Cataract Surgery: Your Questions Answered

At this very moment, over half of Americans over the age of 80 either have cataracts or have had cataract surgery, according to the National Eye Institute.  This article covers some of the most common questions that our patients have regarding cataracts.

What is a Cataract?

A cataract is the clouding of your eye’s normally clear, thin, and flexible lens. With a cataract, your vision becomes increasingly blurry, hazy, and yellow. It may feel as though you are looking through a dusty windshield, or you may not notice much of a visual change at all. The density and location of the cataract determine how much vision loss or changes you may experience.

Cataracts typically form in both eyes, although they can be asymmetric in severity. Cataracts can impede your vision and diminish your ability to see well in everyday activities such as reading or driving. The good news is that they can be surgically removed through a safe procedure to correct the vision problems and ultimately restore your vision. Many patients even report after having cataract surgery that they simply forgot how clear and colorful the world truly is.

What are the 3 Types of Cataracts?

There are 3 primary types of age-related cataracts:

• Nuclear Sclerotic Cataract: This is the most common age-related cataract, in which the nucleus, or the central part of the lens, becomes noticeably hardened, yellow, or cloudy. As this cataract progresses, it changes the eye’s ability to see clearly.
• Cortical Cataracts: This kind of cataract develops on the outer edges of the lens cortex and spreads inward in a spoke-like manner, causing the lens to have opacities (areas where light can’t pass through clearly). Eventually, patients develop decreased vision due to glare or blurred vision caused by light scatter.
• Posterior Subcapsular Cataracts: This type of cataract starts as a small, opaque area that forms at the back of the lens. As it grows, it can become large enough to interfere with your reading vision, reduce your vision in bright light, and cause glare or halos around lights at night.

What Causes Cataracts?

To see clearly, light must pass through the lens, the structure found in the center of your eye that is responsible for focusing light rays onto the retina. The retina then converts the light into signals which are sent to the optic nerve and carried to the brain. When a cataract develops, the lens becomes cloudy due to the breakdown and aggregation of proteins in the lens. As a result, the lens is unable to focus light properly, leading to blurred or hazy vision.

The most common cause of cataracts is aging. After the age of 40, changes in your eyes begin to take place. It is a normal process in which the lens begins to break down, After the age of 60, people are likely to experience some clouding of the lens, causing them to lose some eyesight. Most cataracts develop gradually and cloud more of the lens with time. However, vision problems may not occur until years after the lens starts to cloud.

What are the Symptoms of Cataracts?

Cataracts are progressive, and very frequently, patients do not notice the slow deterioration in the quality and vibrancy of their vision.

You may start to notice the following vision changes if you have a cataract:

• Cloudy or blurry vision
• Shadowing or double vision
• Light sensitivity
• Trouble seeing at night
• Lights give off a glare or a halo
• Seeing bright colors as faded or yellow-tinted
• Needing more light to read
• Difficulty driving, especially at night or in the rain

These symptoms may be a sign of other eye conditions. Be sure to notify your ophthalmologist or optometrist if you notice any of these cataract symptoms. Over time, cataracts can lead to vision loss.

What is the First Sign of Cataracts?

In the earliest stages of cataracts, there are no noticeable symptoms. Changes in vision caused by cataracts develop very slowly, which is why this condition can easily go unnoticed until it is serious enough to impact your lifestyle. Eyes become greatly impacted by the aging process around the age of 40. Once over age 55, most people will notice a change in the quality of their vision. Their cataract symptoms will worsen with time.

In addition to scheduling a comprehensive eye exam, keep the following questions in mind when considering cataract surgery:

• Are you having difficulty driving at night?
• Does your vision seem blurred or dim?
• Do colors seem “dull” rather than bright?
• Do you see a halo around lights?
• Have you had to change your eyeglass prescription more frequently than usual?
• Do bright lights make it more difficult to see?
• Does your vision seem distorted at times?
• Do you have problems reading or watching television?
• Is it difficult to cook, shop, do yard work, climb stairs, or take medications?

Are Cataracts Hereditary?

Growing older is the most common cause of cataracts. It is uncommon to experience cataracts that are not age-related. However, cataracts can be brought on earlier in life due to the following reasons:

• Family history of early-onset cataracts (genetics)
• Certain medical problems, such as diabetes
• Certain chronic diseases
• Eye injury
• UV damage
• Certain medications, such as steroids

There is no way to predict how quickly cataracts will develop. Vigilance and routine preventative eye examinations are key to addressing vision quality loss.

What is Cataract Surgery?

Cataract surgery is one of the safest and most common surgical operations performed in the United States. This type of eye surgery offers refractive benefits with a high success rate and is the only way to treat cataracts and stop the progressive loss of vision. The procedure involves removing the lens of your eye and, in most cases, replacing it with an artificial lens. That lens is called an intraocular lens (IOL). This outpatient procedure is straightforward, and surgery typically lasts 20 minutes or less. Typically, the surgery is performed under a local anesthetic, reducing the risk associated with general anesthesia,  and allowing the cataract surgeon to communicate with you during your procedure. It typically takes 3 to 6 weeks to fully recover from cataract surgery.

Your ophthalmologist will recommend removing a cataract when it affects your eyesight and quality of life. If your cataract symptoms are not yet affecting your way of life, it may not be time to remove the cataract. Early in the progression, adjustments such as changing your glasses prescription can help with vision. However, as cataracts progress, prescription changes will eventually not provide much or any relief from symptoms. In addition, there are no medications or eye drops that have been proven to stop the condition from progressing. Opting for cataract surgery to replace the cloudy lens will be the only way to improve your eyesight.

