1. What are cataracts and how do they develop?
The human visual system functions much like a camera. In a camera, incoming light rays are focused through the camera lens onto the film in the back of the camera. If the lens of the camera is clear and the light rays are focused directly onto the film, a bright clear image is produced. The same thing holds true for the eye. Incoming light rays are focused through a clear lens onto a layer of light sensitive cells in the back of the eye known as the retina. If the eye is normal, a bright, clear image will be produced.
As a person gets older, the lens of their eye continues to develop and new layers are formed on top of the old. In time, this will cause the lens to harden and begin to lose its transparency. A person will then complain of cloudy or blurred vision. This is known as an age related cataract.
The development of age related cataracts is normal and takes place in most individuals. Although development usually occurs in both eyes, the rate of development between the two eyes often differs. If the development is mild, and doesn't cover much of the lens, vision may only be slightly altered. If on the other hand, development is extensive, vision can be greatly altered.
2. How are cataracts diagnosed?
A thorough eye examination by an ophthalmologist will detect the presence of a cataract. Using an instrument known as a slit lamp bio-microscope the ophthalmologist can get a three dimensional view of the lens. This instrument will also aid the ophthalmologist in diagnosing many other eye conditions that may cause blurred or cloudy vision.
3. How do I know if I have a cataract?
If you have a cataract, you may experience one or more of the following:
- Dulled or yellowish vision
- Painless blurred or dimming vision
- Difficulty with night vision
- Sensitivity to light and glare
- Multiple images
- Reduced depth perception
- Visual distortion or ghost images in either eye
4. How are cataracts treated?
If your cataract is mild, and your vision is only slightly blurred, changing your eyeglass prescription may help for a period of time. If you change your eyeglass prescription and still feel that you are unable to see well enough to do all the things that you like to do, then it is time for you to schedule your surgery.
Surgery is the only option to remove cataracts. Medications, eye drops, exercises or glasses will not make a cataract go away. A doctor of ophthalmology (an ophthalmologist) is licensed to perform cataract surgery. Cataract surgeons are ophthalmologists who spend four years of medical school, one year of internship and three years of residency developing their surgical skills. Dr. Allen is a board certified ophthalmologist and has performed thousands of cataract surgeries.
5. How is a cataract removed?
Phacoemulsification is the most common procedure used today. It requires a small incision in the side of the cornea. A tiny instrument is inserted through the cornea. Using high frequencey ultrasound, this instrument breaks up the center of the lens. Any remaining tissue is suctioned out through the incision. In the event that the cataract is very dense and more mature, a larger incision may be used. The whole lens is removed in one piece using a technique called extracapsular extraction.
After the cloudy lens is removed, the surgeon inserts a new intraocular lens (IOL) made of plastic, silicone, or acrylic. This new lens will once again focus light rays clearly on the retina. The new IOL becomes a permanent part of the eye. Most IOL's are inserted behind the colored part of the eye known as the iris. This type of lens is called a posterior chamber lens. Sometimes the IOL must be placed in front of the iris. This is then known as an anterior chamber IOL. When the IOL is in place, the incision is closed. Stitches are usually not needed to close the incision. In the event that stitches are used, they usually dissolve naturally and rarely need to be removed.
For patients desiring little dependence on glasses post-operatively, multifocal intraocular lenses may be placed. Most patients with multifocal implants can see distance and near without glasses. Talk to Dr. Allen if you would prefer that a multifocal implant be placed during your surgery.
Learn about Multifocal Lenses
6. What should I expect pre-operatively?
Prior to your surgery, the length of your eye will need to be measured in order to prescribe the proper lens implant.
You will be asked to skip breakfast the day of your surgery. At the surgery center, you will be given eye drops and medication to help you relax.
Before you have your surgery, the skin around your eye will be thoroughly cleansed, and a sterile covering will be placed around your eye.
7. What type of Anesthesia is used?
In general, cataract surgery is performed under topical or local anesthesia. Patients feel no pain during the procedure, and do not have to worry about keeping their eye open. You will not be able to see the actual surgery, but may see light and movement during the procedure. This is rare however.
8. How long will I be at the surgery center?
Cataract surgery is performed as an outpatient procedure. It does not require an overnight stay in the hospital. Cataract surgery does not have many restrictions. You should be able to resume your normal activities shortly after your procedure.
