I Have A Cataract, What Now?

By Frank J. Weinstock, MD, FACS. Dr. Weinstock is an ophthalmologist, board-certified,with extensive experience in practice management, and in medical and surgical ophthalmology. He is a Professor of Ophthalmology NEOMED, Affiliate Clinical Professor in the Charles E. Schmidt College of Biomedical Science at Florida Atlantic University, Boca Raton, and Volunteer Professor of Ophthalmology at the University of Miami Leonard M. Miller School of Medicine.

Editor’s note: With World Sight Day occurring in October and its emphasis on eye care for all, it is timely to discuss the impact and treatment of cataracts, which is a world health problem. According to the World Health Organization, “cataract is responsible for 51% of world blindness, which represents about 20 million people. Although cataracts can be surgically removed, in many countries barriers exist that prevent patients to access surgery. Cataract remains the leading cause of blindness. As people in the world live longer, the number of people with cataract is anticipated to grow. Cataract is also an important cause of low vision in both developed and developing countries.”

Explanation of Cataracts

A cataract is a progressive cloudiness, hardening, and yellowing of the normally transparent lens of the eye. According to the National Eye Institute, approximately 50% of all Americans will either have a cataract or will have had cataract surgery by age 80. Cataract surgery is not generally required unless it gets dense enough to interfere with vision and activities; normally,that can take years. In fact, nine out of ten individuals do not require cataract surgery until later in life. But a cataract may progress very rapidly (rarely in days) to the point where the vision is sufficiently impaired. This could be mild to severe blurring of vision or severe disabling glare. Due to the progress in cataract surgery, many people are electing to have their surgery much earlier than in the past.

Important Facts About Cataract Surgery

When the decision to have cataract surgery is made, it is usually perfomed in an outpatient setting, either hospital or physician owned.

Usually one eye at a time is operated upon. Surgeons usually perform surgery on the other eye within one to two months, if needed. However, often the other eye may have good vision and may not require surgery for many years.

Almost all cataract surgery involves removing the cataract and replacing it with an intraocular lens.

You may want to read more about how cataract surgery is performed.

Decisions to Make About Cataract Surgery

What are the decisions that you must make?

First, all decisions are based on your communication with your ophthalmologist.
You must decide upon the surgeon. If you have an ophthalmologist, make sure that he or she performs cataract surgery since some do not perform this type of surgery. If he or she doesn’t perform cataract surgery, ask your primary care physician, ophthalmologist, optometrist, local hospital or medical society for a recommendation.
It is possible to you may check him or her on the Internet to find out about qualifications or potential problems. However, beware since much Internet information consists of paid ads.
Many insurance programs have lists of providers that you may use. If you go outside this list, they often will pay less or will pay nothing. This also applies to the facility where the surgery will be performed. You must have this information before you undergo the surgery in order to prevent potentially expensive surprises.
Once you decide on surgery, you must decide when to have it done. Usually you should be in town for two to four weeks after surgery in case there are any complications (fortunately complications are rare, but they may occur). Unless your insurance requires the use of certain facilities, depending upon your location, you may have a choice. Many ophthalmologists operate at several different hospitals or facilities.

Intraocular Lens

Acrylic MICS-IOL in holder provided through wikipedia

As mentioned previously, most cataract surgery involves the implantation of an intraocular lens after removal of the cataract. There may be some choices in which lens will be best for you:

A single vision intraocular lens will usually, but not always, require the use of glasses for near vision tasks unless a technique called monovision is used. In this situation one eye is corrected for near vision and one for distant vision. Also, with single vision lenses you may still require some corrective glasses for driving or for other tasks. Requiring glasses after surgery is not a complication or a sign of poor surgery.
Multifocal lenses attempt to provide clear vision both at distance and near simultaneously. Even with a multifocal lens you may have to wear glasses for some near or distant vision tasks. With some multifocal lenses there is increased glare and halo effect with driving, which may improve with time. Usually you have excellent vision within a day or two, it may take several days or weeks to attain your best vision. With any lenses, you might need a small amount of additional correction to obtain maximum vision.
If you have significant astigmatism, a toric lens may correct this astigmatism for your distant vision and your near vision. These lenses, as well as multifocal lenses, are called “premium lenses,” which are not reimbursed completely by Medicare, requiring you to pay an extra amount.

Possible Risks or Complications

Prior to surgery, you will be told of potential complications and risks. There is a rare risk of infections, glaucoma, retinal detachment, corneal problems, and many other potential problems. This applies to any ophthalmic surgeon and his or her patients. As with any medical procedure, adverse medical events can occur, especially with a primarily older population.

Preexisting conditions of the eye such as glaucoma, macular degeneration or corneal disease may compromise the final results. In addition, pre-existing diseases of the eye or the body such as diabetes, glaucoma or macular degeneration may get worse and interfere with the final result.

What to Expect After Surgery

The surgery is usually quick and efficient. You will be able to go home the same day, normally within a few hours of the surgery. You need to take someone with you to drive you home. Read more about what happens after surgery.

Cataract and implant surgery is amazingly successful for most individuals, often requiring no glasses (or minimal need for them) after surgery. The fact that glasses might be necessary for optimum vision after surgery is not a sign of poor results. It is usually a misunderstanding as to what to expect or a limitation of the type of implant used.

Resources for Eye Care

Here are some organizations that provide cataract surgery free of charge, with defined eligibility requirements:

Mission Cataract USA. Mission Cataract offers free cataract surgery to people of all ages who have no means to pay. This is a list of participating doctors in the program.
EyeCare America. EyeCare America is the public service program of the Foundation of the American Academy of Ophthalmology that provides eye care through volunteer ophthalmologists (Eye M.D.) at no cost to those who qualify. EyeCare America facilitates eye care for U.S. citizens or legal residents who are without an Eye M.D. and who do not belong to an HMO or do not have eye care coverage through the Veterans Administration.
Lions Clubs International. You can usually find a local club listing through your Chamber of Commerce.