Factors to consider such as when to have cataract surgery, what kinds of IOLs to have implanted, and what type of surgery to have will be unique to every individual based on their eyes, their health, and their vision preferences.

Is Cataract Surgery Painful?

Many patients prolong their decision to proceed with cataract surgery due to feeling anxious about being awake and feeling pain. However, cataract surgery is not painful. In fact, many patients eagerly describe their satisfaction with the process and remark on how quick and pain-free it was! There are steps taken before and during the surgery to ensure that no pain will be experienced such as IV sedation and anesthetic drops to numb the eye. We will keep you comfortable and relaxed.

How is Cataract Surgery Done?

During cataract surgery, the cloudy lens is removed and an artificial lens, an intraocular lens (IOL), is implanted. There are two methods of doing this. You can opt for traditional cataract surgery or laser-assisted cataract surgery.

Traditional cataract surgery: This surgical option is one of the most common surgeries in the world and is universally recognized as being safe and effective. It is also more cost-effective in comparison to laser-assisted cataract surgery. In this procedure, the cataract surgeon will make 2 small incisions on the side of your cornea and will then use an ultrasound handpiece to break up the cataract. The handpiece will then suction out the broken pieces and the surgeon will proceed to replace what was initially the cataract-clouded lens with a clear acrylic lens (IOL).

Laser-assisted cataract surgery: Although the use of lasers is not covered by insurance plans, it provides several advantages. In this procedure, the cataract surgeon will place a camera above your eyes to map both the surface and interior structures of the eye. This 3D map will be sent to a specialized computer that programs the laser. This laser, known as a femtosecond laser, will then receive information such as the precise location, depth, and size of the cataract. The surgeon will then use the laser to treat astigmatism, create small incisions in your cornea and lens capsule, and soften the cataract, making it easier to break up and remove. An ultrasound handpiece will be used to break up the cataract and suction out the pieces. The surgeon will proceed to replace what was initially the cataract-clouded lens with a clear acrylic lens (IOL).

Dos and Don’ts After Cataract Surgery

What to do after cataract surgery:

• Use your drops as prescribed
• Use lubricating drops (Retaine, Systane, Refresh, or similar) 4 times an hour for a dry, scratchy, or gritty feeling
• Wear glasses, if comfortable. Older glasses may not work properly after surgery. Wear sunglasses as needed for light sensitivity
• Wear your eye shield for the first 5 days when asleep
• Wash around your eyes gently with a clean warm washcloth twice a day, including when you take showers.
• Take Ibuprofen if your eye aches, but be sure to call your doctor for severe pain
• Resume your activities and routines
• Bring your surgery drops, glasses, and a driver with you to your post-op visit the day after surgery

What NOT to do after cataract surgery:

• Do NOT rub your eye at any time!
• Do NOT let soap or water in the eye
• Do NOT let any dirty water in your eye – no swimming pools, saunas, or hot tubs for 5 days
• Do NOT drive yourself to your post-op appointment unless otherwise approved by your doctor.

Can Cataracts Come Back?

After undergoing cataract surgery, your cataracts cannot come back. The surgical procedure to remove a cataract involves replacing the clouded lens (cataract) with an artificial lens, a process known as an intraocular lens transplant. It is impossible for the artificial lens to develop a cataract.

There are cases, however, in which patients may experience a “secondary cataract” months or years after having undergone cataract surgery. With secondary cataracts, also known as posterior capsule opacification, the lens capsule that holds the intraocular lens in place becomes clouded. This is due to the formation of scar tissue behind your lens implant, causing the capsule to become cloudy or wrinkled over time. This can result in blurry vision. This thin membrane of scar tissue is known as posterior capsule opacification, or “secondary cataract.” It can be removed with a quick, painless, and low-risk laser procedure called YAG Laser Capsulotomy. Once the scar tissue is removed, it cannot come back.

How Much Does Cataract Surgery Cost? / Does Medicare Cover Cataract Surgery?

Your cataract surgeon will recommend options based on your eyes and lifestyle preferences. Out-of-pocket costs are determined by your deductibles, copays, and coinsurance.

The costs of traditional cataract surgery (non-laser) and monofocal intraocular lenses are typically covered by Medicare and private insurance. Astigmatism management, toric intraocular lenses, and multifocal intraocular lenses are not covered by Medicare or private insurance.  Learn more about affording cataract surgery here.

More About Dr. Amy Cherof, M.D.

Dr. Cherof is an ophthalmologist at the Marietta Eye Clinic who specializes in laser-assisted and traditional cataract surgery. She serves the Roswell office. Dr. Cherof graduated with her Bachelor of Science from the University of Georgia suma cum laude with highest honors. She received her medical degree from the Medical College of Georgia. She is a member of the American Academy of Ophthalmology and a member of the American Society of Cataract and Refractive Surgery. Read her full bio here.

References and Additional Resources

https://www.nei.nih.gov/learn-about-eye-health/eye-conditions-and-diseases/cataracts

What are cataracts

https://my.clevelandclinic.org/health/treatments/21472-cataract-surgery

Cataract Surgery

https://www.nhs.uk/conditions/cataract-surgery/#:~:text=Cataract%20surgery%20is%20a%20straightforward,home%20on%20the%20same%20day.

Overview – Cataract Surgery

https://www.aao.org/eye-health/diseases/what-are-cataracts

What Are Cataracts?

https://www.hopkinsmedicine.org/health/conditions-and-diseases/cataracts

Cataracts

https://www.mayoclinic.org/diseases-conditions/cataracts/symptoms-causes/syc-20353790

Cataracts

https://www.aao.org/eye-health/diseases/traditional-vs-laser-assisted-cataract-surgery

Traditional Cataract Surgery vs. Laser-Assisted Cataract Surgery