Cataract Surgery.

Learn about vision and cataract surgery.

Understanding How the Eye Works.

In the normal eye there are two structures that are mainly responsible for refracting, or bending light so that it focuses properly on the retina. The first structure is the outermost dome shaped structure called the cornea. The second is the crystalline lens, which is located behind the colored part of the eye, or the iris. The lens can be examined by your ophthalmologist during your consultation by using various instruments to look through the pupil (the dark center of the iris). Both the cornea and the lens must be perfectly clear if your vision is to be crisp and clear. While the cornea maintains its clarity throughout life, if you are relatively healthy, the lens may undergo a number of changes as you age.

Presbyopia.

One of the earliest changes that you will experience occurs when the lens loses its flexibility. Up until the age of approximately 40, the lens is both “crystal “ clear and quite soft and flexible. This flexibility permits the lens to change its shape and alter its curvature so that it can help focus your vision at various distances-from far, to near, to arms length, to far or near again. Having this flexibility allows the ability to see things at all distances. Around the time we enter our 40's, the lens begins to stiffen, which makes it progressively more difficult to change focus and see clearly at all distances. Usually this lessens our ability to easily see objects at see arms length or close objects or reading material. When this loss of flexibility occurs, it is called presbyopia (click on link for more information).

Cataract Surgery.

Cataracts.

As the lens loses it flexibility, it is often followed by another type of change whereby it begins to lose its transparency. As you progress through your 50's and 60's, the normally crystal clear lens gradually becomes yellow and cloudy. As the lens loses its transparency and its optical clarity, it may begin to impair your ability to see well in dim illumination, such as for night driving. The cloudiness may also create glare, light sensitivity or an overall decrease in your vision. If parts of the lens become too cloudy they may cause a significant decrease in both your day and night vision. The cloudy, yellowed lens is called a cataract (click on link for more information).

Cataract Surgery.

Cataract surgery today is safe, effective and quite common. In fact, if you have been told that you have a cataract, you are definitely not alone. Each year in the United States, more than 2.5 million people have cataract surgery.

Thanks to advanced cataract surgical procedures and lens implant technology, cataract surgery is not only one of the most frequently performed surgical procedures in the United States, but it is also one of the safest and most successful surgical procedures that you can have. Cataract surgery is performed on an outpatient basis and usually only requires a few hours of your time from beginning to end.

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How is Cataract Surgery Performed?

Warren E. Hill, MD, FACS Board Certified Ophthalmologist

Cataract surgery today is quite comfortable. First, the procedure will begin with your eye being treated with an anesthetic so that you will feel little if anything during your surgery and minimal if any discomfort.

Your eye surgeon operates while looking through a highly specialized microscope, designed exclusively for this purpose. A very small, beveled incision, less than 1/8 of an inch, is made at the edge of the "clear cornea". The clear cornea is the transparent covering of the front of the eye.

The incision is just large enough to allow a microscopic instrument the size of a pen tip to pass through it. Once the microscopic instrument is actually passed through the tiny incision, ultrasound from the tip of the microscopic instrument will be used to gently break the cataract into pieces small enough to be washed away, drawn through the instrument and removed from the eye.

Through the tiny incision, a microsurgical, ultrasonic, oscillating probe is inserted, which gently fragments the cloudy lens, using high frequency sound waves. Simultaneously, this same instrument suctions out the fragmented pieces. This process is called "phacoemulsification". The posterior capsule, an elastic bag-like membrane that held the lens, is left in place.

The incision is commonly called "self-sealing" because the eye's natural internal pressure holds the incision tightly closed allowing the eye to heal without stitches. The chances of developing astigmatism (distorted vision) after surgery are significantly decreased by eliminating stitches, which tend to pull the eye's surface slightly out of its natural shape.

Once all the minuscule bits of the cataract have been removed, a tiny new clear implant lens is folded, inserted through the small incision, and allowed to open up inside the posterior capsule.

The surgery typically takes 20-30 minutes, and is performed on an outpatient basis. This means that you will have the surgery and then go home, usually around 30 minutes afterwards. Most of the time only local anesthesia is used, so you will be awake for the entire process. After the surgery, you are taken to the recovery room and then released. You will need someone to drive you home.

Premium Lens Implants for Correcting Presbyopia

In the past, all lens implants were of a type called a "monofocal" lens implant. A monofocal lens implant provides excellent vision after cataract surgery, for one set distance only — usually for seeing things at a distance and thus does not correct presbyopia, meaning it does not enable you to see close objects or read without reading glasses or bifocals. For seeing at a distance, such as looking at signs when driving, going to a movie or going to a ball game, a monofocal lens implant will provide the vision you need to see clearly. With a monofocal lens implant you will most likely need to wear eyeglasses for any type of near vision activities, such as reading, sewing, playing cards or writing, which would require you to wear glasses.

