What is a cataract?
Inside the eye, there is a lens which helps us to focus on what we see. With the normal aging process, this
transparent lens can slowly become cloudy. This is cataract. This
cloudiness can become severe enough to decrease vision.
What causes cataracts?
The main cause is aging (senile cataract). But Cataract can develop due to other causes, like diabetes, chronic intake
of steroids, severe eye trauma, and hereditary causes, and hence can develop at any age.
What do I feel if I have cataract?
Visually significant cataract can make things look blurry, with possible glare seen especially at night with bright lights
on, such as when looking at the oncoming headlights of a car.
How can a cataract be treated?
A cataract may not need to be treated if your vision is only slightly blurry. Simply changing your eyeglass prescription
may help to improve your vision for a while. There are no medications, eye-drops, exercises or glasses that will cause
cataracts to disappear once they have formed. Surgery is the only way to remove a cataract. When you are no longer
able to see well enough to do the things you like to do or when you are bothered driving at night, cataract surgery
should be considered.
In cataract surgery, the cloudy lens is removed from the eye through a small incision. In most cases, the natural lens
is replaced with a permanent intraocular lens (IOL) implant.
What can I expect if I decide to have cataract surgery?
Before Surgery: After having a thorough eye examination, your eye will be measured to determine the proper power
of the intraocular lens that will be placed in your eye. Ask Dr. Farah if you should continue taking your usual
medications before surgery. Usually Aspirin is stopped 7 days before surgery. You should make arrangements to
have someone drive you home after the procedure.
The Day of Surgery: Surgery is usually done on an outpatient basis, so you come in to have your surgery and go
home the same day. You will be asked to skip breakfast.
When you arrive for surgery, you will be given eye-drops and a mild sedative to help you relax. A local anesthetic will
numb your eye. The skin around your eye will be thoroughly cleansed, and sterile coverings will be placed around
your head. Oxygen will be flowing under the sheets. Your eye will be kept open by an eyelid speculum. During
surgery, you may see light and movement, and you may feel touch but there is no pain.
Under an operating microscope, a small incision is made in the eye. Tiny surgical
instruments are used to remove the cloudy lens from the eye. The back
membrane of the lens (posterior capsule) is left in place, over which an artificial
lens is inserted at the end of he procedure.
As seen in the picture, tiny instruments are used in cataract surgery to remove
the cloudy lens from the eye. The intraocular lens replaces the natural lens.
After the procedure is completed, your doctor may place a protective shield
over your eye. After a short stay in the outpatient recovery area, you will be
ready to go home.
Following Surgery: You will need to:
Use your eye-drops, and bring them with you to every clinic visit
Be careful not to rub or get water in your eye
Continue normal daily activities but avoid strenuous exercise for 1 week
Wear an eye-shield for 2 weeks while sleeping
To administer your eye-drops, lie down or tilt your head back, and put the drop
in the inner angle of the eye without touching your eyelids. Blink few times
before wiping away any excess. Wait one to two minutes between drops to
prevent washing one out with the other.
Will cataract surgery improve my vision?
The success rate of cataract surgery is excellent. Improved vision is achieved in the majority of patients. Only a small
number of patients continue to have problems with their vision following cataract surgery. Keep in mind that there
may be coexistent pathologies especially in the center of vision (Retina).
Even if cataract surgery is successful, some patients may not see as well as they would like to mostly because they
may need some eyeglasses. Other eye problems such as macular degeneration (aging of the retina), glaucoma or
diabetic retinopathy may limit vision after surgery. Even with these problems, cataract surgery may still be
worthwhile.
What to expect after cataract surgery
Vision usually improves markedly by the first day, but sometimes takes longer.
Patient need to be examined the first day, within a week, and then at 6 weeks later.
Avoid direct water exposure to the operated eye for the first week.
Avoid rubbing the eye, bending over, or lifting heavy objects for the first week.
Sometimes a membrane can form behind the lens implants, decreasing vision. This is called posterior
capsule opacification. It may happen even years after surgery. It is successfully treated by “zapping” the
opaque capsule using a laser in the office (YAG laser capsulotomy).
What are the risks associated with cataract surgery
In the majority of cases, approximately 99% of the time, the surgery is uncomplicated, with excellent visual
improvement and patient satisfaction. Cataract surgery should however never be trivialized. In a small percentage of
patients, often unpredictable events can occur which can lead to less than ideal results, even if the surgery is
performed by the most experienced surgeon. They include:
Infection
Bleeding
Excessive Inflammation
Elevated intraocular pressure
Posterior Capsule rupture with lens material remnants
Posterior Capsule opacification treated by zapping it with laser in the clinic
Detachment of the retina
Macular swelling
Corneal swelling and decompensation
All side-effects can be treated. The chance of a serious complication which could limit your vision is about 1 in 1000.
Call Dr. Farah immediately if you have any of these symptoms after surgery:
Pain not relieved by pain medication
Loss of vision
Nausea, vomiting, or excessive coughing
Injury to the eye
Types of implanted artificial lenses
There are several types of intraocular lens implants:
Conventional (spherical) Hard Lenses: Some are meant to be placed behind the iris, while others are
designed to be inserted in front of the iris.
Conventional (spherical) Foldable Lenses.
Aspheric, Blue-Light Filtering, Foldable Lenses: filter light wavelengths which are harmful to the retina. Their
benefit is the decrease of optical aberrations in the eye.
Toric Foldable Lenses: Conventional lenses don’t compensate for astigmatism, whereas Toric lenses correct
pre-existing corneal astigmatism.
Multifocal Foldable Lenses: Help in improving near-vision. Work best when they are implanted in both eyes.