Cataract

Overview

A cataract is a loss of transparency or clouding of the normally clear lens of the eye. As one age, chemical changes occur in the lens that makes it less transparent. The loss of transparency may be so mild vision is hardly affected or so severe that no shapes or movements are seen, only light and dark. When the lens gets cloudy enough to obstruct vision significantly it is called a cataract. Glasses or contact lenses cannot sharpen your vision if a cataract is present.

Causes

The most common cause of cataracts is aging. Other causes include trauma, medications such as steroids, systemic diseases such as diabetes, or prolonged exposure to ultraviolet light. Occasionally, babies are born with a  cataract. Reducing the amount of ultraviolet light exposure by wearing a wide-brim hat and sunglasses may reduce your risk of developing a cataract.

Symptoms

The most obvious symptom of cataracts is a gradual decrease in vision. Other common symptoms associated with cataracts may include:

  • Blurred vision

  • Glare and halo especially at night

  • Frequent changes in eyeglasses or contact lens prescription

  • Fading of colors

  • Yellowish hue when looking at photos and other images

  • Double vision

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Lens with a cataract

Treatment

Once a cataract is developed there is no cure except to have the cataract surgically removed. Outpatient surgical procedures can remove the cataract through a small incision phacoemulsification cataract surgery. Usually, the time to have the surgical procedure is when your vision is bad enough that it interferes with your lifestyle.

Dr. Kim can diagnose your cataracts, track their progression, and remove them to allow you to have clear sight again. Use our online form to schedule a consultation.

Cataract Surgery

Glasses, contact lenses, or medicine cannot improve vision when a cataract is present. Cataract surgery is the only way to eliminate cataracts and it is a very successful operation. One and a half million people have this procedure every year in the US and about 98% of cataract surgery patients have a complication-free experience. In most cases, vision, as well as the quality of life improves with the surgery.

At Polaris Eye & Laser, Dr. Kim performs cataract surgery at a local outpatient surgery center utilizing topical anesthetic eye drops and intravenous sedation. No injections are made around the eye, which avoids bleeding and facilitates faster recovery. Dr. Kim employs a surgical technique called phacoemulsification which generates ultrasound energy waves to liquefy and remove the cataract. The back membrane of the lens (called the posterior capsule) is left in place and a clear plastic intraocular lens (IOL) implant is placed inside the capsular bag.  The surgical incision is usually only 2.4 mm, less than half the width of a standard pencil.  Thus in most cases, no sutures are required at the end of the surgery. The surgery takes approximately half an hour or less and many people do not remember it afterward. Patients will use special eye drops for several weeks after the surgery, and Dr. Kim will monitor the recovery.

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Dr. Kim performing cataract surgery

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High-frequency ultrasound instrument is used to break up the cataract

Intraocular Lens

An intraocular lens (IOL) is a tiny, lightweight, clear plastic disk placed in the eye during cataract surgery. An IOL replaces the focusing power of the eye’s original lens. The lens of the eye plays an important role in focusing images on the retina. When the lens loses its clarity, as it does when a cataract develops, light rays do not focus clearly and the image one sees is blurry.

The artificial IOL is not affected by aging and remains clear for the patient’s lifetime. Unlike contact lenses, which must be removed, cleaned, and reinserted, the IOL remains in the eye after surgery.
 

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Intraocular lens (IOL) in the eye

An IOL may be placed either in front of or behind the iris, though behind the iris is the most frequent placement site. They may be made of hard plastic, soft plastic or soft silicone. Soft, foldable lenses can be inserted through a small incision which shortens recovery time following surgery. Rapid evolution of IOL designs, materials, and implant techniques has made them a safe and practical way to restore normal vision.

Intraocular Lens Options
Monofocal Lenses

Conventional lens implants are monofocal IOLs and they have been used for several decades. Monofocal implants only focus on one distance range. They can be set to provide the best corrected vision at a near, intermediate, or far distance. Most people who choose monofocal implants have their IOLs set for distance vision and use reading glasses for near vision.


Presbyopia Correcting Lens Implants: Multifocal Lenses

Over time, the lens and muscles of the eye lose some strength and flexibility needed to focus on near objects. This normal aging process is called presbyopia and nearly everyone develops some degree of presbyopia after the age of 40. Recent advances in cataract lens implant technology have made it possible to experience life without reading glasses or bifocals after cataract surgery. Lens implants are now available that allow focusing power at multiple viewing distances. These IOLs are called presbyopia-correcting lens implants or multifocal IOLs. With these lens implants, vision can be clear at distance and near without the use of glasses. For people who desire freedom from glasses after cataract surgery, multifocal IOLs may be an excellent option. There are several different types of multifocal implants available in the US and Dr. Kim offers the most advanced multifocal lenses to our patients so that they can experience the highest quality of vision.

Toric Lenses

Astigmatism is a type of refractive error of the eye which occurs when the surface of the cornea is not perfectly round. One side of the curve is steeper than the other, like a football. This causes light to focus at more than one point in the back of the eye, resulting in blurred vision. Glasses and contact lenses are effective in correcting astigmatism. A person who has both cataracts and corneal astigmatism will still need glasses to regain high-quality distance vision after cataract surgery. However, if corneal astigmatism is corrected at the time of the cataract surgery with toric IOLs, a person could be free of glasses for distance vision.

 

Toric intraocular lenses (IOL) are specially designed to correct astigmatism, as well as near or farsightedness, for cataract patients. In addition to restoring vision that was clouded by cataracts, this lens can reduce or eliminate corneal astigmatism at the same time. The result is normally less dependence on glasses and improved distance vision. Most patients will still need corrective glasses for near and intermediate tasks.

YAG Laser Posterior Capsulotomy

YAG laser posterior capsulotomy is a surgical laser procedure that may be necessary after cataract surgery. During cataract surgery, part of the front portion (anterior capsule) of the elastic-like capsule that holds the lens is removed in order to extract the cataract lens.  After completely evacuating the natural lens through this anterior capsular opening, an intraocular lens is positioned inside the capsular bag. The clear back capsule, called the posterior capsule, remains intact. 

As long as the posterior capsule stays clear one has good vision. However, following cataract surgery, the capsule may produce cloudy cells that can cause blurred and hazy vision.  This common condition, known as posterior capsular opacification (PCO), occurs in up to 40% of patients who undergo cataract surgery and may occur months or years after the surgery.  When this happens, an opening can be made in the center of the cloudy posterior capsule with a YAG laser (posterior capsulotomy) to restore normal vision.

Before the laser procedure, the ophthalmologist does a thorough ophthalmic examination to make sure there is no other reason for vision loss. YAG laser posterior capsulotomy is a painless outpatient procedure and takes about five minutes to perform. Most patients notice an instant improvement in their vision, while others experience a gradual improvement over several days.  At Polaris Eye & Laser, we are pleased to provide YAG laser treatment here in our office for patients’ convenience and affordability.

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Schedule an appointment with us online or call us at (408) 358-3932.

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