The eye is very much like a camera in that they both have a lens that focuses an image onto
film. In the eye, the lens is focused using muscles, and the film consists of a thin membrane
of nerves that line the inner back of the eye, called the retina. If the lens of your camera were
to be smudged or scratched, your pictures would be blurred. Similarly, when the lens in your
eye becomes cloudy, light cannot pass through easily, and you see the world as blurred or
distorted. The term cataract therefore is used to describe a natural lens which has turned
cloudy, usually as part of the natural aging process. Cataracts are not a growth, a film, or a
type of cancer.

What causes a cataract?

Cataracts develop for a number of reasons, but the most common cause is aging. Age-related
cataracts develop as a result of natural changes within the lens. In other cases, an injury or
blow to the eye may cause a traumatic cataract. Some cataracts may also result from the use
of certain drugs, exposure to harmful chemicals or excessive amounts of ultraviolet radiation,
or some diseases. In addition, a small number of babies are born with congenital cataracts as
a result of unusual prenatal factors. Very infrequently, cataracts can develop during
childhood. Fortunately, almost all cataracts can be successfully removed and vision restored
through modern microsurgery.

What are the symptoms of a cataract?

Because cataracts form in different ways, the symptoms of cataracts are variable. Of course,
only your eye doctor can tell for sure if you have a cataract, but there are several symptoms
that may indicate the presence of a cataract. Most people notice that their vision gradually
deteriorates. Objects may begin to look yellow, hazy, blurred or distorted. Colors that were
normally bright and vibrant may appear faded and washed out - especially greens and blues.
Many people also find that they need more light to see clearly, or that they experience glare
or haloes from strong sunlight during the day or lights at night. Other common problems
include increasing nearsightedness, double vision, or the appearance of dark spots or
shadows in the vision.

Normal Vision

Simulated Blurred Vision

Simulated Yellowed Vision

Simulated "Halos"

Simulated Double Vision

Who is a candidate for cataract surgery?

Different people have different visual needs. If you are visually limited from performing your
daily activities from cataracts, then you may be a candidate for cataract surgery. One does
not have to wait until the cataract is "ripe", unless you choose to. Leaving a cataract in the
eye is not dangerous except for rare situations. Cataracts in general do not harm the eye. In
most cases, surgery can be postponed for as long as the patient desires or not done at all.
The only side-effect would be the blurred and progressively worsening vision due to the
cataract. With time cataracts do increase in size and hardness, and if the cataract is very
advanced, the surgery can be slightly more difficult to perform. However even in these
situations the result is usually very good.

The surgical procedure that seeks to restore your vision involves removing the cloudy lens
and replacing it with an artificial lens. Cataracts can be removed at any stage of their
development, but again, the decision is yours alone. With modern microsurgical techniques,
age or physical condition are seldom obstacles. The timing depends on how much your
cataract limits your vision. When your vision becomes impaired enough to interfere with
normal activities such as driving, reading or watching TV, then surgery may be advisable.

How is the surgery performed?

In the not so distant past, cataract surgery used to involve making a large incision to remove
the cloudy lens, and patients were often brought into the hospital overnight or for several
days. Now advanced surgical techniques and modern lens replacement make "same day
cataract surgery" possible. You can have your cataract removed on an outpatient basis at a
nearby hospital and go home the same day!

Today, cataract surgery is among the most highly perfected, safe, and successful procedures
in all of medicine. Over one million cataract operations are performed in this country every
year. The surgery is most often performed with monitored anesthetic care with appropriate
sedation given as necessary and thus does not carry the risks of general anesthesia. It is
painless and usually takes less than an hour.

A sophisticated micro-surgical technique, called phacoemulsification, is used to remove the
cataract through a small incision. Phacoemulsification is an ultrasound technique which
allows the doctor to remove the clouded lens in small fragments, instead of whole. This
technique permits the smallest possible incision and the shortest recovery period. In the
hands of an experienced cataract surgeon, phacoemulsification also reduces the incidence of
complications and produces the best possible visual results. Once the cataract has been
removed, a new clear implant lens is folded, inserted through the small incision, and allowed
to open up in the same "bag" that used to hold your own lens in place. In some cases, an
implant lens may not be implanted, or a different type of lens implant may be placed outside
of the "bag" if your surgeon feels this is best for your eye. Fine-tuning the patient's vision is
performed with the appropriate choice of intraocular lens implant power having been chosen
earlier. Usually, the incision is so small that it is able to heal rapidly, leaving no visible scar
and eliminating the need for sutures.

