Cataracts. Cataract and Primary Eye Care Service Main Number Physician Referral AT-WILLS

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1 Main Number Physician Referral AT-WILLS Emergency Service Cataract and Primary Eye Care Service Retina Service Cataract and Primary Eye Care Service Contact Lens Service Cornea Service Glaucoma Service Neuro-Ophthalmology Service Oculoplastic Service Ocular Oncology Service Pediatric Ophthalmology and Ocular Genetics Service Low Vision Service Laser Vision Correction Center To learn more, please visit us at 840 Walnut Street Philadelphia, PA Phone AT-WILLS Web December 2010

2 America s first eye hospital A patient s guide to

3 When you first learned you had a cataract, you may have feared you would lose your vision...but such a diagnosis does not sentence you to blindness. Today, surgery can restore useful vision in most cataract patients who have normal, healthy eyes. The Process of Sight The eye acts like a camera that takes a picture. The picture is then transmitted by the optic nerve to the brain, where the image is interpreted. It s the brain that does the actual seeing. The lens never stops growing, so an adult s lens is larger, thicker and more opaque than a child s. By the time a person is 40, the lens is less flexible and can cause near-vision problems which lead people to say, My arms are not long enough or I can t read small print. This problem is caused by an overgrown lens, which occurs long before the cloudiness, or cataract, begins. At age 65, this overgrown lens blocks one-third of the light entering the eye. Diagram 1 Every camera must have a lens to properly focus the picture. Your eye has a lens, too, which lies directly behind the pupil in a sac-like capsule. Your lens, which is about the size of an M&M, is normally clear and transparent. It focuses images onto the retina, which acts as the film that records the picture. Diagram 2 2 3

4 If the lens becomes cloudy, the light reaching the retina is blurred and distorted, and your vision is affected. This clouded lens is called a cataract, and it must be removed before vision can be restored. A clouded lens can be compared to a window that is frosted or fogged with steam. are not cancerous and are not a cause of irreversible blindness. Two common types of cataracts are shown in the following photographs: a cortical cataract (Figure 1) and a posterior subcapsular cataract (Figure 2). Many cataracts take years to develop to the point where vision is seriously affected. Most occur as a result of the normal aging process. There are other kinds of cataracts not related to the aging process. Some can develop as a result of an eye injury, called traumatic cataracts. Others can develop from metabolic and blood disorders, eye infections and inflammations, and certain types of medications. Another type, called congenital cataract, occurs at birth, particularly if the mother has had rubella (German measles) during pregnancy. Research continues to look for ways to prevent cataracts. can be removed at any age. You no longer have to wait until the cataract ripens or until you lose your sight before surgery can be performed. The time to remove a cataract is when it is reducing vision to the point that it interferes with your daily activities. Figure 1 Cortical cataract Figure 2 Posterior subcapsular cataract Depending on the type of cataract, a patient will experience different vision problems. However, the most common cataract symptoms include blurred vision, sensitivity to light or glare, double vision in one eye, poor night vision, needing brighter light to read, or experiencing fading or yellowing of colors. If the cloudiness is not near the center of the lens, you may not be aware that a cataract is present. Removing A cataract clouded lens must be surgically removed. The most common surgical procedure used today is phacoemulsification. The surgeon first makes a small incision (usually between 2 and 3 millimeters in length). An opening is then made in the front (anterior) capsule of the lens. The lens tissue within the capsule is then removed using a computerized instrument consisting of a needle 4 5

5 about the size of a ballpoint pen tip, which vibrates at about 40,000 times a second. This ultrasonic vibration dissolves the cataract into fine particles, which are then vacuumed through an opening in the instrument. The sac-like capsule that surrounds the lens remains in place (except for the opening in the anterior capsule made at the start of surgery). This capsule is left intact for two reasons: to avoid disturbing the gel, or vitreous, that fills most of the back of the eye, and to support an intraocular lens. The small incision in the eye made at the beginning of surgery usually does not require sutures. Phacoemulsification allows an early return to normal activity for patients undergoing cataract surgery. Because the IOL lies safely inside the eye, as shown in Diagram 3, it is never handled or adjusted. Most patients are good candidates for the implant. Most patients have the device implanted during their surgery. Those who have had cataract surgery without the IOL implant, and who later discover they cannot tolerate contact lenses or cataract glasses, have to be evaluated very carefully before a second operation for a lens implant is recommended. Contact lenses and cataract eyeglasses are the other alternatives for restoring vision after cataract surgery but are only used in the rare patient who cannot have an IOL. Restoring Sight After a Cataract is Removed Because the clouded lens is removed in cataract surgery, some type of substitute or replacement lens is needed to restore vision. There are three ways of doing this: An intraocular lens implant, or IOL, is an artificial lens made of plastic, silicone, acrylic or other material that is implanted inside the eye during cataract surgery. The IOL is usually implanted within the capsule, which provides permanent support for the lens. This is the most natural and preferred way of restoring vision. Diagram 3 6 7

