Cataracts

Cataract surgery is truly "a miracle of modern medicine," an outpatient, same-day surgical procedure which produces a dramatic improvement in vision, and in a patient's lifestyle. At Ophthalmology Associates, our physicians are among the most experienced and successful cataract surgeons in New Jersey. Our surgery is performed at state-of-the-art surgical centers, known for sensitive patient care, excellence in safety, and exceedingly high patient satisfaction.

Cataract surgery involves the removal of the lens of the eye, which is clouded in some manner as a result of cataract formation. Removing the lens eliminates the cloudiness, but it also removes an important structure that focuses light onto the retina. To compensate for this, intraocular lens implants (IOL's) are inserted in the eye at the time of cataract surgery. This maintains the focus of the eye without the need for thick, "Coke-bottle" spectacles, as were commonly used before implants were available.

In many cases, patients find that after cataract surgery, they can be far less dependent on spectacles than they were prior to the surgery; indeed, some patients may be without glasses for certain tasks for the first time since their childhood. However, it is important to understand that most implants correct either distance or near vision, but not both simultaneously. In addition, the implants do not correct any astigmatism, or lack of roundness of the eye, which may have been present before the surgery. Therefore, most patients will wear spectacle correction for at least some tasks, and possibly most or all of the time, following cataract surgery.

New developments in implant technology, however, have now made possible a new type of implant. This has the potential to revolutionize cataract surgery. At Ophthalmology Associates, we now offer selected patients these new implants, known as "multifocal" implants. Such implants can correct the near vision and far vision simultaneously, thus eliminating the need for spectacle wear most or all the time. It should be emphasized that not all patients can have these implants, but nevertheless, this is an exciting development which we are pleased to be able to offer our patients. Your surgeon will discuss your eligibility for these advanced implants at your pre-surgery consultation visit.

As for the surgery itself, the procedure is relatively brief. The time from when your doctor begins surgery to the end is typically less than 30 minutes. Of course, pre- and postoperative care may necessitate a several hour stay at the surgery center. Nevertheless, virtually all patients are home early the same day. Cataract surgery is performed under local anesthesia, thus minimizing medical risks. Some patients may have only topical anesthesia, in which only drops are used to numb the eye, while others may require some additional medication administered around the eye. In all cases, however, patient comfort is always maximized, and cataract surgery can nowadays be correctly viewed as painless.

On the day of your surgery, you will arrive approximately 1 hour before the surgery. The pupils will be dilated, and you will have an intravenous placed in your arm. An anesthesiologist will administer some mild sedation through the intravenous, and the eye will be numbed without your experiencing any discomfort. You will then be taken into the operating room, lie down on a comfortable bed, and the eye will be cleaned and prepped for surgery. The doctor uses an operating microscope, so the surgery can be done under high magnification for maximal safety.

There are three basic techniques for removing the lens in cataract surgery. They are: intracapsular, extracapsular, and phacoemulsification. In intracapsular surgery, the lens of the eye is removed in one piece using a freezing probe. This procedure was popular prior to 1970. It involves the need to make a very large incision, since the lens is removed in one piece. This can prolong recovery time. In addition, because the capsule that surrounds the lens is removed together with the lens, there are certain risks such as retinal detachment, which are increased with this procedure. Nevertheless, the procedure is still occasionally used for certain types of rare cataract.

Extracapsular cataract surgery involves making a small incision in the capsule that surrounds the lens of the eye. This allows the surgeon access to the inner portion of the lens - the nucleus - without completely removing the lens. The capsule can therefore act as a barrier, keeping those structures in the eye which are behind the lens in their natural place. This provides important safety advantages. The nucleus of the lens is removed in one piece, so the incision still needs to be reasonably large, though not as large as in Intracapsular surgery. After the lens is removed, the capsule remains as an empty bag, which provides the perfect place for insertion of the intraocular lens. It is typically then inserted in the bag, so that it occupies the same place that the natural lens of the eye did prior to the surgery.

Phacoemulsification brought about the period of "modern cataract surgery". This procedure, which we at Ophthalmology Associates use in virtually all cases , is similar to extracapsular surgery in the sense that the capsule is left intact except for a small opening made in the front of the capsule. That is where the similarity ends, however. Instead of removing the nucleus of the lens in one piece, a small ultrasonic probe is placed in the eye, and the nucleus is broken up into small pieces using this ultrasound. It is then able to be sucked out through an opening in the ultrasonic tip. This procedure involves a far smaller incision than other cataract procedures. In fact, the total length of the incision is less than 1/10 of an inch. Because of this, patient recovery is far more rapid, and the likelihood of difficulties with the incision following surgery is dramatically reduced.

Because of the small size of the incision in phacoemulsification, new implant technology had to be developed so that the implant could fit through this new, smaller, incision. Our surgeons therefore use the so-called "foldable" implants, which are actually rolled up into a small injector, and then inserted through the same small incision that was used to allow the ultrasonic tip access. The implant is then unfolded within the eye, into its proper position within the capsular bag.

This truly remarkable technology results in far safer, more comfortable, and quicker healing for our patients. Overall, though of course cataract surgery, like all surgery, has risks, a success rate of over 98% can be expected. Patients can quickly return to their previous levels of activity. Overall, cataract surgery has come a long way from the days of long hospital stays, and sandbags around the head.