Cataract Surgery Philadelphia | Cataracts Philadelphia, PA

What Happens During Cataract Surgery?

During the surgery, the natural lens (now a cataract) is removed, and an artificial lens in implanted. Two small incisions are made, constructed in such as way that nearly all will seal without sutures (stitches). The shell that holds the cataract in place (the capsule) is opened.

Phacoemulsification (a technique involving a small ultrasonic probe) is then used to remove the cataract from the capsule. This surgical technique allows the cataract to be removed through very small incisions (instead of removing it as a whole).

That said, rare cases are not amenable to this technique. The artificial lens (intraocular lens or IOL) is then inserted through the small incision into the capsule, which holds it securely in place. While cataract surgery can greatly reduce a patient’s dependence on glasses, there is still a chance of needing glasses for the clearest vision possible post-operatively.

Each patient is unique, and the surgeon reviews this for every individual. Additional options are available for most patients who are seeking to further reduce their glasses dependence after surgery.

Cataract Evaluation

If you are coming in to the office for a cataract evaluation, there are several steps to expect. First, a technician will take a detailed history of all medical conditions, medications, and prior procedures. Please bring a list to ensure an accurate record. Your pupils will likely be dilated during this visit. This allows for a detailed examination of the cataracts are other structures of the eye. It also means that your vision will be blurry for several hours. It is mostly near vision that is affected by these drops, but please plan to bring someone with you in case you are unable to return home safely alone. You will have a thorough examination by one of our surgeons.

If cataract surgery is being considered, you will have measurements of the eyes. These measurements provide the information necessary to chose the appropriate IOL (artificial lens) power and surgical plan for you specifically. At this point, your surgeon will discuss the options available to you, including whether you are a candidate for the premium IOLs and laser-assistance. You will have a comprehensive discussion with your surgeon about the surgery. Finally, you will meet with the surgical coordinator to set a specific date for the procedure and to review the logistical details of surgery. A cataract evaluation, with all steps above, takes longer than a comprehensive eye exam. Please allow for up to two hours for this entire process.

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IOL Options

Standard IOL

A standard monofocal IOL corrects for a single distance. Most patients chose to set the eye either for far distance or near work. A discussion with the surgeon can help guide a patient to the best decision for that individual.

Some patients with cataracts in both eyes chose the option of monovision. This is when one eye is set for far distance while the other is set for near, reducing the dependence on glasses significantly. Not everyone is tolerant of monovision. This involves a thorough discussion prior to surgery.

Mini monovision is a compromise between mono vision (described above) and single distance vision. With mini monovision, one eye is set for far distance and the other eye is set for an intermediate distance (approximately an arm’s reach). This reduces glasses dependence for many things, but reading glasses are still required to do near work. Because the difference between the two eyes is small, it is more widely tolerated by patients than full monovision.

Toric IOL

Toric IOLs are premium lenses that reduce corneal astigmatism. Corneal astigmatism occurs when the curvature of the cornea is irregular. Many doctors use the analogy of a football shaped cornea (one with astigmatism) versus a basketball shaped cornea (one without astigmatism) to help illustrate this concept. A Toric IOL has the power required to reduce this astigmatism built into the lens, allowing for greater glasses independence. The effect of uncorrected astigmatism on vision is blurring or distortion. If astigmatism is present, and not reduced during surgery, the astigmatism can still be corrected in glasses or contact lenses.

Toric IOLs come in monofocal, extended depth, and multifocal lens variations. The monofocal version gives a single focal distance as described above, but with astigmatism reduction. The other versions are described below.

Multifocal IOL

Multifocal IOLs are premium lenses which allow for both far distance and near vision in a single lens. These lenses can very successfully minimize glasses dependence. Unfortunately, not all patients are candidates for this type of lens. There are some optical compromises to these lenses to get the range out of glasses, which will be thoroughly discussed for all patients considering this lens. A detailed examination and discussion with the surgeon is necessary to determine which patients are candidates.

