A cataract is an opacification or cloudiness that develops
within the lens of the eye. This is a normal part of
the aging process that most people experience at some
point. The lens is the part of the eye that focuses light
on the retina and allows us to see things sharply. The
lens functions best when we are younger because it is
crystal clear. As we age, the lens slowly turns yellow,
then brown, and sometimes becomes opaque and white. An
analogy is a window that is never washed. As dirt accumulates,
the window loses its clarity, and it is no longer possible
to see through it. Similarly, sometimes a cataract progresses
to the point that vision decreases.
Age is not the only cause of cataracts. Trauma or injury
to the eye, certain medications such as prednisone or
cortisone, diabetes and other less common medical conditions
may also cause cataracts. Sometimes people are even born
with cataracts. Cataracts present at birth may be small
and harmless or may be large enough to interfere with
A person with a cataract may notice problems such as
blurred or distorted vision, glare from sunlight, headlights,
or other lights, or trouble focusing on things. When
these symptoms begin to interfere with activities of
daily life, removal of the cataract may be recommended.
Cataract surgery is a precise and technically demanding
procedure. Cataract surgery is micro-surgery, which
means that it is performed under a high-powered operating
microscope. This surgery is one of the most commonly
performed surgical procedures in this country and at
Chelsea Eye. It is also one of the most successful
procedures. It is usually performed as an outpatient
procedure, which means that you do not have to stay
in the hospital overnight.
Dr. Coad will first numb the eye with topical anesthetic
drops. Sometimes an anesthetic injection is required.
Your doctor will make a tiny incision, approximately
1/5" in or next to the cornea of your eye. This
is called a "clear cornea" incision. The
doctor will then use an ultrasound-powered needle to
liquify and remove your cataract. This part of the
procedure is called phacoemulsification. Researchers
are experimenting with lasers to remove cataracts,
but laser cataract removal currently offers no advantage
When the cataract has been removed, your doctor will
implant a new lens into your eye. This new lens (refractive multifocal lens or conventional monofocal lens) is
made of plastic. Sometimes a foldable plastic lens
is used so that the initial incision does not have
to be enlarged. The advantage of keeping the incision
small is a more rapid healing time and a quicker
recovery from the procedure. Once placed into the
eye, the lens is unfolded and placed in proper position.
Usually, no stitches are needed to close the incision
in the cornea. Your doctor will place a shield or
protective glasses over the operated eye before you
go home. In most cases you can resume normal activity
as early as the next day. Drops will be prescribed
to prevent infection and inflammation in the eye,
and your doctor will give you detailed instructions
regarding postoperative follow-up examinations. Dr.
Coad is a recognized expert in no stitch cataract
surgery and is available to answer questions about
this exciting procedure.
Presbyopia and Cataract/Lens Surgery
Patients who have cataracts may have, or will eventually develop, an age-related condition known as presbyopia. Presbyopia is the reason that reading glasses become necessary, typically after age 40, even for people who have excellent distance and near vision without glasses. Presbyopic individuals require bifocals or separate (different prescription) reading glasses in order to see clearly at close range. There are several options available to achieve distance and near vision after cataract surgery.
- GLASSES You can choose to have a monofocal (single focus) IOL implanted for distance vision and wear separate reading glasses, or have the IOL implanted for near vision and wear separate glasses for distance.
- MONOVISION IOLs with two different powers, one for near vision, and another for distance vision, could be implanted. This combination of a distance eye and a reading eye is called monovision, and it would allow you to read without glasses. It has been employed quite successfully in many contact lens and refractive surgery patients. Dr. Coad will discuss and demonstrate this option.
- MULTIFOCAL IOL (ReSTOR and ReZoom) A multifocal IOL could be implanted. These IOLs, more recently approved the FDA, provide distance vision AND restore some or all of the focusing (accommodating) ability of the eye. Depending upon the technological features of the IOLs, they may be described as "accommodating", "apodized diffractive" (ReSTOR®) or "presbyopia-correcting". All of these lenses are "multifocal", meaning they correct for both distance vision and other ranges, such as near or intermediate.