Today, we are able to offer you the choice of a presbyopia correcting multifocal lens implant. A presbyopia correcting multifocal lens implant provides excellent vision after cataract surgery at a variety of distances. Depending on your specific vision requirement, there are several types of presbyopia correcting multifocal lens implants that your eye surgeon might suggest, including the ReStor Lens Implant .

Each of these lens implants or intraocular lenses (IOL) works in a different way to help you achieve your vision correction goals of being able to see at a variety of distances after cataract surgery, without being dependent on eyeglasses. Presbyopia correcting multifocal lens implants correct both your distance vision and your presbyopia after cataract surgery. For the vast majority of patients, having a multifocal lens implant means that you will be able to see at distance and up close with less dependence on eyeglasses. So, patients choosing to have a presbyopia correcting multifocal lens implant will likely find that they can drive, watch television, read or do crafts without the need for glasses. Patients choosing multifocal lens implants typically experience a greater overall freedom from glasses allowing them to participate in most everyday activities without dependence on, or the hassle of glasses. Follow this link for more information on Advancements in Cataract Surgery.

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Cataract Surgery.

Are Lasers Used to Remove Cataracts?

Dr. Neal Nirenberg, MD, FACS Board Certified Ophthalmologist

No — Lasers are not part of a cataract operation. Cataracts are removed using ultrasonic sound waves, not laser light.

However, lasers are used for the removal of "capsular haze", which is a thin film of scar tissue that occasionally forms on the posterior capsule behind the new implant lens. This haze is harmless and painless, and it occurs in a small percentage of cataract surgery. Patients sometimes think their cataract has "grown back", but it hasn't. Once a cataract has been removed, it will not reoccur.

A special Nd:YAG laser is used to remove capsular haze by the following — An opening is made in the scar tissue with the laser, allowing vision to be restored. With modern intraocular lens implant designs, and materials, the incidence of posterior capsule clouding has fallen to approximately one percent.

Click here for an inside view of scar tissue removal by laser.

Is cataract surgery scary or painful?

A strange new world.

It is perfectly normal to be a bit apprehensive before any unfamiliar experience. All this information about cataracts and surgery may seem odd or a little frightening to you. That's okay because we are here to walk you through it and make everything as simple and smooth as possible.

Our patients most often report that their surgery was remarkably pleasant, and that pain was not even a consideration. Some have even told us that they haven't felt that relaxed in years!

At East Valley Ophthalmology, we promise to be attentive to your needs and well-being and will do everything possible to make sure you are completely comfortable throughout the entire procedure. You will be given a relaxant to enhance calmness and will neither see nor feel any part of your eye surgery. After you are released, we will call you that evening to see that you are doing well. The next morning, you will visit with your physician for evaluation and to address any concerns you might have. We are always here for you.

Do both eyes have cataract surgery at the same time?

No. Cataract surgery is best performed on one eye at a time, to enable you to use one eye while the other is healing. They are typically scheduled two weeks apart.

How long do lens implants last?

Assuming your eye is normal and healthy, the intraocular lens implant should last your entire lifetime. Lens implants are not known to "wear out."

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What are the risks of cataract surgery?

Modern cataract surgery: advancements worth celebrating!

Cataract surgery is one of the most successful of ALL surgeries, but just as it can be risky to cross an empty street, as with any surgery, there are some risks involved. The only way to avoid all risk is to do nothing.

Complications are possible during or after cataract surgery even with the most excellent care. Those complications most commonly seen are associated with unusual eye anatomy (very long or very short eyes), certain inherited eye diseases, and prior trauma. Such complications include bleeding, infection, glaucoma, corneal clouding, swelling of the center of the retina, retinal detachment, decreased vision, or in exceptionally rare cases, loss of the eye itself. While it is impossible to predict in which patients these complications will occur, the risk of these complications is very small.

There are times when a cataract can be removed successfully but vision is not improved — because of other conditions or diseases of the eye. One such disease is macular degeneration, where the central part of the retina — the area that is critical for "fine" seeing — is damaged. Occasionally, macular degeneration cannot be diagnosed prior to the cataract removal because the presence of the cataract itself may prevent seeing the macula in sufficient detail. It is sometimes only after the cataract is removed that macular degeneration is diagnosed.

In addition, other pre-existing conditions of the eye can limit vision after cataract surgery, such as diabetic retinopathy or glaucoma. All such pre-existing conditions limit the eye's ability to regain normal vision, even if the cataract surgery itself is a huge success.

All that said, remember that cataract surgery has a high success rate, higher than any other surgical procedure. It is most likely that your vision will be remarkably better and that your quality of life improved.

What Is the cataract recovery time?

