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Cataract Surgery Update

Techniques in cataract removal make this outpatient procedure successful in 95 percent of patients and restores quality of life along with clearer vision.

After age 70, older adults are likely to suffer from vision problems—most likely arising from a cataract on the lens of the eye or age-related macular degeneration in the retina. But for nearly four of five people, vision problems are made worse by the presence of at least one other chronic health problem and this leads to a faster decline in their quality of life.

These findings are part of a report by Dutch researchers at the VU University Medical Center in Amsterdam published in the online journal Health and Quality of Life Outcomes. The study covered 246 people with vision problems over a five-month period.

The take-home message from the study is that patients with visual problems should tell their ophthalmologists about other health problems. This information will also be crucial to the eye doctor if cataract surgery is being considered. On the flip side, removal of the cataract could make it easier to manage further declines in well-being and overall functioning.

Cataract Update: Characteristics Of Cataract

Cataract is a normal part of aging and is the most common form of treatable blindness in the world. The condition is present in about half of Americans ages 65 to 74, rising to about 70 percent in adults age 75 and over.

Most cataracts occur as a result of cumulative exposure to environmental and other influences such as ultraviolet radiation (especially UVB rays), smoking and elevated blood sugar levels, and are often called age-related cataract. A smaller number of cataracts are due to specific eye or systemic diseases, such as diabetes, while others may be genetically inherited. Most of the time cataract develops in both eyes, but injury and certain causes can trigger development in only one eye.

Cataract clouds the lens of the eye, making vision problematic—think of looking through a window fogged up by your breath. With clouded vision, quality of life declines since normal activities, like driving a car (more so at night), reading a book or seeing the expression on a loved one’s face, now become difficult to do. Cataract does not irritate the eyes or cause pain, but it causes a lot of inconvenience. Eventually, as the clouding worsens and further cramps normal lifestyle, cataract surgery might be necessary.


Cataract Update: Surgery Choices

An ophthalmologist will conduct a series of tests to diagnose cataract. Once a positive diagnosis is made, treatment options can be discussed. Cataract surgery is generally recommended only when the condition is such that quality of life suffers and the vision impairment interferes with the performance of normal daily activities.

It’s important to have a good appreciation of the risks and benefits of cataract surgery. In cases where cataract comes along with other vision-limiting conditions such as advanced glaucoma, cataract surgery is not going to help. But when cataract is the only ocular problem, cataract surgery is generally successful 95 percent of the time.

The operation involves removing most of the lens and replacing it with a plastic disc (called an intraocular lens). Sometimes the lens is not replaced and you are fitted with contact lenses or cataract glasses instead. Your doctor will help you decide on the choice that suits you best.

There are three types of surgery to remove lenses affected by a cataract:

  • Extracapsular surgery. The doctor removes only the lens, and not the back half of the lens capsule (which is the outer covering of the lens).
  • Phacoemulsification. This is a variation on extracapsular surgery. Sound waves are used to soften the lens, which is then removed with a needle; no sutures are required. The doctor leaves behind the back half of the lens capsule. This is now the preferred method.
  • Intracapsular surgery. The entire lens, including the lens capsule, is removed. This procedure is seldom used.

Surgical techniques have improved immensely; surgery is now performed on an out-patient basis, under local rather than general anesthesia. The success rate is high, and serious complications rarely occur. However, you will need to have someone take you home after the operation. You may require assistance for at least a day so you can follow your doctor’s instructions closely.

Cataract Update: Post-op Recovery

The eye will need a few months to heal completely after cataract surgery. Progress checks by the doctor are necessary to make sure your eye is getting proper care until recovery is complete.

Your doctor will give you steroid and antibiotic eye drops, to be applied several times a day, for about two weeks. The magnification power of the intraocular lens is usually calculated so that you won’t need glasses for distance vision. But for reading and other close-up work, you will need prescription glasses. Your doctor will prescribe new glasses once the incision has healed (usually after a few weeks). The time required for visual rehabilitation and prescription of new glasses is much shorter with the phacoemulsification method of surgery.

The removal of cataracts reduces the risk of injury and improves your quality of life. The specific improvements include better night vision, fewer falls and fractures, restoration of the ability to drive, enhanced ability to live independently and better performance in standardized tests on cognitive functioning. And a brighter outlook on life, literally, is the cherry on the whipped cream.