Learn About Cataracts

A cataract is a condition that develops in the lens of the eye. Cataracts are made from a protein that has altered from its natural state (denaturation), distorting and eventually prohibiting required light from entering into the retina, the part of the eye that receives light. Often cataracts cause no problems for many years but as the cataracts matures the cloudiness increases on the lens, the light reaching the retina decreases and significant sight loss and perhaps blindness can result. Cataracts are considered a condition and not a disease therefore they develop for multiple reasons. Secondary cataracts develop from procedures preformed to correct other vision problems such as Glaucoma. Traumatic cataracts develop from injury to the eye lens or the eye as a whole. Congenital cataracts are genetic and are found in babies and sometimes develop in childhood. There are also radiation cataracts that develop after some kinds of exposure such as excessive sunlight. It has been shown that cataracts can develop from long term use of certain steroids as well as some lifestyle habits. A cataracts can cover the eye lens partially or completely. It can be stationary, meaning its growth is in one place and slow or stopped, or it can be progressive and grow rapidly. Cataracts can also be hard or soft. In the case of any type of cataracts the procedure for treatment and eventually removal are similar. Cataracts surgery is one of the most progressive surgeries, having little or no side effects or post surgery complications. Cataracts surgery is the most common surgery performed on people over the age of 65, is covered by Medicaid and most medical insurance and the positive results are obvious within a week after surgery. Once a cataracts is removed it never comes back.

Historical Cataract Definitions

A few of the terms used to indicate varieties of cataract are quite fanciful, while still others indicate conditions that have nothing whatever, either, directly or indirectly, to do with a loss of transparency in the lens or its capsule. Even the word cataract itself (derived from, the Greek kata, down,

and arassein, to fall) has a misleading etymology, based upon an ancient and mistaken pathology. The Greek kataraktes is probably a translation of the still older Arabic word for a spot in the pupil, which meant a "waterfall," i.e., "water entering the eye." This meaning of the word is further shown by a medieval synonym for cataract, aqua descendents in oculo. Obviously incorrect and misleading, also, are such terms as fibroid cataract (opacity, not in the lens), green cataract (a medieval term for glaucoma), grumous cataract, albuminose cataract, dry cataract (cataract arida), hyaloid cataract, choridal cataract, hemorrhagic cataract, and other examples that will occur to the reader. Because of their obsolete character and for other reasons a considerable proportion of cataract nomenclature has ceased to be employed in the literature of modern ophthalmology. On the other hand, the student of medical history and of early ophthalmic literature will find the minor headings following this rubric of some assistance in his researches. Classification. As proposed by Dor, all cataracts may be divided into three general divisions, i.e., congenital, traumatic and acquired. Beard (Ophthalmic Diagnosis, p. 150) .gives a most useful classification, as to age, cause, etc. It is as follows:

According to the age at which it appears: Congenital, juvenile, adult, senile. According diabetic, to the cause: Spontaneous, malarial, traumatic, symptomatic, naphthalinic,

albuminuric, arterio-sclerotic, chemic, thermic, heat, cold, electric, glaucomatous, phosphaturic, spasmodic, ergotinic, ciliary cramp, tetanic, thryoidismic, uveitic.

According to consistency: I.1iquid, soft, 'semi-hard, hard, ossific, calcific.

A.ccording to color: White, gray, greenish, amber, black, blue.

According to extent: Total, partial, nuclear, perinuclear, cortical, capsular.

According to the seat and disposition of the opacities; Central, nuclear, perinuclear, anterior cortical, pooterior cortical, anterior polar, posterior polar, equatorial, disseminated; punctate, zonular.

According to the presence or absence of complications: Simple, complicated.

According to the period of development: Incipient or commencing, immature, mature, hyper-mature or regressive.

Etiology. Although cataract is generally considered to be (as it is in the majority of instances) a senile degeneration, yet almost all pathologic states that effect the nutrition of the eyeball may produce it. In that sense it is generally a. secondary disease, and we know that nephritic alterations, diabetes, exposure to great heat, various poisons, arteriosclerosis, ergotism, auto-intoxication, eye-strain, injury to the lens or surrounding parts, heredity, etc., are regarded as exciting causes of it. Symptoms. There are no constant symptoms of cataract in general especially in the early stages. Sight will not be much affected until the nucleus (in the area of the pupil) is involved.

