Cataracts

If you are over 60 and your vision is a little blurred, light from a lamp seems overly glaring, or you see a halo around street lights at night, you may be developing cataracts.

A cataract is clouding of the eye’s natural lens which lies behind the iris and the pupil. “The lens of the eye works much like that of a camera, focusing light onto the retina at the back of the eye,” says ophthalmologist Dr. Charles Kirby.

Are They Clouding Your View?

By Charlotte Boatwright, RN, PH.D.

“The lens also adjusts the eye’s focus, giving a clear, sharp image, near, distant and in-between. Sealed in a capsule, old cells die and accumulate over time and cause clouding so that images appear fuzzy or blurred. Cataracts occur as a natural part of aging in most people and are the leading cause of visual loss in adults age 55 or over. They usually start out small and have little effect on vision in the beginning,” notes Dr. Kirby.

Injuries to the eye, medications, alcoholism, or diseases such as diabetes may also cause cataracts. “When folks reach the 60s or 70s, they may develop enough opacity so that the lens is clouded enough that the person cannot do the things they like or need to do, so it is time to remove the cataract,” Kirby explains.

The decision to have cataract surgery is somewhat a subjective one based on the patient’s ability to fulfill duties and engage in routine activities. Some people can continue to watch television, drive, or even work at a computer for years after diagnosis. When the decision is made, the cloudy natural lens is removed and replaced with a permanent lens implant. Prior to surgery, it is important for the patient to tell the eye surgeon about all medications or nutritional supplements they are taking. Some medications, such as alpha-blockers, may need to be discontinued until after surgery.

 Preparation for Cataract Surgery

“If you have a cloudy lens in a camera, you have to remove it, and that is what we do with the lens in the eye. We remove it and replace it with an artificial one,” says ophthalmologist Dr. Deborah Distefano. “We have had artificial lenses since the 1970s. Before that, people wore really thick coke-bottle glasses before we had lenses to correct for cataracts. The older intraocular lens only allows you to see one focal length. Now, we have three or four premier new dimensions in intraocular lenses which allow you to see both near and distant vision in the same eye. That technology has only been available for the last three to four years. In essence, we may be doing cataracts on people who are maybe a little bit younger because the technology is so good. If we have someone in his late 40s or 50s that has a small cataract, we can offer him that technology. Depending on the level of the cataract, it may or may not be covered by insurance. What insurance companies have said, including Medicare, is that they will pay up to the cost of the standard lens; then the patient pays the difference. There are certain criteria you must meet before you are eligible for cataract surgery. If you meet that criteria, then you are generally covered for the standard lens; then there is an additional fee the patient must pay for the new lens,” Distefano explains. “The outcomes are wonderful,” says Distefano. “If we use the new refractive lenses, most people are out of glasses 80 to 90 percent of their day after their surgery. In dim light you might still need glasses to read a menu, so we don’t tell patients to throw them away. My goal is to make them as free of glasses as possible.”

Not everyone is a candidate for multifocal lenses. You need to have a healthy eye. “If you have glaucoma or retinal disease, for instance, you may not be a candidate,” says Dr. Charles Kirby. “Not everyone can adapt to the visual aberrations of the multifocal lens. These are multiple-powered lenses, and not all patients can adjust to this new experience. There is also an adaptation period after surgery since the brain must learn to use the new lens,” he added.

 Surgical Implantation

If cataracts are to be removed from both eyes, surgery is usually done on only one eye at a time and is usually an outpatient procedure. “About 11 years ago, I brought the modern procedure where the eye was numbed with eye drops, so you need no needles, patches or sutures to Chattanooga from Los Angeles,” says ophthalmologist, Dr. David Friedrich at the North Park Eye Center. “We make a tiny incision of only 2.2 millimeters to remove the old lens. Smaller, unsutured incisions are less likely to leak and are stronger than sutured ones, so we no longer have to put restrictions on the patient’s activity as we used to do. Like a grape, a clear, cellophane-like sac surrounds the lens. We make a circular opening in the front to remove the contents of the lens with an ultrasound device that breaks up the lens and suctions it out. The real trick here is to do this without breaking the surrounding sac. Into the empty sac we insert a small plastic lens that is calculated to have the correct power to correct for distant vision and in some cases near, distant, and in-between. We use a computerized system that determines the power of the lens based on the curvature of the surface of the eye and the degree of far- or near-sightedness that you had previously, as well as the length of the eye. If you get exactly the correct lens; then you have very good vision without glasses,” says Friedrich.

We now have a variety of lenses or implants. “Until recently, Medicare required that everyone get a lenses that provided a single focus, near or distant; then you used glasses to fill in,” Friedrich explains. “Traditionally, we would use lens that allowed for driving or a distant vision; then you used glasses for reading. Some people opted for monovision where one eye is corrected for near vision and the other for distant. Trouble is, not everyone could tolerate that sort of correction, so it was pretty much reserved for those who had used that correction in contact lenses. Medicare recently said that you may have whatever lens you choose, but you must pay for it. There is a new lens called the Toric which corrects astigmatism. In the past, we have done Limbal relaxing incisions for correction of astigmatism. At present, there is no Toric lens that also corrects for far and near vision, but I know that a Toric multifocal is on its way,” says Friedrich.

Over 80 percent of people who get the new multifocal lenses do not need to wear glasses. “We even have people who don’t have cataracts wanting that sort of correction just to restore near vision,” Fredrich comments. “This should be a lifetime correction. If it comes out well, you should be set for life. I would say the vast majority of people are very happy, but it is very important to have realistic expectations because it does not restore vision as it was at age 25.”

 Charlotte Boatwright is a native Chattanoogan. She has a doctorate in health care administration, is a registered nurse, and licensed professional counselor. Charlotte has been involved with health care for 35 + years and is the founding member and President of The Coalition Against Domestic & Community Violence of Greater Chattanooga, Inc./ Chattanooga Family Justice Alliance. She can be reached at cboatwright@comcast.net.