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 A cataract is any clouding or opaque area in the eye's natural lens, which is normally crystal clear. It is not a tumor or skin-growth over the eye. Most cataracts progress and eventually hamper vision, but merely having a cataract does not necessarily mean you have to do anything about it.

 No one knows why some cataracts develop rapidly and others slowly. Generally, the clouding of the lens is a slow, gradual process that may take decades. On the other hand, with


 some conditions, such as poorly controlled diabetes, a cataract can progress rapidly. 

What Causes a Cataract?

 Cataracts are not caused or made worse by using or "overusing" your eyes. Most cataracts develop as part of the aging process, from a change in the chemical composition of the lens. Several major studies have shown that prolonged exposure to sunlight over many years, especially the ultraviolet-B rays, can hasten their development. Mostly they don't become a problem until your 60s or 70s. If everyone lived long enough, we would all develop cataracts.       

        Cataracts can also occur at any age from an eye injury (even many years earlier), certain eye diseases (such as uveitis), medical conditions (such as diabetes), heredity, birth defect, some medications (such as steroids, diuretics, tranquilizers), excessive alcohol consumption, and smoking.

How Do You Know if You Have a Cataract?

        In the early stages, a cataract may not cause any symptoms at all, or you may notice a gradual blurring or dimming of vision. Using a bright reading light may help you see better (but it may also make vision worse!). You might not notice even a dense cataract in one eye if your other eye sees well. You may see "halos" or haze around lights, especially at night, and/or have hazy or double (or multiple) vision. The symptoms may occur only in dim light or when you face bright oncoming car headlights, which makes night driving difficult.

        Eye pain, headaches, and eye irritation are not symptoms of a cataract. Unless a cataract is very dense and white, it will not be visible to a casual observer.

How Are Cataracts Treated?

        Once a cataract has formed, it cannot be reversed. The only effective treatment is surgical removal of the cloudy lens. Cataract surgery is one of the safest operations performed today. The high success rate is due to advances in microscopic techniques and high-tech precision instruments.

       If the cataract is mild, surgery may be postponed for a while by changing your glasses prescription. If you have cataracts in both eyes, surgery is not done at the same time. You usually wait for the first eye to heal before it is safe to proceed with the second surgery -- typically one week is adequate for healing between eyes.

Who Decides When To Remove a Cataract?

        You do. You can postpone surgery until the cataract interferes with your vision so much as to make a difference in your life or livelihood. You will be advised that you are a candidate for the surgery and how much improvement in vision you can expect from a cataract removal that is free of complications. You will then have to decide if the cataract is causing you enough trouble to warrant surgery. Since everyone's visual needs differ, this point will differ from one person to another. It is not necessary to wait until a cataract is "ripe" (totally opaque) before having it removed.

There are certain rare circumstances that require cataract removal regardless of vision: if the lens begins to break down (become "overripe"), if the lens releases chemicals (breakdown products) that might damage the eye and contribute to a type of glaucoma, or if the cataract is so dense that it prevents observation or treatment of another eye problem.

How Is a Cataract Removed?

        The surgery is typically done in an outpatient surgical suite.  During surgery, your eye remains in its normal position. It

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 is never taken out of its socket.   A small incision is made in the front of the eye and an instrument is inserted into the eye to remove the cloudy lens.  The lens is then removed by phacoemulsification.  With "phaco," a needle-like instrument that vibrates at high speed is inserted into the cataract to break it up. Then the tiny fragments are gently suctioned out, and an artificial lens (IOL) is inserted. The incision is self-sealing and rarely requires stitches.       

Will You Be Awake During the Operation?

        Most people choose to stay awake (though drowsy) with a local anesthetic to numb the nerves for pain. You will be given a sedative through an IV line, and eye drops to numb the eye.  General anesthesia is rarely necessary.  If someone is unable to hold still or does not tolerate the sedation, it may be used. Children always need to have general anesthesia.

When Can Normal Activity Be Resumed?

You will probably be up and around on the day of surgery. You should be able to resume full, normal activity in a few days, although heavy, strenuous activity should be avoided for the first week.  Swimming is also not recommended for a week following surgery.

What Will Vision Be Like After Surgery?

Your vision after surgery will depend on many factors, such as your vision before the cataract developed and the eye's overall condition. Most patients will notice improvement in the vision in the first day or two.  Complete healing in most cases takes about a week.  The IOL is a permanent replacement for your natural lens. After it has been placed inside your eye, it requires no care. You cannot feel or see it, and it is not noticed by others.

        Even though vision can be good with an IOL, you may require some correction for reading and possibly a correction to fine-tune your distance vision.  A multifocal IOL is now available that is designed to allow both distance and near vision.  This lens does have some trade-offs.  It may take several weeks before the operated eye is fully healed and vision is stabilized.

        Some patients, even with optical correction, do not obtain clear eyesight after surgery. Some have pre-existing disease affecting the retina (such as macular degeneration) or optic nerve (such as advanced glaucoma). Others develop one of the rare complications of cataract surgery.

What Complications Are Possible?

        Any eye surgery, no matter how safe, presents some risk of infection, corneal problems, chronic intraocular inflammation, or retinal swelling and detachment. Fortunately, these are usually temporary and/or can be treated with medications or surgery.

        Surgical results can never be guaranteed, but the odds are excellent that everything will be fine, and you will see just as well after the operation as you did before the cataract developed, and perhaps even better.

To learn more about Cataracts and the health care we can provide,

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