Questions about Cataracts
This page provides information on the nature of cataracts and the medical treatment options available. Please take time to view the video animations to better understand this condition and the various surgical procedures used to treat it.
What is a cataract?
A cataract is a clouding of the lens in the eye that adversely affects a person’s vision. Most cataracts are related to the aging process and are very common in older people.
A cataract can occur in either or both eyes, but cannot spread from one eye to the other.
What causes cataracts?
Within the eye, the lens is located behind the iris and the pupil (see animations above). It operates much like a camera lens, focusing light onto the retina at the back of the eye, where an image is recorded. The lens also adjusts the eye’s focus, allowing us to see things clearly, whether at close range or at long distance. The lens consists of mostly water and protein. The protein is arranged in a precise way that ensures that the lens remains clear and allows light to pass through it.
However, as we age, some of the protein may clump together and begin to cloud a small portion of the lens. This is a cataract, which over time, may increase in size and cloud ever more of the lens, making it increasingly difficult to see.
Research suggests that smoking and diabetes may be contributory factors in the development of cataracts. However, medical experts also accept that the protein contained in the lens simply undergoes changes as a result of general wear and tear over the course of a person’s life.
Who is at risk for cataract?
The risk of developing a cataract increases as we age. Other risk factors include:
- Certain diseases such as diabetes.
- Personal behavior such as smoking and alcohol use.
- The environment including prolonged exposure to sunlight.
How is a cataract treated?
The initial symptoms of a cataract may be alleviated with new eyeglasses, brighter lighting, anti-glare sunglasses, or magnifying lenses. If these measures are ineffective, surgery is the only effective treatment. Surgery involves removing the cloudy lens and replacing it with an artificial one.
A cataract requires removal only when vision loss interferes with your everyday activities, such as driving, reading, or watching TV. Following discussions with your eye care professional, so that you understand both the benefits and the risks of surgery, you can make an informed decision with regards to whether cataract surgery is right for you. In most cases, delaying cataract surgery will not cause long-term damage to your eye or complicate the upcoming surgery. Sometimes a cataract should be removed even if it doesn’t cause vision problems. For example, a cataract should be removed if it prevents examination or treatment of another eye problem, such as age-related macular degeneration or diabetic retinopathy. Sometimes, even if a cataract is found, you may not need cataract surgery for several years or even at all. By undergoing regular vision tests, you and your eye care professional can discuss if and when you might need treatment.
If you have cataracts that require surgery in both eyes, the procedure will be performed on each eye on separate occasions, usually four to eight weeks apart. Many people who need cataract surgery also suffer from other eye conditions, such as age-related macular degeneration or glaucoma. If you have other eye conditions in addition to a cataract, talk with your doctor to learn about the risks, benefits, alternatives, and expected consequences of cataract surgery.
How is cataract surgery performed?
A cataract is removed through the surgical process known as phacoemulsification. In this procedure, a small incision is made on the side of the cornea, the clear, dome-shaped surface that covers the front of the eye. Your doctor inserts a tiny probe into the eye. This device emits ultrasound waves that soften and break up the lens so that it may be removed by suction. Most cataract surgery today is performed using phacoemulsification technology.
Following its removal, an artificial lens called an intraocular lens or IOL often replaces the natural lens. An IOL is a clear, plastic lens that requires no care and becomes a permanent part of your eye. Light is focused clearly by the IOL onto the retina, improving your vision. You will not feel or see the new lens.
What are the risks of cataract surgery?
As with any surgery, cataract surgery poses risks, such as infection and bleeding. Prior to surgery, your doctor may ask you to temporarily stop taking certain medications that may increase the risk of bleeding during surgery. Following your procedure, you must keep your eye clean, wash your hands before touching your eye, and use the medications prescribed by your doctor to help minimize the risk of infection. Any serious infection following your surgery may result in loss of vision.
Cataract surgery slightly increases your risk of retinal detachment. Other eye disorders, such as high myopia or nearsightedness can further increase your risk of retinal detachment after cataract surgery. An indication of a retinal detachment is a sudden increase in flashes or floaters. Floaters are little ‘cobwebs’ or specks that seem to float around in your field of vision. If you notice a sudden increase in these, you should consult an eye care professional immediately, since a retinal detachment represents a medical emergency. An eye surgeon must examine your eye as soon as possible, so if necessary, go to an emergency service or hospital. A retinal detachment causes no pain, but early treatment can often prevent permanent loss of vision. The sooner you seek help, the more likely you will be to regain good vision, although even if you are treated promptly, some vision may be lost.
Talk to your eye care professional about these risks and to determine whether cataract surgery is right for you.
Is cataract surgery effective?