Not so long ago, cataract surgery involved making an incision large enough to remove the clouded lens in one piece. Patients were often stayed at the hospital overnight or for several days. With the aid of new technologies, now cataract surgery can be performed through a very small incision and usually occurs on an outpatient basis, with a significantly shorter recovery time.

The day following your surgery, you will have an office appointment to ensure that you are healing properly. Your vision could be blurred from ointments associated with eye surgery or you might see quite clearly. Every patient is an individual and heals somewhat differently. Over the following weeks, visual clarity progressively improves, and after one month, the eye is typically healed and ready for refracting for new glasses, if needed. Follow-up visits are usually scheduled for the next day, one week, and then one month after surgery. During this time you will be using eye drops to help the eye to heal and to prevent infection.

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Cataract Surgery.

Will cataract surgery impact on my activities?

It is a good idea to accept some assistance after cataract surgery.

Your sight will usually improve within a few days, although complete healing may take several months. It is a good idea to have some help at home if you can, especially if you find it difficult to put your eye drops in.

For the first four days following cataract surgery, we ask you to avoid any and all heavy lifting or bending over that bring your head below the level of your heart. After that, and for the month following surgery, you can resume most of your normal activities, but minimize lifting, bending, and straining. Carrying reasonably lightweight objects, such as a purse or a small bag of groceries, is usually fine.

You will also be asked to avoid getting water in the operated eye for one to two weeks. Avoid swimming. Water that is normally safe for showering and drinking has bacteria in it, and this can possibly cause an infection where the incision was made in your eye. Just adjust your routine to wash your hair leaning backwards rather than forwards, for example. Or better yet, treat yourself and have someone else wash it for you!

You don't need to stay indoors, but try to avoid being out in the wind, as something might blow in your eye. You'll need to keep your hands out of your eyes as well. Your surgeon may give you an eye-shield to wear at bedtime to inhibit possible rubbing or pressing on the eye in your sleep. Avoid eye make-up for six weeks. As for returning to work or driving, this varies from one patient to another and the kind of work involved. Discuss your situation with your doctor who is here to address all of your concerns.

Will I see better after cataract surgery?

AcrySof IQ lens implant inside the eye. This eye is "dilated" (pupil is enlarged) - otherwise you would not see the lens.

Well over 95% of cataract surgeries improve a patient's vision. If having a cataract is the only cause of your decreased vision, removing it will improve clarity. If you have an additional problem (such as macular degeneration, prior uveitis, retinal detachment, diabetic retinopathy, or glaucoma), a determination will be made by your ophthalmologist as to which issue needs to be addressed, and when. Cataract surgery can be successfully carried out even in the setting of most of these other eye conditions

Will I need glasses after cataract surgery?

You may or may not have to wear glasses for reading.

Depending on your eyes and refraction, and the type of lens implant that is chosen, you may or may not have to wear glasses for reading or distance.

Once a cataract has been removed, light can once again pass undistorted through the cornea and the newly implanted artificial lens, to the retina in the back of the eye. However, you may still be required to wear glasses to see more clearly because the incoming light needs to be focused directly on the retina. If you eye cannot do so on its own, eyeglasses will be needed to provide that focus.

In addition, the implanted artificial lens cannot change shape for close vision the way a natural, youthful lens does. A natural lens accommodates, or changes shape, to bring objects into focus at distance, or close up. The intraocular lens implant provides clearest vision at a single focal distance, with the great majority implanted to correct for distance vision. This means that an eye focused for distance will have sharpest vision for activities such as driving, but, if you do not qualify for an accommodating lens implant, you would still require bifocal lenses or reading glasses in order to see clearly at close range.

How do I prepare for cataract surgery?

East Valley Ophthalmology utilizes the most modern technology available, including the Zeiss IOL Master

A comprehensive eye examination is the first step. During your examination for cataract surgery, you will be evaluated for any special medical risks. Your eyes will be measured with the most up-to-date technology, including the IOLMaster, to determine the proper power of the intraocular lens that will be inserted during surgery. Be sure to inform your eye surgeon of all medications you are presently taking, and ask if you should continue your usual dosages. When your cataract surgery date is set, you will be given a simple list of preoperative instructions.

Cataract Surgery.

The eye specialists of East Valley Ophthalmology perform advanced technology diagnostic testing and treatment, as well as taking the time necessary to provide each patient with information needed to fully understand their condition and to achieve their best possible visual outcome.

If you would like further information, please call our office at:

480-981-6111

East Valley Ophthalmology

Eye Doctors - Mesa, Arizona

If you or a family member or friend have not had a recent routine eye examination, have a specific eye condition that needs addressing, or are looking for an eye specialist or professional eye consultant please take a moment to Request an Appointment.