Cataract

Cataract and Cataract Eye Surgery

 

What are cataracts?

A cataract is the clouding of the natural lens inside the eye. The lens is normally clear in our youth, but as we age the lens becomes cloudy.
 
cataract
 
Once cataracts cause visual difficulty and impair your day-to-day lifestyle, it is important to discuss these visual difficulties with an ophthalmologist.

 

What causes cataracts to develop?

Cataracts develop because of a natural aging process in the lens itself. Ultraviolet (UV) exposure may play a role, but otherwise we aren’t completely certain of the cause. Some cataracts occur in younger people due to direct trauma to the eye (such as getting hit in the eye with a ball), genetic conditions, medications, or occasionally vitamin deficiencies.
 

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 may notice that television captions become increasingly difficult to read.
 

Can cataracts be reversed or prevented?

Generally speaking, no; however, wearing ultraviolet (UV) protecting sunglasses may help reduce the progression of cataracts. In addition, a balanced diet containing a reasonable amount of antioxidant vitamins may help slow the progression of 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.
 

When should cataracts be removed, and why?

The decision for surgery is based on when vision problems begin to interfere with normal activities of daily living, like driving, reading, work, or hobbies. Poor vision due to cataracts can be a serious health risk. If you can’t see something in your path due to the cataract, you may trip or fall, leading to an injury.
 

About Cataract Surgery

Who performs the procedure?

Dr. Benjamin Chun performs all cataract procedures.
 

Is cataract surgery performed in a hospital or in an ambulatory surgery center?

The majority of our patients have their cataract surgery performed as an outpatient procedure at UPMC Mercy South Side Outpatient Center in Pittsburgh or South Hills Surgery Center in West Mifflin.
 

Can I drive myself to and from the surgical center on the day of surgery?

No. Even if you elect not to have relaxing medication administered before surgery, your vision will be blurry in the operative eye (due to dilation and anesthesia) and not suitable for driving. You must arrange for transportation to and from the hospital outpatient center or surgical center.
 

How long does the cataract surgery take?

Cataract surgery takes about 10 minutes in the operating room. Most people are in the outpatient or ambulatory surgery center for about 90 minutes, including pre- and post-operative time.
 

Can I have cataract surgery performed in both eyes at the same time?

No, we make sure your first eye is healing correctly and you are seeing well before Dr. Chun performs surgery on your second eye. Typically, the surgeries are done 2-4 weeks apart.
 

Is cataract surgery performed under a general anesthesia?

Cataract surgery is routinely performed with local anesthesia. Intravenous medications are usually administered to help patients fully relax. Numbing drops are also given so patients feel comfortable during surgery. A small number of patients may require general anesthesia and/or the surgery to be performed at an inpatient hospital operating room due to other medical conditions.
 

Is cataract surgery painful?

Thanks to numbing drops and medications to help you relax, this procedure involves minimal discomfort. It is normal to experience some scratchiness, foreign body sensation, or a mild headache during the first 24 hours after surgery, but severe pain is rare and should be reported to Dr. Chun right away.
 

How is the cataract removed?

The cataract is removed during a 10-minute procedure. A small opening (less than 1/8 inch) is made in the front of the eye (the cornea) to allow for the smooth removal of the natural lens material. An artificial Intraocular Lens (IOL) implant made of silicone or plastic is folded into itself and then inserted into a small incision made in the eye. After insertion, the lens opens and is placed into the proper position. The standard IOL can be selected to correct nearsightedness or farsightedness. Multifocal lens implants are designed to correct vision at all distances, and toric lens implants address astigmatism.
 

Cataract Surgery

cataract-surgery
 

Can you correct astigmatism during cataract surgery?

Cataracts and astigmatism are common ophthalmologic issues that affect many of our patients. In many situations, Dr. Chun at The Cataract & Laser Institute of Pennsylvania uses the Limbal Relaxing Incisions (LRI) surgical procedure to correct astigmatism during cataract surgery. With LRI, incisions are made at the edges of the cornea, reshaping the cornea and correcting the astigmatism. Because the cuts are outside of the field of view, they do no not cause glare or other visual effects.

