CATARACTS- Overview, Treatment & Options
The lens inside the eye focuses light onto the retina (back of the eye) in order for us to see clearly. If the lens becomes cloudy or opaque then the lens has what we refer to as a cataract. Cataracts are very common and can be congenital (at birth) or occur at any stage of life. The causes of cataracts are numerous and can include trauma to the eye, the side effects of medications and long term ultraviolet exposure. Since any opacity of the lens (no matter how small) is considered a cataract, most people over the age of 65 probably have minor cataracts that are insignificant. We routinely note them during the course of an eye examination on elderly patients and they are only an issue if they are large enough to interfer with your vision. When the catarct affects your ability to function visually then the lens can be removed surgically and replaced with an artifical lens called an intraocular lens (IOL). The surgery itself is done by an ophthalmologist (surgeon) on an out patient basis and has a very high success rate. We routinely co-manage cataract surgeries with surgeons with which we have the utmost respect .
Correcting Myopia/ Hyperopia in addition to the Cataract
Fortunately, today there are many options available should you need cataract surgery that can actually improve your vision dramatically. Since the surgeon has to replace the eye's natural lens with the IOL this allows them the opportunity to correct existing problems such as myopia and hyperopia. Myopia and hyperopia can be readily corrected by simply choosing an IOL that corresponds to the patients degree of either of the two. All standard intraocular lenses can correct for myopia or hyperopia, though they do not correct astigmatism nor prebyopia . The following photo is a magnified view of a standard IOL. The extensions on the lens are used to keep the lens in place inside the eye.
Correcting Astigmatism in addition to the Cataract
Astigmatism can be corrected (in addition to the hyperopia & myopia) by using a toric intraocular lens. A toric lens is one that has two different curvatures that correspond with the degree of the patients astigmatism. It is a more complex lens to implant since it must be aligned precisely in the eye. Most insurances plans at this time consider the toric intraocular lens a "deluxe lens" brand that requires a higher fee due to the increased cost of the lens and professional time to fit it. The toric lens is an excellent choice for patients having cataract surgery that have significant astigmatism. Below are two examples of toric IOLs. If you look closely you may note a marking on the side of the lens used to align it inside the eye.
Correcting Presbyopia in additon to the Cataract
Over time the natural lens in the eye loses the ability to focus up close so most people over age 40 need to use bifocals or progressive lenses. This condition is called Presbyopia. With the advent of multifocal intraocular implants many times the ability to focus can be restored and patients won't have to rely on reading lenses after cataract surgery. The multifocal IOLs lenses correct the cataract, presbyopia and myopia (or hyperopia). However, multifocal lenses do not correct astigmatism. There are many different types of multifocal implants and each have advantages and disadvantages. The decision of which type of multifocal lens to use is a discussion you will want to have with Dr. Mason should you be considering cataract surgery. As with the toric lenses above at this time multifocal intraocular lenses are considered a deluxe lens by most insurances and require a higher fee for the procedure. Below are two examples of current multifocal IOLs. The second photo is an enlargement of the first IOL and you can see faint circular rings which correspond to the changing powers of the multifocal.
Co-Management of Cataract Surgery
Dr. Mason co-manages cataract surgery with many local opthalmologists (surgeons) and can help guide you through the process. He can provide preoperative care and consult with you on the options available for correcting cataracts. He can also help arrange referrals to the proper surgeons and after the surgery provide the post-operative care required. Dr. Mason will serve as your advocate through the process that for many patients can be daunting and somewhat apprehensive.
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Dr. Daniel L. Mason, Optometrist
(619)656-1081