Treatment of cataract
Author: Sherman Winston Reeves, M.D., M.P.H.
Non-Surgical treatment:
In the early phases of cataract, the vision may be affected very little, if at all. One of the first signs of progression of the cataract may be that the glasses prescription may change. While a change of glasses may suffice for awhile, with time, more glasses changes are likely to be required as the cataract develops. When the vision starts to decline, even with a best-fit pair of glasses, or annoying symptoms like glare or double vision begin to occur, removing the cataract is the best way to restore visual function.
Cataract Surgery:
When the cataract begins to impair visual function or cause disturbing symptoms that interfere with a person’s daily activities, it can be removed. Several additional testing procedures must be performed prior to cataract surgery, including measurements of the length of the eye and assessment of the curvature of the cornea.
Many options are available today for the prosthetic lens that replaces the crystalline lens with its cataract. Some lenses, called multifocal lenses or accommodating lenses, allow for correction of both near and distance vision.
During cataract surgery, extremely small incisions, usually less than 3 mm long, are made at the edge of the cornea. The crystalline lens in which the cataract has formed is then broken into small pieces and removed with an ultrasound process called phacoemulsification. Next, a plastic or silicone prosthetic lens is inserted into the eye into the same space formerly occupied by the crystalline lens. This prosthetic lens stays in the eye permanently, and works to focus light on the retina again. The wounds in cataract surgery are so small that often they do not even require a suture to close them at the end of the surgery.
Cataract surgery is typically performed on an outpatient basis. The procedure itself usually takes about 20 minutes or less. Your doctor will typically see you the day after surgery to make sure the lens is in proper position and there is no sign of infection. About 1 to 3 weeks following your surgery, your doctor will see you again for a full eye exam and will prescribe any glasses if needed.
Cataract surgery is generally very safe. Advanced surgical techniques and equipment, plus the high level of skill eye surgeons acquire during training, have greatly decreased severe complications that occur during cataract surgery. A recent analysis of 90 published studies of cataract surgery outcomes found that 97% of people having cataract surgery had no problem during the surgery or the recovery period. Of the problems that may occur, most are self-limited or resolve with additional treatment. Rarely, cataract surgery can result in vision threatening complications, such as severe infection (< 0.5%), severe swelling of the cornea or retina (<1%) or retinal detachment (<1%).
Posterior capsule opacification:
After several months, or even years, following cataract surgery, about 10-20% of patients develop posterior capsule opacification, or “PCO.” In this condition, sometimes referred to as a “secondary cataract,” a fine, hazy film develops on the back side of the prosthetic lens implant, which may cause a gradual decline in vision or glare symptoms. Your surgeon can remove this film and restore the vision with a simple, in-office laser procedure, called YAG Capsulotomy.