The combination of the cataract surgery with an LRI allows our patients to accomplish the correction of astigmatism at the same time as cataract removal.
 

What is bladeless Laser-Assisted Cataract Surgery?

Just as there are options when it comes to choosing the lens that you receive during cataract surgery, there are also options in the technology that’s used to perform the procedure. That means, in most cases, you have the choice between surgery performed by hand or with the assistance of laser technology.

Either type of procedure can be effective when performed by Dr. Benjamin Chun, but laser-assisted cataract surgery procedures can be more predictable, more precise, and more gentle.
 

Customized Precision with the LenSx® Laser

If Dr. Chun and you believe that laser cataract surgery is right for you, he will operate using the LenSx® Laser, which offers a level of accuracy exceeding that of manual surgery methods.

The LenSx® Laser first measures your eye to plan a procedure that’s unique to you. It then performs incisions to break apart the cataract with more speed and precision than is possible manually, increasing accuracy and contributing to more predictable surgical outcomes.

Medicare and private insurance typically cover some of the costs associated with laser-assisted cataract surgery. In most cases, there may also be out-of-pocket expenses involved, including the charge for the use of the laser as well as the charge for implanting advanced technology lenses.
 

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. However, it is possible 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 years after surgery, and is sometimes called a “secondary cataract.” Treatment of this film is simple and done with a laser in our office. There are usually no post-operative restrictions or downtime.
 

Are there different types of lenses?

Yes, there are!
 

Monofocal IOLs

Monofocal lenses were the first lens type created. They are still in use today and are the lenses included in the basic cataract procedure covered by Medicare. The word monofocal means that patients can select “one best” vision type, either near or far. Monofocal lenses leave patients dependent on glasses and/or contact lenses for whatever “one best” vision type was not selected and as such, certain lifestyle activities are impacted (for example, golf or needlework).
 

Lifestyle IOLs

Lifestyle IOL implants refer to a category of lens implants determined by the Centers for Medicare and Medicaid Services (CMS) as new technology Intraocular Lenses (NTIOLs). Lifestyle lenses allow for viewing at all distances, and thus are suited to ANY LIFESTYLE.

Medicare does not cover the cost of Lifestyle IOLs. However, they do allow members to pay the difference in cost for the new technology lenses when they have their cataract surgery. These lenses are also called “premium lenses” because patients usually pay out of pocket to receive these lenses. The terms premium lenses and lifestyle lenses are basically interchangeable, although technically “premium” simply refers to the pricing, while “lifestyle” refers to their performance.
 

What types of Lifestyle IOLs are there?

A multifocal IOL has several rings of different powers built into the lens. As its name suggests, a multifocal lens allows for multiple viewing distances. The part of the lens (ring) you look through will determine if you see clearly at a far, near, or intermediate distance. ReSTOR® IOL is Dr. Chun’s preferred multifocal lens.

Toric IOLs designed to correct astigmatism are also considered “premium” lenses.
 

What restrictions will I have after cataract surgery?

After surgery, an eye shield is placed on the healing eye. During this time we recommend restful activity. Patients can begin administering their post-operative eye drops as soon as they go home. Patients should wear the eye shield every night for one week following surgery. During the day, eye protection such as the shield or eyeglasses is recommended.

For two weeks after surgery, heavy lifting (more than 20 pounds) is not allowed, and we recommend avoiding eye makeup for two weeks. All restrictions will be fully discussed with you prior to surgery. No bending at the waist for one week.
 

What are the risks of cataract surgery?

There are risks with every kind of surgery, and cataract surgery is no exception. The risk of complications, such as infection, severe bleeding during surgery, or retinal detachment, is about 1 in 1000. 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. Chun has extensive experience performing cataract surgery and can fully discuss these risks during an office consultation.

cataract-machine-piclensx-pic