Extended Depth of Focus IOL

Extended Depth of Focus IOLs are the newer generation of the multifocal IOLs. These premium lenses allow for far distance through intermediate zone vision in a single lens. Typically, this ranges from things far away through approximately computer and tablet distance and includes larger print near work, without glasses. The side effect profile is quite minimal with this type of lens and it may be offered to more patients than the multifocal lenses. This lens will give a greater degree of glasses independence than the standard, but patients should expect to still wear a low power pair of reading glasses for very small print. Again, a detailed examination and discussion with the surgeon is necessary to determine which patients are candidates.

Accommodating IOL

Accommodating IOLs are premium lenses which allow an increased range of vision at different distances. This lens can decrease the need for glasses. It is similar in goal to the multifocal lenses listed above; however, this lens works by a different mechanism and often has a slightly more limited range of glasses independence. It also has a different possible side effect profile.

Laser-assisted Cataract Surgery

The femtosecond laser is cutting edge technology used to assist in cataract surgery. The laser does several stages of the cataract surgery, including the critical steps of opening the capsule (the shell surrounding the cataract) and softening the cataract. It also reduces mild to moderate levels of astigmatism. Laser-assistance can minimize the amount of ultrasound energy required to remove the cataract, allowing for less swelling and a faster recovery. It can improve the safety of surgery in certain patients. The laser can also aid in the precision of intraocular lens (IOL) placement. Precise IOL positioning is crucial, especially for some patients choosing the premium IOLs listed above.

Intraoperative Wavefront Aberrometry

Intraoperative wavefront aberrometry is newly available technology which allows the surgeon to verify or refine the power of the IOL during surgery. This is helping to further minimize the need for glasses after surgery in many patients. It is especially useful in patients who have had prior refractive surgery including LASIK.

Risks of Cataract Surgery

While cataract surgery is extremely successful, there are, of course, risks with any surgery. The surgeon will review risks specific to each patient prior to surgery. All questions about risk will be addressed in the office. A common question involves whether the cataract will ever “grow back.” Cataracts do not recur after surgery. Some patients may develop a clouding of the capsule (the shell holding the artificial lens) in the months or years after surgery. This is called a posterior capsule opacification. This condition is treated easily with a laser procedure called a laser capsulotomy. The procedure takes only minutes and is painless.

Cataracts FAQ

A cataract is a clouding of the lens in the eye that affects vision. Most cataracts are related to aging. Cataracts are very common in older people. By age 80, more than half of all Americans either have a cataract or have had cataract surgery.

A cataract can occur in either or both eyes. It cannot spread from one eye to the other.

Yes. Although most cataracts are related to aging, there are other types of cataract:

Secondary cataract. Cataracts can form after surgery for other eye problems, such as glaucoma. Cataracts also can develop in people who have other health problems, such as diabetes. Cataracts are sometimes linked to steroid use.
Traumatic cataract. Cataracts can develop after an eye injury, sometimes years later.
Congenital cataract. Some babies are born with cataracts or develop them in childhood, often in both eyes. These cataracts may be so small that they do not affect vision. If they do, the lenses may need to be removed.
Radiation cataract. Cataracts can develop after exposure to some types of radiation.

The lens lies behind the iris and the pupil (see diagram). It works much like a camera lens. It focuses light onto the retina at the back of the eye, where an image is recorded. The lens also adjusts the eye’s focus, letting us see things clearly both up close and far away. The lens is made of mostly water and protein. The protein is arranged in a precise way that keeps the lens clear and lets light pass through it.

But as we age, some of the protein may clump together and start to cloud a small area of the lens. This is a cataract. Over time, the cataract may grow larger and cloud more of the lens, making it harder to see.

Researchers suspect that there are several causes of cataract, such as smoking and diabetes. Or, it may be that the protein in the lens just changes from the wear and tear it takes over the years.

