Cataracts - Wills Eye

Main Number.........................................215-928-3000
Physician Referral................................1-877-AT-WILLS
1-877-289-4557
Emergency Service.................................215-503-8080
Cataract and Primary
Eye Care Service..........................215-928-3041
Retina Service............................................. 215-928-3300
Cataract and Primary Eye Care Service......215-928-3041
Contact Lens Service..............................215-928-3450
Cornea Service.......................................215-928-3180
Glaucoma Service...................................215-928-3200
Neuro-Ophthalmology Service..................215-928-3130
Oculoplastic Service...............................215-928-3250
Ocular Oncology Service..........................215-928-3105
Pediatric Ophthalmology and....................215-928-3240
Ocular Genetics Service
Low Vision Service..................................215-928-3450
Laser Vision Correction Center..................215-928-3700
To learn more, please visit us at www.willseye.org
840 Walnut Street • Philadelphia, PA 19107
Phone 1-877-AT-WILLS • Web www.willseye.org
© December 2010
Cataracts
America’s first eye hospital
A patient’s guide to
Cataracts
CATARACT S
Cataracts
When you first learned you had a cataract, you may
have feared you would lose your vision...but such
a diagnosis does not sentence you to blindness.
Today, surgery can restore useful vision in most
cataract patients who have normal, healthy eyes.
The picture is then transmitted by the optic nerve to the
brain, where the image is interpreted. It’s the brain that
does the actual seeing. The lens never stops growing,
so an adult’s lens is larger, thicker and more opaque than
a child’s.
The Process of Sight
By the time a person is 40, the lens is less flexible and
can cause near-vision problems which lead people to
say, “My arms are not long enough” or “I can’t read small
print.” This problem is caused by an overgrown lens, which
occurs long before the cloudiness, or cataract, begins.
The eye acts like a camera that takes a picture.
At age 65, this overgrown lens blocks one-third of the light
entering the eye.
Diagram 1
Diagram 2
Every camera must have a lens to properly focus the picture.
Your eye has a lens, too, which lies directly behind the
pupil in a sac-like capsule. Your lens, which is about the
size of an M&M®, is normally clear and transparent. It
focuses images onto the retina, which acts as the film that
records the picture.
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CATARACT S
Cataracts
Cataracts
If the lens becomes cloudy, the light reaching the retina
is blurred and distorted, and your vision is affected. This
clouded lens is called a cataract, and it must be removed
before vision can be restored. A clouded lens can be
compared to a window that is frosted or “fogged” with
steam. Cataracts are not cancerous and are not a cause
of irreversible blindness.
Two common types of cataracts are shown in the following
photographs: a cortical cataract (Figure 1) and a posterior
subcapsular cataract (Figure 2).
Many cataracts take years to develop to the point where
vision is seriously affected. Most occur as a result of the
normal aging process.
There are other kinds of cataracts not related to the
aging process. Some can develop as a result of an eye
injury, called traumatic cataracts. Others can develop
from metabolic and blood disorders, eye infections and
inflammations, and certain types of medications.
Another type, called congenital cataract, occurs at birth,
particularly if the mother has had rubella (German measles)
during pregnancy.
Research continues to look for ways to prevent cataracts.
Cataracts can be removed at any age. You no longer have
to wait until the cataract “ripens” or until you lose your
sight before surgery can be performed. The time to remove
a cataract is when it is reducing vision to the point that it
interferes with your daily activities.
Figure 1
Figure 2
Cortical cataract
Posterior subcapsular cataract
Removing Cataracts
A cataract – clouded lens – must be surgically removed.
Depending on the type of cataract, a patient will experience
different vision problems. However, the most common
cataract symptoms include blurred vision, sensitivity to
light or glare, double vision in one eye, poor night vision,
needing brighter light to read, or experiencing fading or
yellowing of colors. If the cloudiness is not near the center
of the lens, you may not be aware that a cataract is present.
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The most common surgical procedure used today is
phacoemulsification. The surgeon first makes a small
incision (usually between 2 and 3 millimeters in length). An
opening is then made in the front (anterior) capsule of the
lens. The lens tissue within the capsule is then removed
using a computerized instrument consisting of a needle
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CATARACT S
Cataracts
about the size of a ballpoint pen tip, which vibrates at about
40,000 times a second. This ultrasonic vibration dissolves
the cataract into fine particles, which are then vacuumed
through an opening in the instrument.
The sac-like capsule that surrounds the lens remains
in place (except for the opening in the anterior capsule
made at the start of surgery). This capsule is left intact
for two reasons: to avoid disturbing the gel, or vitreous,
that fills most of the back of the eye, and to support an
intraocular lens.
The small incision in the eye made at the beginning of
surgery usually does not require sutures. Phacoemulsification allows an early return to normal activity for patients
undergoing cataract surgery.
Because the IOL lies safely inside the eye, as shown in
Diagram 3, it is never handled or adjusted. Most patients
are good candidates for the implant.
Most patients have the device implanted during their
surgery. Those who have had cataract surgery without the
IOL implant, and who later discover they cannot tolerate
contact lenses or cataract glasses, have to be evaluated
very carefully before a second operation for a lens implant
is recommended.
