Cataracts are a disease in which the eye’s clear lens becomes clouded, requiring surgical removal. Cataracts are treated with intraocular lens (IOL) implants. "Hundreds of IOLs are now on the market," says Kevin M. Miller, MD, Kolokotrones Professor of Clinical Ophthalmology at UCLA’s Jules Stein Eye Institute. While all IOLs improve vision, eligible people willing to pay out-of-pocket costs for certain “premium” lenses may be able to avoid the need for glasses completely. Premium IOLs have in some cases moved from monofocal to multifocal -- potentially enabling the individual to see well, without glasses or contacts, at both near and far distances. According to Dr. Miller, when planning cataract surgery, people should discuss their options with their doctor.
Premium IOLs fall into two categories. Toric lenses are designed to correct a significant level of astigmatism -- in which vision is blurred because of an irregularly shaped cornea -- and thus reduce dependence on glasses for distance vision (reading glasses are still needed). Presbyopia-correcting lenses come in two types -- multifocal and accommodating. Unlike toric lenses, presbyopia-correcting lenses aim to achieve both distance and near vision without the need for glasses. Many people don’t qualify for presbyopia-correcting lenses, including people with macular degeneration.
"With any of the premium lenses, you’re paying for the increased likelihood that you won’t need glasses to watch television or a movie, recognize people coming in from across the room or drive a car," says Dr. Miller. "With toric lenses, you might only have to wear drugstore-style reading glasses, and with the presbyopia-correcting lenses, you have increased odds of being able to read without glasses as well. But if that convenience isn’t worth the out-of-pocket cost, then the premium lenses aren’t needed."
Cataracts
Cloudy vision, foggy vision - that's how people describe cataracts. A cataract is a clouding of the eye's lens that happens so gradually you may not really notice it until you have trouble driving at night or difficulty reading. At that point, you may need cataract surgery - a standard procedure that is very effective.
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UCLA Health answeredCataract surgery “is very safe and takes only 15 minutes,” says D. Rex Hamilton, M.D., director of the UCLA Laser Refractive Center. Vision generally returns to normal by the next day, and Dr. Hamilton adds that multifocal lenses implanted during the surgery give patients distance and near vision without glasses.
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Emilia Klapp , Nutrition & Dietetics, answeredSee All 2 AnswersVegetables, especially spinach, may save you from cataracts and cataracts surgery because spinach is rich in the antioxidant beta-carotene. Cataracts are cloudy crystals on the lens of the eye that are thought to develop from oxidation resulting from the lens’ exposure to the sun. Studies show that people who don’t eat enough fruits and vegetables have a higher risk of developing them. Research from the U.S. Department of Agriculture found that people who ate less than three and a half portions of fruits and vegetables a day had a fourfold higher chance of developing cataracts. The antioxidants, vitamin C, and folic acid in fruits and vegetables are all preventative measures. -
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Dr. Laura C. Fine, MD , Ophthalmology, answeredBleeding within the eye is a potential problem during and after cataract surgery. This rarely occurs in phacoemulsification procedures -- the most commonly used technique for cataract surgery, which requires only a tiny incision that often needs no stitches and heals rapidly -- because the smaller incision used with this technique is placed in the clear cornea, in front of the blood vessels, and no blood vessels are cut inside the eye. Even bleeding caused by larger incisions may stop automatically without causing any damage. Hemorrhaging from the choroid in the back of the eye is a rare but serious cause of vision loss. -
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Dr. Laura C. Fine, MD , Ophthalmology, answeredPronounced astigmatism -- a common vision impairment that results from an irregularity in the curve of the cornea (the curved, transparent dome of tissue through which light first passes on its way into the eye) and causes blurred vision -- develops in some individuals after cataract surgery because of swelling of the tissue or tight stitches (if stitches are used) that pull on the cornea and distort its shape. After the eye has healed from the operation, swelling diminishes and any stitches may be cut. This usually corrects the astigmatism. In some people, cataract removal can relieve existing astigmatism, as incisions may be designed to adjust the cornea's shape
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Dr. Laura C. Fine, MD , Ophthalmology, answeredIf a person develops an infection inside the eye during or after cataract surgery, vision -- and even the eye -- could be lost. Most ophthalmologists use antibiotics before, during, and after surgery to minimize this risk. Surface inflammations or infections usually respond well to medication. Inflammation inside the eye without infection, which may occur in response to surgery, is usually minor and can be treated with postoperative steroids.
Although uncommon, a slight leak in the incision may occur, creating a greater risk for infection inside the eye. The doctor may apply a contact lens or a pressure bandage over the eye to promote healing. In rare cases, the wound has to be reclosed with a stitch. -
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Dr. Laura C. Fine, MD , Ophthalmology, answeredOnce at home after cataract surgery, you will use antibiotic and cortisone drops or ointment, as well as a nonsteroidal anti-inflammatory drug, to prevent infection and reduce inflammation. To prevent infections, wash your hands thoroughly before applying the drops, and avoid touching the bottle tip to your eye. Because the eye is sensitive after surgery, avoid rubbing or touching your eye, and guard against any sudden movement that could jar your head. To avoid accidental rubbing of your eye while you are sleeping, you may need to wear a protective metal eye shield at night for a few days or weeks.
Your doctor or health professional will show you how to clean your eyelids, which may become crusted from discharge. Many people prefer to wear medium-density sunglasses when outdoors to screen out the glare, even though most implants have ultraviolet blockers.
Make sure you understand all of your doctor's postoperative care instructions. It's important that you follow these instructions carefully to help ensure a full and rapid recovery. Discuss any questions you have with your doctor. -
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Dr. Laura C. Fine, MD , Ophthalmology, answeredLocal anesthesia keeps the eye comfortable and immobile during cataract surgery. The entire procedure usually lasts less than half an hour, during which you may see light, hear noises, and be aware of the presence of the surgical team. However, you probably will not see formed images, and you may not be able to tell whether your eye is open or closed. Most people do not have pain of any sort during the procedure.
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Dr. Laura C. Fine, MD , Ophthalmology, answeredf your vision is only slightly blurry, you may choose to delay cataract surgery for a while by taking these steps:
- Get a new eyeglass prescription if it improves your distance vision.
- Increase lighting at home, particularly for close work.
- Reduce glare by positioning lights directly behind you, focused on the task at hand, and by shielding your eyes from direct light.
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Dr. Laura C. Fine, MD , Ophthalmology, answeredBefore cataract surgery, inform your eye surgeon if you take or have ever taken an alpha blocker. Alpha blockers, which include alfuzosin (Uroxatral), doxazosin (Cardura), silodosin (Rapaflo), tamsulosin (Flomax), and terazosin (Hytrin), are used mainly to treat enlarged prostate in men, but they may be prescribed for high blood pressure or urinary retention in women. These drugs, along with tolterodine (Detrol) and the herb saw palmetto (both used to treat enlarged prostates), can interfere with the medications used to keep the pupils dilated during cataract surgery, raising the risk of complications. If the surgeon knows ahead of time, special steps can be taken before or during surgery to avoid these complications. Depending on your medical situation, your doctor may prescribe antibiotics, anti-inflammatory drugs, or both before the surgery.