What are the treatment options?

Cataract Surgery for Cataracts for Houston & Galveston from The Eye Clinic of Texas

Having Cataract Surgery for Houston and Galveston patients is a decision to be made when the presence of a cataract has become significant enough that it interferes with one’s lifestyle and ability to carry on everyday tasks and activities comfortably and safely. Early cataracts may not need any surgical intervention. You may only need a new prescription for glasses or contact lenses. You also may want brighter lighting, anti-glare sunglasses, or magnifying lenses. If these measures don’t help, surgery is the only effective treatment. A cataract needs to be removed when the loss of vision interferes with your daily activities, such as driving, especially at night, and reading fine prints. You and your ophthalmologist can make this decision together after a comprehensive eye exam. Surgery involves removing the cloudy lens and replacing it with an artificial lens implant.

Cataract surgery is performed on an outpatient basis. The cataract can  easily be removed and your ophthalmologist only needs to  make a small incision (phacoemulsification) in the eye. A synthetic intraocular lens (IOL) is inserted at the time of cataract extraction to replace the focusing power of the natural lens. IOLs can be monofocal (fixed-focus for a preset distance) or multifocal, which allows focused vision at many distances. If you have cataracts in both eyes that require surgery, each eye is done separately with a few weeks in between.

Implanting an IOL takes about 20 minutes and is an outpatient procedure. In addition to a preoperative eye exam, your eye surgeon will take some measurements of your eyes. The surgeon makes a few small incisions close to the edge of the cornea and then inserts a small, ultrasound instrument to break up the center of the eye’s natural lens. The lens is then vacuumed out through one of the incisions. The surgeon folds and inserts the IOL through the same incision. These incisions are usually self-sealing, requiring no stitches.

Cataract surgery is a very successful operation. One and a half million people have this procedure every year in the United States, and 95% have a successful result. As with any surgical procedure, complications can occur during or after surgery, and some are severe enough to limit vision. But in most cases, vision, as well as quality of life, improves greatly.

Intraocular Lenses

An intraocular lens (IOL) is a tiny, lightweight, clear acrylic or silicone disc placed in the eye during cataract surgery. An IOL replaces the focusing power of the eye’s natural lens.

If you are going to have cataract surgery, you and your ophthalmologist should discuss which IOL may be best for your vision needs.

Intraocular lenses offer many advantages. Unlike contact lenses, which must be removed, cleaned, and reinserted, the IOL remains in the eye after surgery. The rapid evolution of IOL designs, materials, and implant techniques has made them a safe and practical way to restore normal vision after cataract surgery. There are mainly 3 choices of IOLs: monofocal, toric, or multifocal, or accommodative.

Monofocal IOL: this implant corrects for one preset vision, usually distant only. This is the most common type of IOL. The monofocal lens helps you attain clearer vision at one distance. This lens does not correct astigmatism or near vision. Note that eyeglasses and contact lenses are still required in order for you to see clearly at all ranges of distance.

Toric IOL: this implant corrects for your astigmatism and distance vision. You normally would only need to wear    over-the-counter reading glasses afterwards.

ReSTOR/Multifocal IOL: this implant corrects both distant and near vision. The multifocal lens has several rings of different powers built into the lens. The part of the ring you look through will determine if you can see clearly at far, near, or intermediate distances. It greatly eliminates the need of glasses after surgery.

Another type of IOL is the accommodative IOL. The accommodative lens has a hinge designed to work with your eye muscles, allowing the lens to move forward as the eye focuses on near objects and backward as the eye focuses on distant objects. This movement allows you to focus clearly at different distances.

Phacoemulsification

Phacoemulsification (Phaco) is a surgical method used to remove a cataract, which is a clouding of the eye’s naturally clear lens. A cloudy lens interferes with light passing through to the retina, the light-sensing layer of cells at the back of the eye. Having a cataract can be compared to looking at the world through a foggy window.

In phacoemulsification, an ultrasonic oscillating probe is inserted into the eye. The probe breaks up the center of the lens. The fragments are suctioned from the eye at the same time. A small incision that often does not require sutures to close can be used, since the cataract is removed in tiny pieces. Most of the lens capsule is left behind and a foldable intraocular lens (IOL) is implanted permanently inside to help focus light onto the retina. Vision returns quickly and one can resume normal activities within a short period of time.

Extracapsular Cataract Extraction

Extracapsular cataract extraction (ECCE) is a method for surgically removing a cataract, which is a clouding of the eye’s naturally clear lens. A cloudy lens interferes with light passing through to the retina, the light-sensing layer of cells at the back of the eye. Having a cataract can be compared to looking at the world through a foggy window.In extracapsular extraction, an incision is made in the side of the cornea at the point where the cornea and sclera, the white part of the eye, meet. Carefully entering the eye through the incision, the surgeon gently opens the front of the lens capsule and removes the hard center, or nucleus, of the lens. The soft lens cortex is then suctioned out leaving the back of the capsule in place.

An incision requiring sutures is necessary because the lens is removed in one piece. A plastic implant called an intraocular lens (IOL) is substituted for the original lens. The implanted IOL allows light to be focused on the retina.

It may be up to six weeks before the sutures are removed and best-corrected vision is achieved. During recovery, it may be necessary to avoid bending over or lifting heavy objects

Posterior Capsulotomy

A posterior capsulotomy, commonly referred to as a YAG Laser, is a laser procedure that sometimes is necessary after cataract surgery.

During cataract surgery, part of the front (anterior) capsule of the eye’s natural lens is removed to gain access to and remove the lens. The clear, back (posterior) capsule remains intact and supports an intraocular lens (IOL), a silicone lens that is implanted in the eye and replaces the natural lens. As long as that capsule stays clear, you will experience good vision. But in 10% to 30% of cases, the posterior capsule loses its clarity. When this happens, the ophthalmologist can create an opening in the capsule using a laser in order to restore normal vision. This procedure is called a posterior capsulotomy.

Before the laser procedure, the ophthalmologist does a thorough ophthalmic examination to make sure there is no other reason for vision loss.

The posterior capsulotomy is painless and takes less than five minutes. Vision usually improves within hours.

Is cataract surgery effective?

Cataract surgery is one of the most common operations performed in the U.S. It’s also one of the safest and most effective types of surgery.  Ask your ophthalmologist about any potential risks or complications of cataract surgery.