Contact lenses and cataract eyeglasses are the other
alternatives for restoring vision after cataract surgery but
are only used in the rare patient who cannot have an IOL.
Restoring Sight After a
Cataract is Removed
Because the clouded lens is removed in cataract surgery,
some type of substitute or replacement lens is needed to
restore vision. There are three ways of doing this:
An intraocular lens implant, or IOL, is an artificial lens
made of plastic, silicone, acrylic or other material that is
implanted inside the eye during cataract surgery. The IOL
is usually implanted within the capsule, which provides
permanent support for the lens. This is the most natural
and preferred way of restoring vision.
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Diagram 3
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CATARACT S
Cataracts
Development of Intraocular
Lens Implants
Intraocular lens implants (IOLs) have been used since 1949.
Physicians at Wills were the first in the United States to
perform the implant procedure in 1952, and millions have
been done since then.
Present-day IOLs (Figure 3) have undergone many
improvements and refinements over the years, and results
have generally been excellent. Most of the IOLs being
used today are made of acrylic or silicone. These materials
are soft and foldable allowing them to fit through a small
incision.
Research into new types of IOLs is ongoing. Newer
versions include lenses that can correct astigmatism and
multifocal and accommodative IOLs that are often able
to give patients vision, both at distance and near, without
the aid of glasses.
Your Surgery
Most patients can have their cataract surgery done through
Wills Eye Institute’s Day Surgery program or at one of the
Wills surgery centers located throughout the region. On
the day of surgery, you will be given medication to calm
and relax you.
The area surrounding your eye will be cleansed and sterile
drapes will be placed over you, exposing only the eye to
be operated on.
Topical anesthesia in which the eye surface is numbed
with drops or a gel-like substance is most often used for
modern cataract surgery. You might have a local anesthetic
consisting of small injections around your eye. General
anesthesia is also available. The surgery is essentially
painless. The surgeon will use a microscope to magnify
the delicate procedures to be performed.
Later in the day you will be released, and you can resume
normal, moderate activity as soon as you feel up to it.
When you return home, you will begin using your eye
drops as prescribed. You may be instructed to wear
glasses or sunglasses during the day, and an eye shield
at night or when showering to protect the eye.
Figure 3
Examples of intraocular lens implants used today
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CATARACT S
Cataracts
Convalescence
Cloudiness of the Capsule
Most of the healing occurs within one month. During
that time, it is important to visit your ophthalmologist
and use the eye-drops as prescribed. If you have had an
intraocular lens implanted and have no complications,
you will notice improved vision in a week, or even sooner.
In about 20% of patients who have a cataract removed, the
capsule becomes cloudy several months or years after the
original surgery. Often, this condition is referred to as a
“secondary cataract.” However, this does not mean that
the patient has another cataract; it is only the capsule—
not the lens—that has become cloudy.
You can get temporary glasses shortly after the surgery,
but your final eyeglass or contact lens prescription will not
be given until most of the healing is completed.
Complications of Surgery
or Lens Implantation
If this cloudiness blurs your vision, a clear opening can
be painlessly made in the center of the posterior capsule
membrane with a YAG laser. This procedure is done on an
outpatient basis in about 15 minutes, without injections.
Of the vast majority of patients who have cataract surgery,
only a small number experience complications. Infection,
bleeding and retinal swelling or detachment might occur.
Also, glaucoma, corneal clouding or loss of an eye are
some of the more serious, but rare complications.
Those most at risk include alcoholics, substance abusers,
diabetics, and people with glaucoma, high myopia or
vascular disease. If your eye is healthy before the surgery,
the likelihood is that the surgery will be successful.
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CATARACT
Cataracts
A Final Note
We hope this brochure has given you a better understanding
of cataracts and what to expect during your surgery. We
encourage you to discuss any questions with your eye
surgeon.
Few hospitals in the world perform more cataract surgeries
than Wills Eye Institute and its surgical network. Many of the
latest advances in surgery, implants and instrumentation
were developed at Wills.
Until the time comes when there is a way to actually prevent
the development of cataracts, it is our goal to provide you
with the best care in managing this common condition.
About Us
Since our founding in 1832 as the nation’s first hospital
specializing exclusively in eye care, Wills Eye Institute
has become a world-class leader in ophthalmology. Our
motto – Skill with Compassion – is central to every aspect
of patient care. Today, we continue to shape the field,
thanks to our talented, skilled physicians and staff who are
dedicated to improving and preserving sight.
One of our core strengths is the close connection between
innovative research and advanced care. Wills physicians
pursue research that can be quickly translated into clinical
care. Our tradition of excellence has also made Wills a
premier training site for all levels of ophthalmic medical
education, and a leader in innovative, high tech community
outreach efforts.
Wills Eye remains steadfast in our commitment to improving
quality of life for our patients and their loved ones.
Become a valued partner in the work we do.
Your gift to Wills Eye Institute will help us continue providing
the best care possible, advance research for innovative
treatments, and train new generations of ophthalmologists.
Please call 215-440-3154 or
visit www.willseye.org/donations
and make a gift today!
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