Understanding Cataracts

What is a cataract?

If you have a cataract, it means that the lens in your eye has become cloudy. We’re all born with a lens inside each of our eyes. The lens helps to focus light inside the eye so we can see. Over time, the lens becomes cloudy and interferes with vision.

Here are some things you may notice if you have cataracts:

In the early stages of a cataract the changes may not be noticeable. Very advanced cataracts can cause near-total blindness.

What causes cataracts?

Most cataracts develop over time as natural changes in the lens in the eye. The regular arrangement of proteins in the lens becomes disrupted, causing the lens to become cloudy. Sometimes, cataracts are the result of injury, steroid medication use, prior eye surgery, or other causes.

What can be done to prevent cataracts?

Usually there is nothing you can do to prevent cataracts. Everyone who lives long enough will develop cataracts. Some things will make them develop faster, such as smoking, steroid use, and injury, and avoiding these things, if possible, may delay the age at which you develop cataracts.

Will I go blind from cataracts?

Cataracts are reversible with surgery. If left untreated, vision can decline to the point of blindness, but even then it is usually possible to perform surgery and restore vision.

If I have cataracts, do I need surgery right away?

With very few exceptions, correcting cataracts with surgery is not an emergency. Most patients can wait years, and even decades, before needing surgery. In the early stages, cataracts will often change the prescription in your glasses, so just getting a new pair of glasses may make your vision better. Eventually, new glasses will not help enough, and surgery may be needed to correct the cataract.

When should I have cataract surgery?

In most cases, it is best to have surgery when you are bothered by your vision, and the cataract is causing you some problem in your daily life. People with significant cataracts often have trouble with night driving, seeing the television, reading, or other visual tasks. If everything seems fine with your vision, you usually do not need cataract surgery. As the cataract develops, you will notice that your vision declines, and that you have difficulty seeing well enough to do the things you need to do and the things you enjoy. When the cataract interferes with your life in this way, you should consider surgery.

Is there a medicine or nutritional supplement that I can take instead of having surgery?

No. Currently there is no known medical treatment for cataracts. New glasses will often make your vision better as the cataracts develop, but eventually the only treatment option is surgery.

How is cataract surgery performed?

Your cataract surgery will be a scheduled procedure in an operating room. During surgery, your surgeon will remove the cloudy lens and replace it with an artificial plastic one. You will receive anesthetics to prevent discomfort and make you relaxed.

Does it hurt?

Usually there is no pain with cataract surgery. In many cases you may not even remember the procedure after it is performed. After the surgery, your eye may be red and feel scratchy or feel like something is in it.

Is it done with laser?

There are various ways to remove a cataract. An ultrasound probe is used to break up and remove the cataract in most cases. A laser can be used for some of the procedure to break up the cataract and help to decrease astigmatism. In cases of very advanced cataracts, the procedure is sometimes done manually, where the cataract is removed as one piece through a larger incision. The choice of technique is something you can discuss with your surgeon prior to the procedure.

Is cataract surgery safe?

No surgery is completely risk-free, but modern cataract surgery has a very high success rate. The vast majority of patients do very well, and enjoy significant improvement in their vision. Complications, while rare, can happen. When complications occur, it is usually possible to recover from them and still achieve good vision, although not in all cases.

What are the risks of cataract surgery?

Like all surgeries, cataract surgery has risks. You should weigh these risks against the potential benefits of the surgery in deciding whether to undergo it. Common, less serious risks include blurred vision or discomfort for a few days after surgery, a dark area in your peripheral vision, floaters, sensitivity to bright lights, increased eye pressure, or a droopy eyelid. More serious risks are rare, but it is possible to have a complication that permanently impairs your vision, or requires additional surgery or medical treatments to correct. These include rupture of the capsule that holds the natural lens, infection, detachment of the nerve layer inside the eye (the “retina”), swelling of the retina, or permanent swelling of the clear dome over the surface of the eye (the “cornea”). Fortunately, most patients do not experience these things, and do very well with their surgery.

Are there any guarantees?

No. You and your surgeon will work together as a team to try to get you the best vision possible, but there are no guarantees as to a particular outcome for your surgery.

Will I be glasses-free after my surgery?

Cataract surgery is an exciting opportunity to change the optics in your eyes and refocus them. In many cases it is possible to correct nearsightedness, farsightedness, and astigmatism at the time of surgery. This is done by choosing an appropriate lens to implant at the time of surgery, and deciding whether to use a laser or not. If you are interested in trying to decrease your dependence on glasses after surgery, you should discuss this with your surgeon before the operation. There are some lens implants that are specifically designed to reduce your dependence on glasses after surgery. Some, but not all of these lenses have extra charges that are not covered by your insurance. It is important that you consider your choices before the surgery, because the lens you have implanted will be with you for the rest of your life.

Is surgery covered by insurance?

Cataract surgery is covered by almost all medical insurance plans, including Medicare, as long as you meet certain criteria for visual disability. It is not usually covered by “vision” plans. You may be responsible for co-pays for the surgery, including for the facility fee and/or anesthesia services. In addition, if you select a specialty lens (such as astigmatism-correcting lenses or multifocal lenses) or require non-standard additional services, such as laser catatact surgery, there may be charges for these. You should ask the surgical coordinator for an estimate of these charges prior to surgery.

If I decide to have cataract surgery, how do I schedule it?

To schedule cataract surgery, let your surgeon know that you would like to proceed. The surgical coordinator at the practice will get you a date for preoperative testing and for the surgery, and will arrange the logistics of the procedure.

What if I have other questions about the cataracts?

You should ask your physician if you have other questions about cataracts, particularly if you are considering surgery. You should never decide to have cataract surgery if you do not feel fully informed.