Our cataract surgeons at UC Irvine’s Gavin
Herbert Eye Institute are certified by the American Board of
Ophthalmology. Additionally, all of our cataract surgeons have
had advanced
fellowship training and have
been distinguished as top doctors in Orange County and the nation.
Our
relationship with you as a patient is focused on fulfilling the
needs and priorities of your eye condition, applying state-of-the-art
diagnosis and surgical procedures, and supplying experienced
advice for achieving your best possible visual results.
What are cataracts?
More than 50 percent of people over the age of 60 (and quite
a few younger than that) suffer from cataracts. Almost everyone
develops cataracts as they grow older. Cataract formations
occur at different rates and can affect one or both eyes.
A
cataract is a progressive clouding of the eye's natural lens.
It interferes with light passing through the eye to the retina.
Aging and other factors cause proteins in the eye's lens to clump
together forming these cloudy areas. Early changes may not disturb
vision, but over time cataracts typically result in blurred or
fuzzy vision and sensitivity to light. People with progressed
cataracts often say they feel as if they're looking through a
waterfall or a piece of wax paper.
In fact, eye cataracts are the leading cause of
vision loss among people over age 55, and cataract surgery with
an intraocular lens implant (IOL) is one of the most frequently
performed operations. This may be a reflection
of the changing demographics of our population. In 2006, 80 million “baby
boomers” began turning 60 and it is estimated that by 2011
there will be 40 million people over age 65 in our
population and by 2020 there will be close to 55 million! In
the United States, the incidence of senile cataract has been
reported to be about 42 percent in people age
52 to 64, 60 percent in those age 65 to 74 and 91
percent in those age 75 to 85.
Diagnosing cataracts:
Regular eye exams help your doctor determine if cataracts are affecting your
vision. If you have experienced a gradual drop in vision, with the symptoms
described above, you may have cataracts and should schedule an appointment
with one of our comprehensive ophthalmologists or cataract specialists.
Treating
cataracts:
Currently there is no medical treatment to reverse or prevent the development
of cataracts. Once they form, the only one way to achieve clear vision again
is through cataract surgery.
In your parents' or grandparents' day, cataract
surgery was considered risky, required a lengthy hospital stay and was
usually postponed for as long as
possible. Today, cataract surgery is performed on an outpatient basis and
takes only a few minutes. It is now one of the most common and successful
medical procedures performed. In fact, after cataract surgery,
many patients’ vision is better than before they developed cataracts.
During surgery your clouded lens
is removed and replaced with an intraocular lens (IOL). Your doctor will
help you choose the correct IOL for you. Depending
on the health of your eye and your needs, there are multiple IOL options
that may be available to you.
Monofocal IOL – These are single focus lenses that
allow for vision at distance or near. Glasses are generally
needed after surgery. (Tecnis Monofocal, AcrySof Monofocal)
Toric IOL* – These IOLs correct for astigmatism
in addition to correcting for either distance or near.
Toric IOLs allow for clearer vision as a result of astigmatism
correction. (AcrySof Toric)
Multifocal IOL* – These IOLs give a wider range
of vision without glasses. In most cases, glasses will
not be needed either for driving or TV and also close up
vision, such as computers or reading. These lenses function
somewhat like built-in bifocals, splitting the focused
light between distance and near. (Tecnis Multifocal, ReSTOR)
Accommodating IOL* – Like multifocal IOLs, accommodating
IOLs are also designed to increase range of vision without
glasses for most daily activities. These lenses work by
flexing, mimicking the natural focusing action of the eye.
(Synchrony, Crystalens)
*Lifestyle IOL
Choosing the right lens option for you:
Traditionally, cataract
patients received monofocal lens implants that had only a single
power. This meant you had a choice
of correction for
either
far or near
vision. If you suffer from presbyopia like many people over age
40, this would mean that you still need glasses for either reading
or for
distance vision. Over
the last 10 years, the FDA has approved several lifestyle intraocular
lens implants for use by certified ophthalmologists. These
lenses can increase
your chances
for a life free of dependence on glasses or contacts after cataract
surgery for near, far and intermediate vision. If you have worn
glasses for
30 years,
this
might be an opportunity to eliminate them altogether.
The implantation procedure is the same for lifestyle IOLs and
monofocal IOLs. The main point of differentiation between
the IOLs is in the type
of vision
they provide.
All patients should know that one approach or IOL is not better than
another, they are just different. Our goal is to provide the safest
and most effective
cataract surgery for each one of our patients. All efforts will be
made to personalize the cataract surgery approach and IOL choice for
you so
that
you will be able
to enjoy improved vision for years to come.
What exactly is
a cataract?
A cataract is a cloudiness of the eye's natural lens, which lies
between the front and back areas of the eye.
Are cataracts found
only in older people?
About half of the population develops a cataract by age 65, and
nearly everyone over age 75 has at least one. But in rare cases,
infants
can have congenital cataracts. These are usually related to the
mother having German measles, chickenpox, or another infectious
disease during pregnancy, but sometimes they are inherited.
