Loma Linda University Medical Center

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Cataract Surgery and Lens

Cataracts

A cataract is a cloudy or opaque area (an area you cannot see through) in the lens of the eye.

The lens of the eye is normally clear. If the lens becomes cloudy, the condition is known as a cataract. Rarely, cataracts may be present at or shortly after birth. These are called congenital cataracts.

Adult cataracts usually develop with advancing age and may run in families. Cataracts develop more quickly in the presence of some environmental factors, such as smoking or exposure to other toxic substances. They may develop at any time after an eye injury. Metabolic diseases such as diabetes also greatly increase the risk for cataracts. Certain medications, such as cortisone, can also accelerate cataract formation.

Congenital cataracts may be inherited. The gene for such cataracts is dominant (autosomal dominant inheritance), which means that the defective gene will cause the condition even if only one parent passes it along. I families where one parent carries the gene, there is a 50% chance in every pregnancy that the child will be affected.

Congenital cataracts can also be caused by infections affecting the mother during pregnancy, such as rubella. They are also associated with metabolic disorders such as galactosemia. Risk factors include inherited metabolic diseases, a family history of cataracts, and maternal viral infection during pregnancy.

Adult cataracts are generally associated with aging. They develop slowly and painlessly, and vision in the affected eye or eyes slowly gets worse.

Visual problems may include the following changes:

  • Difficulty seeing at night
  • Seeing halos around lights
  • Being sensitive to glare

Vision problems associated with cataracts generally move towards decreased vision, even in daylight.

Review Date: 8/8/2006
Reviewed By: Paul B. Griggs, MD, Department of Ophthalmology, Virginia Mason Medical Center, Seattle, WA. Review provided by VeriMed Healthcare Network.
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ReSTOR Lens

New technology lens implants, such as the Acrysof ReSTOR diffractive implant, are designed to give you focused vision for near, far, and many things in between without glasses. Based on FDA clinical data, there is an 80% chance you will never have to wear glasses again. The goal of the ReSTOR lens surgery is to allow you to read the newspaper, prescription bottles, mail and to see many other things near and far without glasses. There is an additional cost to you that is not covered by insurance for having this lens implanted and there are some vision quality issues that will be explained at your visit.

Cataract Removal

Cataract removal is a procedure to remove a clouded lens (cataract) from the eye to help improve vision. The procedure almost always includes replacing the lens of the eye with an artificial lens.

Description

An ophthalmologist will take several measurements of the eye to determine the type of surgery needed and the power of the artificial lens. An eye ultrasound is done to measure length and the curvature (shape) of the eye's front surface.

Routine testing before surgery is often done to determine your overall general health prior to cataract removal. Because cataract surgery is usually done with local anesthesia (numbing medicine), most patients are able to undergo cataract extraction regardless of other illnesses they may have.

PROCEDURE:

The surgery is performed in a hospital or in an outpatient setting. Children are typically given general anesthesia to keep them in a deep sleep and pain-free; adults usually are awake but sedated and pain-free with local anesthesia.

With the help of a microscope, a small incision is made at the junction of the clear and white outer parts of the eye. The lens can be removed in several ways, depending upon the type of cataract:

With surgical instruments and suction
With an instrument and machine that uses high frequency sound waves (ultrasonic energy) to break up the lens and suction it out (phacoemulsification)
An artificial intraocular lens (IOL) is usually inserted to help the eye focus in the absence of the removed lens. The incision may be closed with fine stitches (sutures) or may be self sealing (sutureless). If sutures are placed, they may need to be removed at a later date.

The surgery typically lasts less than an hour.

Why the Procedure is Performed

This procedure is usually recommended for people who have loss of vision or visual abnormalities caused by cataracts. In about 3% - 4% of cases, the entire lens cannot be removed and another procedure is required at a later date to remove all of the lens fragments. Most of these patients still do very well. In other very rare cases, infection can occur after cataract surgery, which can lead to permanent vision problems.

Risks

Complications of cataract surgery are not common, and serious complications are rare. Most patients have better vision after cataract surgery.

In about 3% - 4% of cases, the entire lens cannot be removed and another procedure is required at a later date to remove all of the lens fragments. Most of these patients still do very well. In other very rare cases, infection can occur after cataract surgery, which can lead to permanent vision problems.

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TORIC Lens

The Acrysof Toric lens is a new technology implant that makes it possible to reduce or eliminate corneal astigmatism at the time of cataract surgery. The unique design of the Acrysof Toric IOL provides significantly improved distance vision without glasses or contact lenses. Most patients with the Toric IOL will need reading glasses after surgery. There is an additional cost to you that is not covered by insurance for having this lens implanted.

Recovery

Generally the patient returns home the same day as the procedure and then returns the following day for examination. A patch is placed over the operated eye and worn until the follow-up examination the next day. Antibiotic and anti-inflammatory eye drops will be prescribed for use for several weeks to assist the healing process.

Expect complete healing in about 10 weeks. Glasses or contact lenses may then be fitted if the clarity of your vision needs to be refined. Close follow-up with the surgeon is essential.

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Crystalens

Crystalens is an “accommodating” lens.  This lens is the only FDA approved lens of its kind.  This lens is approved to work with the eyes natural ciliary muscle to provide distance, intermediate and near vision ranges.  Most patients have reduced their dependence on glasses and are able to drive, read the newspaper or a phone book without glasses.  There is an additional cost to you that is not covered by insurance for having this lens implanted and there are some vision quality issues that will be explained at your visit.

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