Sutureless or "No-Stitch" cataract surgery is the most recent advance in cataract surgery.
Sutureless surgery is made possible by a revolutionary new way of constructing the small
phacoemulsification incision. This new type of incision is self-sealing and requires no
sutures. Yet it is even stronger and heals faster than earlier types of incision, and with even
fewer complications. With no-stitch surgery, cataract surgery patients are usually able to
resume all normal activities within 24 hours after surgery. No-stitch or small incision
surgery, combined with the latest small incision intraocular lenses, offers the cataract patient
the best possible vision in the shortest possible time.

Almost all patients can have their cataracts removed using no-stitch surgery, though the
ophthalmologist makes this determination at the time of the surgery. Both Dr. Greenspan and
Dr. Segal have extensive experience with this technique.

How successful is cataract surgery?

This is one of the most common successful surgeries. Approximately 99% of Pasadena Eye
Associate patients experience marked improvement in their vision. How much improvement
is achieved is dependent upon the initial health of the eye, as certain diseases of the retina
can limit the final visual result. The ophthalmic surgeon will discuss this prior to any
scheduling of surgery.

As with any surgery, there are risks associated with cataract surgery, and complications (such
as bleeding, infection, corneal decompensation, macular swelling, and retinal detachment)
can occur during or after surgery in spite of the best care. It is impossible to predict in which
patients these complications will occur. Fortunately, the risk of these complications is quite
low.

What are the benefits of cataract surgery?

Cataract surgery affords an almost miraculous restoration of clear vision. It is one of the few
medical procedures that can literally turn back the hands of time. In fact, many patients
achieve vision comparable to the eyesight they enjoyed in their youth. Some of the benefits
include the following:

• Improved Color Vision - Once the cataract is removed, colors are no longer tinged by
  its effect. Colors will be much more vivid and vibrant after surgery.
  
• Improved Clarity of Vision - Visual acuity is usually improved. Reading and watching
  television can be enjoyed thanks to sharper, clearer vision.
  
• Increased Independence - Following cataract surgery, many patients eyesight is
  improved to the point that they can regain their driver's license.
  
• Improved Quality of Life - Improved vision leads to renewed interest and
  participation in the fun things in life. Hobbies, work, and enjoying the company of
  friends comes easier when vision is improved.
  
• Reduced Dependence Upon Corrective Eyewear - The lens implant used during
  cataract surgery may be able to compensate for pre-existing focusing problems such
  as nearsightedness or farsightedness. Glasses may be needed for some activities, such
  as reading or driving. When glasses are required all the time, the lenses are often able
  to be much thinner, making the spectacles lighter and more attractive.
  
  

Can cataract surgery be done with laser?

Many people have the misconception that lasers are commonly used for cataract removal.
Cataracts, typically, are actually removed with ultra-sound waves as described above, not
with laser light. However, a small percentage of people develop a condition in the months or
years after cataract surgery where a thin film of scar tissue forms behind the implanted lens
and causes the vision to be blurred. Often these patients will feel that their cataract has
returned or "grown back." However rest assured that once the cataract has been removed, it
is not possible for it to recur. In these cases, an opening can be quickly and absolutely
painlessly made in the scar tissue with a laser, without disturbing the lens implant or any
other tissues within the eye. With light able to once again focus on the retina, clear vision is
thereby restored. Some people hearing of this might incorrectly think that it is some form of
a cataract that is being removed with the laser.

As the field of ophthalmology advances, researchers are exploring many ways in which
cataracts can safely and easily be removed. Interestingly enough, much of the research
revolves around the use certain lasers to break apart a cataract. While the commonplace of
these techniques are certainly in the future, if at all, current cataract surgery achieves equal
and life-changing results today.