My
doctor says I have a cataract, but he wants to wait awhile before
removing it. Why?
A cataract usually starts very small and is practically unnoticeable
until it grows gradually larger and cloudier. Your doctor is
probably waiting until the cataract interferes significantly
with your
vision and your lifestyle.
Continue to visit your
eye doctor regularly so the cataract's progress is monitored.
Some cataracts never
reach the stage where they should be removed. If your cataract
is interfering with your vision to the point that it is unsafe
to drive or makes doing everyday tasks difficult,
it's time to discuss surgery with your doctor.
Is cataract
surgery serious?
All surgery involves some risk, so yes, it is serious. However,
cataract surgery is the most commonly performed type of surgery
in the United States.
What is the right lens for me?
Determining the right IOL for you can be based on many factors,
including the health of your eye, your lifestyle and the fact
that lifestyle IOLs incur out-of-pocket expenses.
If you are interested in correcting presbyopia, which all people
develop beginning at about age 40, you potentially
could decrease your dependence on eyeglasses and restore your
ability to see at all distances with a multifocal IOL or accommodating
IOL.
However, you must
consider that additional cataract surgery costs do occur with "lifestyle" IOLs,
even though they may reduce or eliminate dependency on eyeglasses.
Before
cataract surgery, your eye will be thoroughly measured in a preliminary
examination to determine the proper power of
the intraocular lens that will be placed in your eye. If you
choose a lifestyle IOL, you may need extra tests to make sure
measurements are exact and that you don't have other vision problems
that might hamper the performance of the IOL.
Before Your Cataract Surgery
Should someone accompany
me on the day of surgery?
We request that you bring someone with you on the day of cataract
removal surgery.
Where does the surgery take place?
Our surgery center is located on the UC Irvine Medical Campus
in Orange. The surgery center is on the third floor of
the Chao Family Comprehensive Cancer Center (Building
23).
How long will I be at the surgery
center the day of
my surgery?
Most patients should plan to be at the surgery center between
2-3 hours from the registration to discharge.
What should I bring
with me the day of surgery?
We recommend that you bring the following to the surgery
center:
Friend or family member (someone to help with paperwork,
driving home, etc.)
Medicare or insurance cards
Medication – enough for
the time you will be away from home
List of prescription medication
including dosage and strength
Sweater or jacket
Reading material or busy work
I take several prescription medications,
including a blood thinner. Should I continue these before surgery?
Yes. Take all prescription medications as you normally would
with a sip of water (unless specifically instructed by your doctor).
I
wear contact lenses. May I wear my contacts until the day of
surgery?
Please stop wearing soft contact lenses at least one week prior
to surgery, and hard lenses two weeks prior to surgery.
May I
eat before surgery?
No. Please ensure that you have nothing to eat or drink at least
eight hours prior to surgery.
May I wear makeup?
Please do not wear any makeup on the day of surgery.
I’m
on oxygen. Should I bring it with me?
Yes, bring more than enough oxygen for a 3 hour stay. While under
our care, we will have oxygen available for you.
During Your
Cataract Surgery
Will I feel anything during surgery?
Most patients feel only gentle pressure during cataract removal
surgery.
What do I see during surgery?
Most patients only see the bright lights of the microscope.
May
I have medication for my nerves?
Generally our anesthesia staff is present. A mild anti-anxiety
medication will be administered as needed.
I was told to take antibiotics
before receiving dental work. Should I take them before eye surgery
also?
Unlike the mouth, the eyes are very clean. You will not need
to take antibiotics unless instructed by your doctor before the
operation.
How soon may I leave after having cataract removal
surgery?
Most patients are able to leave within an hour of having cataract
surgery.
I was told I need surgery on both eyes. When may I receive
treatment for my second eye?
You may have your surgeries one to two weeks apart (unless
there is a reason to wait longer.) If applicable, your
doctor will discuss this with you.
Will I be able to see immediately
after the operation?
Most patients’ vision is quite blurred after the surgery
from the dilating drops and bright microscope lights.
What will
happen before I’m discharged?
After the surgery, you will be taken to the recovery room where
we will assess your vital signs (pulse, blood pressure etc.).
At this time, we will also explain your postoperative instructions
and medications to you and a friend or family member.
My back
keeps me from lying flat. What position must I be in for the
surgery?
We will need you to lie down for surgery; however, our experienced
OR team has worked with virtually every medical condition that
presents special needs. We will be able to work with you to make
your experience as comfortable as possible.
Does every patient
need an implant?
The vast majority of patients require an implant to replace the
natural lens or cataract. Only in very rare cases of extreme
nearsightedness is an implant not required.
May I drive myself
home?
No, we require patients bring a friend or family member to drive
them home due to the medications given.
Sometimes my blood pressure
gets high when I’m nervous.
What happens if it’s too high?
If we are unable to manage your blood pressure with medication,
your surgery may be postponed until you consult with your primary
physician.
