Richard A. Levinson, M.D. > Cataract FAQ’s

Cataract FAQ’s

The human lens is mostly made of protein and water. With aging, the proteins in the lens discolor, turning the lens brown, causing what we call a cataract. Diabetes and chronic steroid usage can further increase cataract formation. The increasing discoloration of the lens is similar to a dirty windshield on your car, especially in the winter when slush drys on the windshield. With increasing “dry slush on your windshield”, light entering the eye is scattered by the cataractous lens, causing the patient to experience haze, glare and distortion, ie blurred vision. Changing your glasses prescription will not improve blurry vision caused by cataracts. Cataracts tend to progress but at an unpredictable rate. There is no known, scientifically verified treatment or supplement that prevents cataract formation. Everybody develops cataracts with aging and about 75% of people eventually have cataract surgery.

If your cataract is affecting everyday tasks like walking, driving and reading, or if it is interfering with your quality of life, you should have the cataract removed. Cataract surgery is the only effective way to eliminate cataracts. Cataract surgery removes the clouded eye lens and replaces it with an intraocular lens.

Cataract surgery is one of the most common surgeries performed today. It does carry the risk of certain complications, but it also has an excellent record of safety and a low rate of complications. Most estimates say that less than 5 percent of patients will experience serious complications. Most of those complications are treatable. Certain factors increase the risk of serious complications, such as the presence of other eye diseases. Dr. Levinson will discuss all the risks of cataract surgery with you during your pre-op examination.

First, a tiny incision is made in the cornea – the clear, curved outer portion of your eye. The lens is dissolved with ultrasound energy, called phacoemulsification, and the residual small lens fragments are removed from the eye with suction. An intraocular lens (IOL) is then inserted in the eye. The IOL is held in position by the same lens capsular that held your previously removed cataractous lens. There are no sutures involved in fixating the IOL.

Good question. In 2013, FDA-approved Lasers became available for cataract surgery. These Lasers, called femtosecond lasers, can make the incisions involved in cataract surgery but they DO NOT remove the cataract. They do:

Make the small corneal incision for entering the eye.
Make the opening into the lens of the eye, called the capsulorhexhis.
They soften the lens, making it slightly easier to remove the lens with suction from the eye.
They can partially, but not precisely, make small incisions in the cornea to decrease astigmatism.
With Laser Cataract Surgery, the lens is still removed with phacoemulsification, ie breaking the lens into small fragments and using suction to remove the fragments from the eye. The Laser DOES NOT remove the cataract from the eye, and this is the most difficult step in cataract surgery. The Laser does make more precise, reproducible incisions than the incisions made by the surgeon manually, but the advantage is very minimal, especially in the hands of an experienced cataract surgeon.

The Laser is a small technological advance in cataract surgery, but at what cost? Presently, the femtosecond laser for cataract surgery adds $1000-$1500 to the cost of the procedure. This is an out-of-pocket expense not covered by insurance. There are some theoretical advantages to the more precise incisions made by the femtosecond Laser, but there is scant evidence that Laser-assisted cataract surgery is safer or provides better visual outcomes than traditional cataract surgery, in the hands of an experienced cataract surgeon. The femtosecond laser has limitations that compromise its efficacy in removing the cataract in the more difficult cases, such as when the patient has a small pupil that won’t dilate. And there are some complications associated with the Laser that are not present with non-Laser cataract surgery.

Less than 5% of cataract surgery in the U.S. today is performed with Lasers. I am not offering Laser cataract surgery to my patients, yet. There is no obvious advantage to the Laser, especially at the present cost. However, I think that the technological achievements of the Laser are impressive and will probably become more available as the price, hopefully, drops in the future and the technology continues to improve.

Intraoperative Aberrometry, brand-name ORA, is a new technology to measure, calculate and verify the accuracy of the intraocular lens, IOL, during cataract surgery. Once, again, this is an out-of-pocket expense, about $250 per eye and is not covered by insurance. In every cataract surgery today, the IOL power is always calculated pre-operatively with very accurate, laser-scanning measurements that are extremely precise. The idea behind the ORA is that, perhaps, we can improve the accuracy of the IOL measurements by actually measuring the eye during surgery, after the cataractous lens has been removed. This is not so easy to do. The eye, immediately following removal of the lens, is obviously, not exactly in a normal, physiological state. The pressure, hydration and thickness of the ocular tissue is altered during surgery and intraoperative measurements to calculate the IOL power are not easy, or extremely accurate. The ORA probably offers little advantage in routine cataract surgery but it may be slightly more accurate in calculating IOL power in patients that have had prior Laser Vision Correction or Radial Keratotomy. At this time, I see no advantage to the ORA and am not offering it to my patients.

About 90 percent of patients have better vision after cataract surgery. Your vision may fluctuate for a month or so after surgery. After 3-4 weeks,you will be given a glasses prescription, if needed. If you need cataract surgery in both eyes, the second eye can be done within 1-2 weeks after the first eye, assuming the first eye is healing without problem.

No and yes. No, the cataract itself will not recur. However, when we remove your cataract, we leave the back capsular membrane of your old lens in place to support the new intraocular lens implant. If we didn’t leave this capsular membrane in place, there would be nothing to support the lens implant and it would fall back into the vitreous cavity, the back part of the eye. In approximately 50% of eyes following cataract surgery this capsular membrane will become hazy and interfere with vision. This opacified membrane, or “secondary cataract”, can easily be opened with a procedure called a YAG Capsulotomy. A YAG capsulotomy is a simple, painless, safe procedure that takes just a few minutes to perform. When we perform the YAG capsulotomy, we dilate the eye with an eye drop, that is all you will feel. The YAG Laser is then used to make a small, central opening in the hazy capsular membrane. You won’t feel anything during the YAG capsulotomy procedure. The vision will improve within hours after the YAG capsulotomy.

For the curious, YAG is an abbreviation for Yttrium, Aluminum and Garnet, the 3 metals used in producing the Laser energy. Actually, there is a fourth metal, neodymiun, that is also used, and the full name of the Laser is Nd:YAG Laser.

No. The lens implants are made of inert plastics that are extremely well-tolerated within the eye. They do not wear out and do not need to be periodically replaced.