Cataract removal is one of the most common operations performed in Canada. It also is one of the safest and most effective types of surgery. The far majority of patients will experience excellent visual improvement after cataract surgery.
What happens before surgery?
Your doctor will conduct some tests, which may include measuring the curve of the cornea, plus the size and shape of your eye. This information helps your doctor to select the most appropriate type of IOL.
You may also be asked not to eat or drink anything for twelve hours before your surgery.
What happens during surgery?
At the surgical centre, drops will be placed into your eye to dilate the pupil. The area around your eye will also be washed and cleansed.
The operation usually lasts less 10 to 15 minutes in duration and is painless. You may feel occasional pressure feeling and ache during the procedure but there will be no eye pain. Many people choose to stay awake during surgery, while others may need to be put under anesthetic for a short time.
If you do choose to remain awake, you will be given an anesthetic to numb the nerves in and around your eye.
After the operation, a clear plastic shield, or occasionally a patch, may be placed over your eye and you will be advised to rest for a while. Your medical team will monitor you for any problems, such as bleeding. Most people who have cataract surgery can return home the same day, although you will need someone to drive you home.
What happens after surgery?
Following cataract surgery, some degree of itching and mild discomfort is perfectly normal. Some fluid discharge is also common and your eye may be sensitive to light and touch. If you do experience discomfort, your doctor may suggest treatment, although after a couple of days, moderate discomfort should disappear.
For a few days after surgery, your doctor may ask you to use eye drops to assist healing and decrease the risk of infection. You will need to refer to the sheet provided by your doctor containing instructions on how often you should use the eye drops. If you’re unsure how to use them, you must ask the doctor or one of his associates. You will need to wear an eye shield or eyeglasses to help protect your eye, plus avoid rubbing or pressing on your eye.
Once you are at home, avoid bending from the waist to pick up objects from the floor and do not lift any heavy objects. You may however walk, climb stairs, and perform light household chores.
In most cases, healing will be complete within six to eight weeks, at which point your doctor will schedule examinations to assess your progress.
Can problems develop after surgery?
Problems after surgery are rare, but they can still occur. These can include infection, bleeding, inflammation such as pain, redness or swelling, loss of vision, double vision, and high or low eye pressure. With prompt medical attention, these issues can usually be treated successfully. Sometimes the eye tissue that encloses the IOL becomes cloudy and may blur your vision. This condition is called an after-cataract, which can develop months or even years after your cataract surgery.
An after-cataract is treated in a procedure called a YAG laser capsulotomy, in which your doctor uses a laser to make a tiny hole in the eye tissue behind the lens to allow light to pass through. The procedure is painless and rarely results in increased eye pressure or other optical problems. As a precaution, your doctor may prescribe eye drops to lower your eye pressure before or after the procedure.
When will my vision be normal again?
You can usually resume your everyday activities relatively quickly, although your vision may be blurred. The healing eye needs time to adjust so that it may focus correctly with the other eye, especially if the other eye has a cataract. Be sure to ask your doctor when you can drive again.
If you received an IOL, you may immediately notice that colors are very bright. The IOL is clear, unlike your natural lens, which may have had a yellowish/brownish tint. Within a few months after receiving an IOL, you will become accustomed to your improved color vision. When your eye is fully healed, you may require new glasses or contact lenses.
What is an IOL?
An IOL, or intraocular lens, is plastic lens made specifically to replace your natural lens within the eye. It will allow images to be focused with your retina to provide you with excellent vision.
Are there different types of IOLs?
Yes, there are four types of IOL’s:
This type of lens will provide you with the ability to see clearly at a certain distance. However, patients choosing this IOL will still need to wear glasses primarily for reading, but may also require them to fine tune their distance vision.
This lens is designed to perform all the functions of the standard lens, plus correct astigmatism in your eye. Astigmatism is a curvature present in the eye, which prevents you from achieving clarity of vision unless glasses or contact lenses are worn. The TORIC Intraocular lens will correct your vision for astigmatism in addition to providing the standard lens function.
This lens has a variety of focusing attributes, designed to provide clarity of vision at near, intermediate and far distances. Please note however, that this lens is not suitable for all patients and your eye specialist will need to determine whether you are a suitable candidate.
Visit the ReSTOR Lens Website
Visit the Tecnis Family of IOLs Website
This lens has the ability to move within the eye to allow clarity of vision at near, Intermediate, and far distances. Please note however that this lens is not suitable for all patients and your eye specialist will need to determine whether you are a suitable candidate.
Visit the Crystalens Website
Please note that your doctor will have a discussion with you regarding the various types of IOL and will give you further information pertaining to them. Ultimately your doctor will determine what type of IOL best suits your need. Please talk to your doctor and his associates if you have any questions regarding Intraocular lenses.