Age-related cataracts can affect your vision in two ways:

Clumps of protein reduce the sharpness of the image reaching the retina.
The lens consists mostly of water and protein. When the protein clumps up, it clouds the lens and reduces the light that reaches the retina. The clouding may become severe enough to cause blurred vision. Most age-related cataracts develop from protein clumpings.
When a cataract is small, the cloudiness affects only a small part of the lens. You may not notice any changes in your vision. Cataracts tend to “grow” slowly, so vision gets worse gradually. Over time, the cloudy area in the lens may get larger, and the cataract may increase in size. Seeing may become more difficult. Your vision may get duller or blurrier.
The clear lens slowly changes to a yellowish/brownish color, adding a brownish tint to vision.
As the clear lens slowly colors with age, your vision gradually may acquire a brownish shade. At first, the amount of tinting may be small and may not cause a vision problem. Over time, increased tinting may make it more difficult to read and perform other routine activities. This gradual change in the amount of tinting does not affect the sharpness of the image transmitted to the retina.
If you have advanced lens discoloration, you may not be able to identify blues and purples. You may be wearing what you believe to be a pair of black socks, only to find out from friends that you are wearing purple socks.

The risk of cataract increases as you get older. Other risk factors for cataract include:

Certain diseases such as diabetes.
Personal behavior such as smoking and alcohol use.
The environment such as prolonged exposure to sunlight.

The most common symptoms of a cataract are:

Cloudy or blurry vision.
Colors seem faded.
Glare. Headlights, lamps, or sunlight may appear too bright. A halo may appear around lights.
Poor night vision.
Double vision or multiple images in one eye. (This symptom may clear as the cataract gets larger.)
Frequent prescription changes in your eyeglasses or contact lenses.
These symptoms also can be a sign of other eye problems. If you have any of these symptoms, check with your eye care professional.

The symptoms of early cataract may be improved with new eyeglasses, brighter lighting, anti-glare sunglasses, or magnifying lenses. If these measures do not help, surgery is the only effective treatment. Surgery involves removing the cloudy lens and replacing it with an artificial lens.

A cataract needs to be removed only when vision loss interferes with your everyday activities, such as driving, reading, or watching TV. You and your eye care professional can make this decision together. Once you understand the benefits and risks of surgery, you can make an informed decision about whether cataract surgery is right for you. In most cases, delaying cataract surgery will not cause long-term damage to your eye or make the surgery more difficult. You do not have to rush into surgery.

Sometimes a cataract should be removed even if it does not cause problems with your vision. For example, a cataract should be removed if it prevents examination or treatment of another eye problem, such as age-related macular degeneration or diabetic retinopathy. If your eye care professional finds a cataract, you may not need cataract surgery for several years. In fact, you might never need cataract surgery. By having your vision tested regularly, you and your eye care professional can discuss if and when you might need treatment.

If you choose surgery, your eye care professional may refer you to a specialist to remove the cataract.

If you have cataracts in both eyes that require surgery, the surgery will be performed on each eye at separate times, usually four to eight weeks apart.

Many people who need cataract surgery also have other eye conditions, such as age-related macular degeneration or glaucoma. If you have other eye conditions in addition to cataract, talk with your doctor. Learn about the risks, benefits, alternatives, and expected results of cataract surgery.

There are two types of cataract surgery. Your doctor can explain the differences and help determine which is better for you:

Phacoemulsification, or phaco. A small incision is made on the side of the cornea, the clear, dome-shaped surface that covers the front of the eye. Your doctor inserts a tiny probe into the eye. This device emits ultrasound waves that soften and break up the lens so that it can be removed by suction. Most cataract surgery today is done by phacoemulsification, also called “small incision cataract surgery.”
Extracapsular surgery. Your doctor makes a longer incision on the side of the cornea and removes the cloudy core of the lens in one piece. The rest of the lens is removed by suction.
After the natural lens has been removed, it often is replaced by an artificial lens, called an intraocular lens (IOL). An IOL is a clear, plastic lens that requires no care and becomes a permanent part of your eye. Light is focused clearly by the IOL onto the retina, improving your vision. You will not feel or see the new lens.
Some people cannot have an IOL. They may have another eye disease or have problems during surgery. For these patients, a soft contact lens, or glasses that provide high magnification, may be suggested.