9. What is the surgery like?
You will need to arrange transportation to and from the surgery center on the day of your procedure. You will not be able to drive yourself. You will be expected to arrive 1 -2 hours prior to surgery. Do not eat breakfast. An IV will be placed. Numerous eye drops will be applied. When you arrive in the surgical suite, the anesthesia doctor will apply oxygen, heart, and blood pressure monitors. You will then receive an IV sedative and local anesthesia will be delivered while you sleep for 30 - 90 seconds. When you awake, you will be covered with a drape. Your non-operative eye will be closed. You will hear Dr. Allen or Dr. Najera talking but feel no discomfort. You will not be able to see the surgery being performed. The procedure itself will take approximately 10 minutes. You will be in the surgical suite probably 30 minutes total. Often a patch will be applied. Your doctor will remove the patch in the office at your post-operative appointment.
10. What is involved in the recovery process?
When the surgery is finished, you will be required to stay in the recovery toom at the surgery center for a short time before going home. You will not be able to drive yourself home. As with any surgery, post-operative complications are possible. It is very important to follow your doctors post-operative instructions to avoid bleeding, infection, or other serious problems after surgery.
11. What post-operative care is required after cataract surgery?
Several follow-up visits will be required after your surgery. It is important that you attend your post-operative appointments. Your doctor will not only be monitoring the results of you surgery, but will also be checking the health of your eyes.
Sometimes, the posterior capsule that supports the new IOL becomes cloudy. This generally is noticed several months to years after the initial cataract removal. This is known as "after cataract" or "cloudy capsule". If this occurs, your vision may once again become blurry. In this case, Dr. Allen or Dr. Najera will have to make an opening in the center of the membrane with a laser. This procedure is known as posterior capsulotomy. It is performed at the same surgery center as your original surgery, takes about five minutes to perform and requires no recovery period.
Learn About YAG Laser
12. Will I have to wear glasses after my surgery?
While it is hard to say for sure whether or not you will need glasses after surgery, most patients who wear bifocals or reading glasses for up close vision before surgery will still need to wear glasses after surgery. Patients choosing a multifocal implant will usually have little dependence on glasses post-operatively.
13. What is the risk of a serious complication?
As is true with any surgery, good results cannot be guaranteed. It is important to note that more than 1.4 million cataracts are removed in the United States each year. Approximately 95% of these surgeries occur without complications. Though rare, complications can occur both during and after surgery. Some complications can be severe enough to affect vision. These complications include but are not limited to: bleeding, infection, and a need for a second surgery. Cataract surgery will not correct poor vision that is caused by other eye diseases. Dr. Allen or Dr. Najera will discuss the risks of surgery with you so that you can make an informed decision about whether or not to proceed with the procedure.
14. Can I delay my surgery?
In general delaying a cataract removal until you are ready will not jeopardize your chance of a successful outcome. The presence of a cataract will not harm your eye. Many people are found to have cataracts early in the development stage, and are able to see well enough to continue doing the things they enjoy for many years.
15. Where will my surgery be done?
Our doctors prefer to operate at the following locations:
Aurora Health Center-West Building
8400 Washington Ave.
Racine, WI 53406
Eye Surgery and Laser Center of Wisconsin
10200 Innovation Dr., Suite 700
Milwaukee, WI 53226
16. Will my health insurance pay for my surgery?
Allen Eye Care will assist you in getting specific information from you insurer concerning coverage of your cataract surgery. Ultimately you are responsible for knowing the details of your own policy. However in general, Medicare covers 80% of allowable surgical, anesthesia, and facility charges. Your secondary insurance usually covers the remaining 20% providing that all deductibles and co-pays have been paid. If you have no secondary insurance, then you are personally responsible for the balance.
If you have commercial healthcare insurance, the details of your personal responsibility will vary with your specific policy. You should contact your carrier for details.
17. How will I know when it's time to have my surgery done?
When your vision is effected enough to interfere with your daily activities, you should consider having surgery done. Some patients are perfectionists and will seek surgery when the cataracts are fairly mild. Others may be content with relatively poor vision.
Dr. Allen and Dr. Najera will only insist that you consider surgery if you are no longer seeing well enough to continue driving. Even then you will be given the option to stop driving instead of having surgery.
Our doctors will not pressure you to have surgery. Rather you will be given options and he will perform you surgery when you request it.
18. What are the steps required to schedule my Cataract Surgery?
Simply call Allen Eye Care Associates and tell the receptionist that you wish to schedule your cataract surgery. You will be transferred to our cataract surgery scheduler.
If you haven't seen one of our doctors in more than six months, we will schedule a brief examination. Measurements for the implant will be performed in our office. A pre-operataive physical with your family doctor will be arranged by our office. Our scheduling staff will also verify you insurance information.
In summary, you simply place one phone call and we'll take care of the rest!
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