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Cataracts
 
 

What are cataracts?

A cataract is a clouding of the internal focusing lens inside the eye, which is normally clear in youth, gradually developing density over a lifetime. Cataracts typically do not cause visual difficulty until a person's late 60's or beyond.

What causes cataracts to develop?

Cataracts develop because of a natural aging process in the lens itself If we all live long enough, we will most likely develop cataracts. Ultraviolet (UV) exposure may play a role, but otherwise we aren't completely certain of the cause. Some cataracts occur in younger people because of direct trauma to the eye (such as getting hit in the eye with a hard ball), genetic conditions, or occasionally vitamin deficiencies. Wearing sunglasses in bright sunlight and eating healthy foods are suggested for everyone.

What are the symptoms of cataracts?

Early on, cataract symptoms can be very mild. Many people first notice a distracting glare from oncoming headlights when they drive at night. It may require more and more light to comfortably read, even while wearing glasses. Some people notice that television captions become increasingly difficult to read.

Normal Vision Vision with Cataracts

Normal Eye

A healthy, clear lens focuses light directly onto the retina, causing a crisp, clear image to be seen.

Cataract Eye

A cloudy, cataractous lens scatters light, only partially hitting the retina, causing a hazy image to be seen.

Do glasses help with cataracts?

Sometimes they do. During a routine complete eye examination, we evaluate vision and the total health of the eye, also screening for other disorders like glaucoma, macular degeneration, and diabetes. This allows us to determine whether a change in glasses would provide a significant improvement in vision. However, when cataracts become dense enough, even new glasses will not help because the eye is seeing through a cloudy internal lens that cannot be corrected with glasses.

Can cataracts be reversed or prevented?

Wearing ultraviolet (UV) protecting sunglasses may help reduce the progression of cataract. It is worthwhile for most people to investing in a good quality pair of sunglasses, which need not be very expensive. In addition, a balanced diet containing a reasonable amount of antioxidant vitamins may help prevent cataracts, while supporting overall health.

Do cataracts occur in both eyes at the same time?

Generally, cataracts progress at about the same rate in both eyes, however many people seem to notice cataract symptoms in one eye first. During an examination, we can determine whether any other conditions such as macular degeneration are also contributing to difficulty with vision.


When should cataracts be removed and why?

We no longer recommend surgery when a cataract is "ripe", which is a very dense cataract. Rather, the decision for surgery is based on when visual difficulties begin to interfere with normal activities of daily living, like driving, reading, work, or hobbies.

Is cataract surgery performed in a hospital or as a outpatient?

Cataract surgery is performed as a outpatient at the ElMirador Surgical Center. The nursing staff at the surgery center are highly experienced in helping patients comfortably go through the steps of surgery.

How long does the cataract surgery take?

Cataract surgery takes about fifteen minutes in the operating room. Most people are in our surgery center for about 90 minutes, including pre- and postoperative time.

Is cataract surgery performed with anesthesia?

Cataract surgery is performed with local anesthesia and topical eye drops. We provide intravenous medications to help patients fully relax. We also administer local medicines around the eye so patients don't feel or see anything during surgery.

Is cataract surgery painful?

Most people say that there is no pain during or after cataract surgery. Some may experience a scratchy sensation (like an eyelash in the eye) and mild soreness for about 24 hours after surgery. If necessary, you may take aspirin, Advil (ibuprofen), or Tylenol (acetaminophen). 

How is the cataract removed and is a Laser used?

Bladeless cataract surgery is the state of the art in cataract surgery called Laser assist cataract surgery. Dr. Tokuhara may use the LenSx Femtosecond Laser. The cataract is removed during a fifteen-minute procedure. A small opening (less than 1/8 inch) is made in the front of the eye (the cornea) to allow the surgeon to dissolve the lens of the eye and remove it in tiny pieces. An artificial lens implant made of silicone or plastic is folded into a small package, then inserted into the eye and unfolded in the proper position. In this position, the new lens will remain permanently. It will never need maintenance or replacement. The new lens can be selected to correct nearsightedness or farsightedness. Premium Lens Implants are available to correct astigmatism or presbyopia.

After the surgery, will my cataract come back?

After cataract surgery it is impossible for a cataract to return because the lens of the eye, where the cataract grows, has been completely removed. It is possible, however, for a cloudy film to grow on the lens capsule membrane that is located behind the lens implant. This occurs in about 40% of cataract surgery patients, usually many months or years after surgery, and is sometimes called a "secondary cataract". . Treatment of this film is simple and done with a laser as an outpatient procedure that involves no postoperative restrictions or downtime for most people.

Will I need reading glasses after cataract surgery?

With lens implant technology, Dr. Tokuhara can choose to correct vision to achieve good uncorrected distance vision in both eyes. This allows most people to pass a Department of Motor Vehicles (DMV) test without glasses. In such a case, it would be necessary to wear reading glasses for fine print, though some large print reading may be possible without glasses.

Another option after surgery is monovision, where one eye is corrected for distance and the other for near vision. This option allows many people both to read and drive without corrective lenses, but affects depth perception. This option is usually most successful in people who have previously worn monovision contact lenses or who have had monovision LASIK.

Premium Intraocular Lens Implants are another method of achieving good distance and reading vision after cataract surgery.

What restrictions will I have after cataract surgery?

For the first four hours after surgery, an eye patch is placed on the healing eye and the effects of anesthesia will be wearing off. During this time we recommend restful activity. Eating, watching television, reading, and walking around the house are allowed. After 4 hours the eye patch is removed, patients can begin administering their postoperative eye drops.

For the first few days after surgery, heavy lifting (more than 20 pounds) is not allowed, and we recommend avoiding eye makeup for one week. There are other restrictions as well after surgery. These are fully discussed with our doctors and counselors before surgery. For more information about restrictions after surgery, please contact us.

What are the risks of cataract surgery?

There are risks with every kind of surgery, and cataract surgery is no exception. The risk of severe complications, such as infection, severe bleeding during surgery, or retinal detachment are about 1 in 1000. Other, less severe complications of surgery may occur more frequently, as often as 1 in 100 times, and may include the need for additional surgery or prolonged recovery time with delayed visual improvement. This is not a complete list of risks that occur with surgery, and individual patients may have other risks based on existing medical or eye conditions. Dr. Tokuhara has extensive experience performing cataract surgery in unusual circumstances and can fully discuss these risks during an office consultation.