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Cloudy vision from cataracts (right) |
A cataract is a clouding of the eye’s natural lens. Cataracts can affect vision in many ways, including:
- Blurred, foggy, or hazy vision
- Sensitivity to glare and bright lights
- Difficulty reading or seeing details, especially in dim light
- Double vision or “ghost” images
- Eye strain or fatigue
Take our Visual Function Assessment questionnaire to see if your cataracts may be affecting your vision.
Cataracts result primarily from the normal aging of the eye, but affect people at different rates and degrees. Risk factors for cataracts include a family history of cataracts, eye injury or disease, smoking, or use of certain medications such as steroids.
For people who are significantly affected by cataracts, cataract surgery may be recommended. During cataract surgery, the cloudy lens is removed and replaced with a clear artificial lens called an intraocular lens (IOL) implant.
Recent advances in cataract surgery have made surgery safer, more precise, quicker, and provided better and faster vision recovery than traditional techniques. Coastal Eye Specialists’ surgeons have long been at the forefront of these advances, and have been leaders in our community in introducing and popularizing many of the surgical advances that are considered state-of-the art. Coastal Eye’s Medical Director, W. Lee Wan MD, is also a respected and popular teacher of modern cataract surgery to ophthalmologists-in-training.
Advanced cataract surgery uses a technique known as phacoemulsification, in which a small ultrasonic probe is used to liquefy and aspirate the cataract. This demanding, technically sophisticated technique allows "minimally-invasive" cataract removal, which provides a greater margin of safety, faster healing, less distortion of the eye, and quicker visual recovery. Today, phacoemulsification has become the standard cataract removal method for most cataract surgeons. Modern foldable intraocular lens (IOL) implants are made of soft, foldable materials (silicone, acrylic, or collagen) and can be inserted through incisions smaller than 3 mm. These smaller incisions can be made self-sealing so that stitches are usually not required. This reduces the risk of bleeding, scarring, and irritation, and allows a more rapid return to normal activities and good vision.
These advanced cataract surgery techniques allow most procedures to be performed using topical (eye drop) anesthesia, eliminating the need for injections around the eye. This also allows patients to use the eye immediately after surgery (although vision may still take time to recover), and reduces the need for patching the eye after surgery.
Advances in IOL implant technology offer a new range of choices to ophthalmologists and their patients. Today, these choices include:
Aspheric IOLs:
These advanced lenses have optically-corrected designs to reduce aberrations in vision after cataract surgery. These IOLs compensate for imperfections in the eye’s optics, and provide better vision in low-contrast or low-light situations than traditional designs.
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ReSTOR® |
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ReZoom™ |
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Crystalens® |
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Presbyopia-Correcting IOLs:
Presbyopia-correcting IOLs can provide close as well as distance vision. This is the only proven way to correct presbyopia, the age-related loss of close focus that affects most people in their 40’s. The first presbyopia-correcting IOL was approved in 1997 and Coastal Eye’s surgeons have used them since that time, with excellent results. More recently in 2005, updated designs were introduced that have significantly improved the results and broadened the applicability of this class of IOLs. Presbyopia-correcting IOLs are an increasingly popular choice among patients who want to reduce and minimize their need for glasses after surgery, for distance as well as reading.
Presbyopia-correcting IOLs come in different designs, sometimes referred to as multifocal or accommodative IOLs. Different designs such as the ReStor®, ReZoom™ and Crystalens® all aim to provide good distance and close vision, and are used by Coastal Eye Specialists. Each design has pros and cons, and may not be suitable for all patients; none of them yet re-create the vision of a perfect 20 year-old eye. Coastal Eye’s experienced team can help determine if you are a candidate for these advanced IOLs and which design might be best for you.
Toric IOLs:
Toric IOLs, designed to correct astigmatism (uneven, football-shaped curvature of the eye), were introduced in 1998, and Coastal Eye again pioneered the use of these sophisticated IOLs since then. In 2006, new toric designs and predictive computer software were introduced that further increased the accuracy of astigmatism correction with these IOLs. For patients with certain amounts and types of astigmatism, use of a toric IOL can result in better, sharper vision and less need for glasses than standard IOLs.
Presbyopia-correcting and toric IOLs are considered specialty IOLs; extra measurements, calculations, planning, and post-op care are required for optimal results with these lenses. If cataract surgery is considered "medically necessary," medical insurance will usually cover the costs of the basic surgery and a standard IOL. Patients are then responsible for the difference between the cost of the specialty IOL surgery and standard IOL surgery. Financing is available to help all patients who are candidates for these advanced lenses benefit from the latest technology.
Most patients will get excellent results with a standard IOL, but for those who are appropriate candidates, presbyopia-correcting and toric IOLs offer the opportunity for patients to reduce their dependence on glasses and optimize their vision at the same time they have their cataract removed.
Before surgery, a pre-op exam is needed to verify that you are a suitable candidate for surgery. Measurements are taken to help select the optimal IOL for your eye. Drops are usually started a few days before surgery.
Cataract surgery is performed as an outpatient at one of our affiliated Medicare-approved outpatient surgery centers.
When you arrive at the center, you will be given drops to prepare the eye. The actual surgery typically takes 10-15 minutes, but you will be at the center for several hours for pre- and post-operative care. Surgery is usually done with sedation, given intravenously, to help you feel relaxed and comfortable. You are not put completely to sleep, as the surgeon wants you to be awake so you can cooperate and hold still during the brief, procedure. During the surgery, you may hear noises and feel some touch around the face and eyes, but there is rarely any pain or unpleasant sensation.
After surgery, you will be kept for 15-30 minutes in the recovery room to allow the sedation to wear off. You will be sent home with sunglasses to help reduce light sensitivity (which is common for the first few days), and will be given a protective shield to cover the eye when you are sleeping. You can bend over and lift things immediately after surgery, as long as you don’t strain excessively or allow blood to rush to your head. Avoid rubbing or bumping the eye, and keep it clean and dry for the first week. You will be on eye drops for several weeks after surgery to prevent infection and speed healing.
If your other eye needs surgery, it can be done after the first week once the first eye is healing as expected. Glasses, if needed, can be prescribed anytime after surgery, but typically we encourage waiting several weeks to ensure that the prescription is stable.
If you think you might have cataracts, call Coastal Eye Specialists at (805) 983-0700 to schedule a cataract consultation. Take our Visual Function Assessment questionnaire before your consultation and bring it with you.
Click here for more information on Cataracts
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