What is a Cataract?
A cataract is a clouding of the natural lens of your eye. The lens works like the lens of a camera, or telescope, by adjusting as needed to help you see things up close or far away. With age, the lens loses its ability to focus up close, which is why some patients need reading glasses. The lens is made of water and protein, arranged in a way the lets light pass through unobstructed. As you age, the protein begins to clump together, resulting in a clouded area in the lens, and clouded areas in your vision.
Types of Cataracts
Subcapsular cataracts begin at the back of the lens. This type of cataract is most common in people with diabetes, high farsightedness, retinitis pigmentosa or those taking high doses of steroids.
Nuclear cataracts form in the center of the lens and are associated with the natural aging process.
Cortical cataracts form in the lens cortex, and gradually grow from the outside of the lens to the center. Cortical cataracts are common in patients with diabetes.
Because cataracts forms inside the eye, they cannot be removed with lasers or by changing one’s diet or medication. The best way to treat cataracts is by removing the natural lens and replacing it with a new artificial lens, also called an Intraocular Lens (IOL), through cataract surgery.
Lens options include single vision IOL’s and premium IOL’s:
- Standard, single vision lenses: These lenses are the most commonly implanted intraocular lenses and provide you clear vision at a set distance. The power of the IOL will determine your need for glasses after surgery for some of your visual tasks.
- Astigmatism-Correcting Lenses: These are also called Toric Lenses and are an appropriate choice for patients with corneal astigmatism. Corneal astigmatism is when the front surface of the eye, or the cornea, is shaped like a football instead of a basketball.
- Accommodating IOL’s: These lenses are intended to move within the eye to focus on an object at distance or intermediate distance (such as the computer). These lenses take advantage of the eye’s natural ability to move the position of the lens (or accommodate) within the eye to change the focal point. Often times, patients will need a mild reading glass for near tasks.
- Multifocal IOL’s: These lenses are also called diffractive IOL’s, as they have concentric rings that provide different focal lengths. These lenses tend to give the greatest independence from glasses, however, they may also cause some glare and halos.
There are two types of anesthesia for cataract surgery; topical anesthesia and peribulbar anesthesia.
In this type of anesthesia, minimal intravenous sedation is given by the anesthesia team, followed by a combination of dilating eye drops and anesthetic drops/jelly. Once in the operating room, an anesthetic is injected into the front part of the eye (the anterior chamber) to ensure adequate anesthesia.
Topical anesthesia is an excellent option for patients who are able to lay still for 15 minutes while the surgery is being completed. It also offers the quickest visual recovery, as patients may begin their postoperative drops the evening of surgery. If you are claustrophobic or nervous about surgery, please let your surgeon know to ensure the best outcome.
In this type of anesthesia, minimal intravenous sedation is given by the anesthesia team, followed by a combination of dilating eye drops and an anesthetic that is injected behind the eye. You will not feel or remember the injection due to intravenous sedation.
Peribulbar anesthesia is an excellent option of nervous or claustrophobic patients. It also ensures that the patient doesn’t feel or see anything during the surgery.