. Good as it sounds it is not for everyone. It works best when implanted in both eyes and there must not be much astigmatism (either there is naturally not much astigmatism or if there is any it must be corrected surgically for the lens to work). Since part of the light entering the eye is focused for one distance and part for the other, there is necessarily a loss of contrast. Typically this also results in small haloes around point sources of light at night. For those who are highly critical of their vision this lens is not for them. For those who want to be independent of glasses and are willing to accept some small compromises, they should consider it. Attached to this are some descriptions of what patients have experienced with this lens. The lens is not available in as large a range of powers as traditional lenses, so if you are now very near or farsighted it may not be available in the power you need. Attached is a description by an eye doctor who had this lens implanted in himself describing his experience with it. - Patients who are very near or farsighted and have a cataract in only one eye are a special problem. The power of a lens is measured in diopters. If your eyeglass strength is greater than 2.5 diopters in the eye without the cataract this applies to you. Most people can only stand a difference of dioptric power in their glasses between the two eyes of 2.5 diopters, any greater difference causes symptoms of double vision and eye strain. This is because the size of the image in each eye will be different and they have trouble fusing this different size images into one. Thus, in order to wear glasses, when removing a cataract from one eye and not the other, we must plan on not leaving a difference between the two eyes of more than 2.5 diopters. This may require leaving the operated eye nearsighted or farsighted to match the unoperated eye. For instance- Joe is nearsighted and has a distant eyeglass prescription of -5.00 diopters in both eyes. This means without his glasses on he can see clearly at 20 centimeters (8 inches) and further away from that things get blurry without his glasses. In order to avoid problems with glasses after the surgery we will need to leave the operated eye still nearsighted at 2.50 diopters. This is less nearsighted than before, objects will appear clear at 40 centimeters (16 inches) and blurry beyond. Alternatives here include correcting the eye with the cataract to where it sees clearly in the distance without glasses (an eyeglass correction of zero, technically called plano) and either wearing a contact lens on the other eye or having refractive surgery such as LASIK on the other eye so that it matches the eye that had the cataract removed. What about my astigmatism? Astigmatism is a type of refractive error in which the horizontal light rays are focused in a different plane than the vertical light rays. This is usually caused by the cornea of the eye being football shaped instead of round. The reflections from the left eye in this picture is oblong, indicating astigmatism. The other eye has round reflections and no astigmatism. Cataract surgery doesn't usually significantly change this shape - so if you have astigmatism before the surgery, most of the time you will have it afterwards. Your doctor can determine if you will have astigmatism from the measurements that are taken of the eye before surgery. If you have astigmatism left over after the cataract surgery, then you will need glasses to give you the best vision - without them your vision will be blurry because of the astigmatism. When will I get my glasses after the surgery? After your eye is healed and the eyeglass prescription is stable. Some doctors prescribe glasses after two or three weeks, others wait six weeks.