Cataract Q&A with Dr. Quinn

What is a cataract?
A cataract is clouding of the natural lens inside the eye.

Is there a way to prevent cataracts?
Some studies suggest that dietary anti-oxidants may reduce the likelihood of developing age-related cataracts but, for now, there is no proven preventive therapy.

Are there early warning signs that a cataract is developing?
Cataracts can cause blurred vision and glare. If you have these symptoms, a cataract may be developing.

How quickly do cataracts develop or progress?
It depends on the type and on the person. Usually, cataracts progress gradually, but, for some people, a particular opacity in the lens will get across the center of the visual axis and seem to suddenly cause a lot of visual disturbance (this process is still over months of time).

Is it so gradual that people don’t realize how much their vision has deteriorated over time?
Often people do not realize how much their color perception has deteriorated until they have one cataract removed and notice how much more brilliant colors are out of their surgically corrected eye. Since many cataracts do progress slowly and gradually, it is not uncommon for people to not be aware of how much their visual acuity has declined.

Do people usually develop a certain level of visual impairment before they decide to seek treatment options?
People seek treatment because of vision difficulty – trouble with night driving such as increased glare or trouble with small print. As cataracts progress (i.e. as lens clouding progresses) they are changing the power of the lens inside the eye. Sometimes a change in the power of a person’s glasses lens can be made to account for that, and vision can be improved again just by updating glasses.

Is there a reason that it’s better to seek treatment sooner rather than later?
Yes, to get the benefit that is available from improved functioning with better vision. Very dense cataracts can pose some increased surgical complexity for removal, but essentially we can still remove even advanced cataracts.

Describe how a patient prepares for cataract surgery.
The first step is a visit to an eye doctor. This could be your regular eye doctor who could make the diagnosis and comment on the severity of the cataract and help make recommendations about options which may include observation, updating glasses or considering surgery.

This first step could be combined with, or prior to, an evaluation with a cataract surgeon. A surgeon can explain cataract surgery and help make decisions about when to proceed with surgery. The surgeon also can explain options for refractive outcome targeting, that is, the plan for refractive correction after surgery. Some patients no longer wear glasses after cataract surgery.
Cataract surgery is the removal of the patient’s cloudy lens and at the time of surgery that lens is replaced with a plastic intraocular lens implant to replace the power of the lens that was removed.

There are several options for intraocular lens implants. Currently there are intraocular lenses available that can correct for a variety of refractive errors including near-sightedness, far-sightedness, astigmatism and presbyopia (the requirement for reading glasses for near tasks).
Once the patient and surgeon decide to proceed with surgery, the patient will need a pre-operative physical exam to make sure they do not have uncontrolled health problems that would make the risk of anesthesia unacceptable. This can be done by a patient’s primary care doctor.

Within the week prior to surgery, the patient will have a visit in the eye clinic during which measurements of their eyes will be taken in order to choose the correct lens implant. At this visit the patient also will receive all of their pre-operative instructions. Patients begin using antibiotic and anti-inflammatory eye drops three days before surgery. Patients are also instructed as to how to clean their eyelids before surgery since while surgical infections are very rare, if they do occur they are usually related to the skin bacteria found on eyelids.

Cataract surgery is a fairly short procedure and most patients find that they have minimal discomfort during or after surgery.

What kind of recovery time should be expected?
Depending on the patient’s situation, the vision may clear over one to a few days or sometimes longer. Patients use eye drops for several weeks after surgery. After the eye has healed for about one month after surgery, it can be determined what type of glasses, if any, would best serve the patient.

What kind of outcome/visual improvement can be expected?
This depends on the health of the rest of the visual system ie: the cornea, the retina, the optic nerve, and the brain – these things can be evaluated pre-operatively so that the expected improvement can be anticipated for each patient. Many cataract patients have great improvement and excellent outcomes in terms of vision clarity, color perception, reduced glare and reduced dependence on glasses.

Does the treatment last–or is someone likely to develop a cataract again?
People never develop a cataract again, but it is not uncommon for a membrane just behind the lens implant to become cloudy some time months or years after surgery. This membrane can cloud the vision again and can quite easily be opened surgically with a laser to clear the vision again.

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