Do I need a physical before surgery?
Yes, you will be asked to get a medical clearance prior to surgery.
Our nurse practitioner can perform routine clearances. If you
have a complicated medical history, we may ask you to be cleared
by one of our Hospitalists.
After Your Surgery
Did
I receive a lens implant during surgery?
Intraocular lenses are required except in very rare cases of
extreme nearsightedness.
What material is my implant made of?
Most of the implants used are made of either acrylic, silicone
or PMMA (plastic).
Will the implant need to be replaced in the
future?
The intraocular lens implant will remain in your eye permanently
and will not “wear out.”
Can my eye reject the lens
implant?
No, since the intraocular lens is not made up of human tissue,
your body cannot reject it.
Was a laser used to remove my cataract?
Cataracts are removed by ultrasound, not a laser. In a process
called phacoemulsification, sound waves are used to gently
break up the cataract before it is removed from the eye.
Lasers are currently being developed to remove cataracts.
Should I wear my
old glasses after surgery?
Wearing your old glasses will not harm your eyes, but they will
probably not give you optimal vision either. Most patients
find it best
to wear glasses only for reading.
Why isn’t my close-up vision
as good as my distance vision?
Your ability to see well at close range depends on the type
of intraocular lens you received. For most IOLs, it is normal
to require reading
glasses after cataract surgery.
During at least the first week
after surgery, it is essential that you avoid:
Strenuous activity and heavy lifting (nothing over
10 to 15 pounds).
Bending, exercising and similar activities that
might stress your eye while it is healing.
Water that might
splash into your eye and cause infection. Keep your eye closed
while showering or bathing. Also, avoid swimming or hot tubs
for at least two weeks.
Any activity (such as changing cat litter boxes) that
would expose your healing eye to dust, grime or other infection-causing
contaminants.
How soon
may I resume driving after surgery?
For most cataract surgery patients, vision improves significantly in the first
24 hours after surgery. You may drive as soon as you feel comfortable doing
so.
Is it safe to fly after cataract surgery?
Flying after cataract removal surgery will not harm your eye.
When
may I wear make-up again?
You may wear lipstick and powder immediately after surgery.
However, you should avoid eye make-up for two weeks after surgery.
Is
it safe to have my hair done or get a permanent?
Yes, as long as you take sensible precautions to avoid chemical
contact with your eyes.
Why does it feel like there is something
in my eye after my surgery?
During cataract surgery, a microscopic incision was made on the
surface of your eye. When you blink, you may feel a slightly
scratchy sensation until
the incision
heals. After surgery, many patients find that using artificial tears helps
to alleviate discomfort.
The eye drops that I was instructed to use after
surgery sting my eye. Is this normal?
It is common for some eyedrops to burn or sting. You should continue
to use your eyedrops as prescribed. However, if your discomfort
seems to be worsening,
or
you experience a decrease in vision, call us immediately. Some patients find
that using “artificial tears” five minutes before placing medicated
drops in the eye decreases irritation.
After surgery, I noticed a spot of
blood on the white of my eye. Should I be concerned?
The white part of the eye (sclera) is covered by a clear layer of tissue
(conjunctiva). When a tiny blood vessel breaks, the blood becomes trapped
below the conjunctiva.
Since the tissue is clear, the blood is clearly visible. If this were to
happen on your arm, you would have a blue or purple bruise because the
skin is not
transparent. This will not affect your vision and will gradually resolve
on its own.
On the way home from surgery I saw huge halos around all the
lights. What causes this?
This dramatic glare was due to the fact that your pupil was still dilated
from the surgery. After dilation wears off, vision should return to normal.
My
glare problem has improved dramatically since the surgery, but I still
occasionally notice halos or streaks on lights at night. What causes
this?
There are many factors that can cause glare. A slight need for glasses
(refractive error) is one of the most common reasons you may notice
slight glare at night.
Also, some patients experience minor corneal swelling after surgery
that may cause temporary glare.
Since my surgery a few weeks ago, everything
has a pink tint. What causes this?
This pink tint is due to slight swelling in the retina and is not
uncommon after surgery. It will gradually go away as you use your
postoperative
eye drops. However,
always contact your eye doctor if you notice a change in your vision.
Since sun exposure can aggravate this problem, it is also important
to protect
your eyes
with sunglasses when outdoors
After surgery, why does everything appear to have a
blue tint??
Patients with cataracts see their world through a yellow tint.
It’s just
like wearing yellow-tinted (”blue-blocker”) sunglasses,
which block colors from the lower end of the color spectrum (blues
and violets). When the
cataract is removed and replaced with a clear implant, you will
see these unfamiliar colors again. This is much more dramatic for
some patients than others.
If you have additional questions about
cataract removal surgery
please ask your doctor.
Our
relationship with you as a patient is focused on fulfilling the
needs and priorities of your eye condition, applying state-of-the-art
diagnosis and surgical procedures, and supplying experienced
advice for achieving your best possible visual results.