6 Development of Intraocular Lens Implants Intraocular lens implants (IOLs) have been used since Physicians at Wills were the first in the United States to perform the implant procedure in 1952, and millions have been done since then. Present-day IOLs (Figure 3) have undergone many improvements and refinements over the years, and results have generally been excellent. Most of the IOLs being used today are made of acrylic or silicone. These materials are soft and foldable allowing them to fit through a small incision. Research into new types of IOLs is ongoing. Newer versions include lenses that can correct astigmatism and multifocal and accommodative IOLs that are often able to give patients vision, both at distance and near, without the aid of glasses. Your Surgery Most patients can have their cataract surgery done through Wills Eye Institute s Day Surgery program or at one of the Wills surgery centers located throughout the region. On the day of surgery, you will be given medication to calm and relax you. The area surrounding your eye will be cleansed and sterile drapes will be placed over you, exposing only the eye to be operated on. Topical anesthesia in which the eye surface is numbed with drops or a gel-like substance is most often used for modern cataract surgery. You might have a local anesthetic consisting of small injections around your eye. General anesthesia is also available. The surgery is essentially painless. The surgeon will use a microscope to magnify the delicate procedures to be performed. Later in the day you will be released, and you can resume normal, moderate activity as soon as you feel up to it. When you return home, you will begin using your eye drops as prescribed. You may be instructed to wear glasses or sunglasses during the day, and an eye shield at night or when showering to protect the eye. Figure 3 Examples of intraocular lens implants used today 8 9

7 Convalescence Most of the healing occurs within one month. During that time, it is important to visit your ophthalmologist and use the eye-drops as prescribed. If you have had an intraocular lens implanted and have no complications, you will notice improved vision in a week, or even sooner. You can get temporary glasses shortly after the surgery, but your final eyeglass or contact lens prescription will not be given until most of the healing is completed. Complications of Surgery or Lens Implantation Cloudiness of the Capsule In about 20% of patients who have a cataract removed, the capsule becomes cloudy several months or years after the original surgery. Often, this condition is referred to as a secondary cataract. However, this does not mean that the patient has another cataract; it is only the capsule not the lens that has become cloudy. If this cloudiness blurs your vision, a clear opening can be painlessly made in the center of the posterior capsule membrane with a YAG laser. This procedure is done on an outpatient basis in about 15 minutes, without injections. Of the vast majority of patients who have cataract surgery, only a small number experience complications. Infection, bleeding and retinal swelling or detachment might occur. Also, glaucoma, corneal clouding or loss of an eye are some of the more serious, but rare complications. Those most at risk include alcoholics, substance abusers, diabetics, and people with glaucoma, high myopia or vascular disease. If your eye is healthy before the surgery, the likelihood is that the surgery will be successful

8 CATARACT A Final Note We hope this brochure has given you a better understanding of cataracts and what to expect during your surgery. We encourage you to discuss any questions with your eye surgeon. Few hospitals in the world perform more cataract surgeries than Wills Eye Institute and its surgical network. Many of the latest advances in surgery, implants and instrumentation were developed at Wills. Until the time comes when there is a way to actually prevent the development of cataracts, it is our goal to provide you with the best care in managing this common condition. About Us Since our founding in 1832 as the nation s first hospital specializing exclusively in eye care, Wills Eye Institute has become a world-class leader in ophthalmology. Our motto Skill with Compassion is central to every aspect of patient care. Today, we continue to shape the field, thanks to our talented, skilled physicians and staff who are dedicated to improving and preserving sight. One of our core strengths is the close connection between innovative research and advanced care. Wills physicians pursue research that can be quickly translated into clinical care. Our tradition of excellence has also made Wills a premier training site for all levels of ophthalmic medical education, and a leader in innovative, high tech community outreach efforts. Wills Eye remains steadfast in our commitment to improving quality of life for our patients and their loved ones. Become a valued partner in the work we do. Your gift to Wills Eye Institute will help us continue providing the best care possible, advance research for innovative treatments, and train new generations of ophthalmologists. Please call or visit and make a gift today! 12 13

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