Overview of the Eye and How We See

A normal part of the aging process brings about the development of cataracts in many individuals. The word cataracts is derived from the Latin word for waterfall, and is so named due to the perception that one is looking through a waterfall when a cataracts is present. Cataracts cause normal eyesight to become progressively blurry and cloudy. The once transparent,

clear lens of the eye begins to turn opaque and in some cases causes the patient to see halos around lights. In a healthy eye, the lens brings light into the eye and helps to focus it onto the retina at the back of the eye. The lens is a clear, disk-like structure located behind the iris and the pupil. In order for an image or an object to be seen, the light reflected from the object is filtered through the lens of the eye which focuses the light onto the light-sensitive membrane of the retina. The light from the image activates the membrane of the retina and is transformed into nerve signals. The nerve signals travel along the optic nerve and are translated by the brain and the final picture of the object is "seen". In order for the light to hit the retina and form a complete and clear picture in the brain, the lens must be transparent so that all of the light reflected from the image makes it to the retina. If the lens is clouded, only a portion of the image's light is received by the retina. In turn, the brain is not supplied with enough nerve signals to create a clear and sharp picture. Instead, the picture that the brain "sees" is blurry and cloudy. Additionally, when the lens is affected by a cataracts, the light coming through the lens tends to scatter, also decreasing the quantity of light finding its way to the retina. The lens is composed of three layers. There is the capsule which is a thin, clear membrane. This capsule, or outer layer, protects and surrounds the soft material of the cortex; the middle layer. Inside of the cortex lies the center layer of the lens, the hard nucleus.

Anatomy of a Cataract
Within the lens, cataracts can form in any of the three layers of the lens; the capsule, the cortex or the nucleus. Cataracts which develop in the posterior subcapsular (PSC) area (in the rear region of the lens capsule) are most often associated with diabetes and are the ones most likely to be found in a younger age group. This type of cataracts has also been linked to the long term use of corticosteroids, inflammation of the eye or eye associated trauma. In contrast, cataracts found in the cortical or nuclear areas are usually age-associated although there is a much higher risk of developing cortical cataracts when the eyes have been exposed excessively to damaging UV rays of the sun. Cataracts can develop in one or both eyes and there can be more than one type of cataracts that develops in the same eye. Over time, many individuals with a cataracts in one eye usually go on to develop a cataracts in the other eye as well. Cataracts are not painful, they do not cause the eye to tear abnormally and they are not known to make the eye itchy or red. There are three stages of cataracts currently defined; immature, mature and hypermature. If an individual still maintains part of their vision, meaning the lens still has some clear areas, the cataracts is said to be immature. A mature cataracts is one which is entirely clouded over or opaque. Finally, a hypermature cataracts has begun to leak fluid from its hard outer capsule which may lead to problems with adjacent areas of the eye.

Risk Factors
In a majority of cases, cataracts form as individuals grow older. In fact, it has been suggested that by the time a person reaches 30 years old, the beginning stages of cataracts formation has already begun, although it may take up to another half a century for the cataracts to be fully developed and in need of medical intervention. Statistics show that by age 75, 70% of Americans may have cataracts which cause problems with everyday activities. Besides age, a second leading cause of cataracts is diabetes which is also the number one reason for blindness in adults between the ages of 20 and 74. Diabetes and obesity have both been associated with early onset of cataracts formation. The problem could possibly lie with the excess sorbitol, a byproduct of high blood sugar - glucose, found in the blood of diabetics. The sorbitol may collect in the lens of the eye and promote cataracts development. Although scientists are not positive on the relationship between obesity and cataracts, the fact remains that there is an increased chance of developing cataracts if an individual is overweight and, even more alarming, the risk doubles if the person is obese, as defined by a body mass index (BMI) measurement. 11 Other risk factors for the development of cataracts include lifestyle behaviors such as smoking and the excessive use of alcohol. Male smokers who go through 20 cigarettes or more per day have a two fold increase in their risk of developing cataracts and for women, smoking 35 cigarettes or more a day increases the risk by approximately one half. 11 More than likely, smoking raises cataracts formation risk due to the higher quantity of free radicals

floating around in a smoker's body. A second reason may relate to the inability of a smoker's body to shuttle enough nutrients to the lens where they are used for proper, routine maintenance. Over time, without the correct minerals and vitamins, the lens (especially the proteins of the lens) begins to deteriorate. Long term use of corticosteroids has come under attack for its relationship to cataracts occurrence, too. In one particular study, 80% of patients on a prolonged treatment regimen of oral prednisone of 15 mg a day went on to develop cataracts. In the past, it was thought that inhaled corticosteroids were safe to use, however, a recent study published findings of a 50% increase of nuclear cataracts and a 90% greater occurrence of posterior subcapsular cataracts in those patients using inhaled corticosteroids versus the group not using the steroids. This study is especially important for asthmatic patients to take into account if prescribed inhaled corticosteroids. In many cases, however, the benefit-risk ratio must be studied by both patient and doctor. In a final note on corticosteroids, topical application to the eyelids and corticosteroid eye drops may also increase the risk of developing cataracts later in life. Injuries to the eye, also known as traumatic cataracts formation, can occur from blunt or penetrating trauma as well as exposure to alkaline chemicals. Sometimes cataracts will develop soon after the trauma and in other cases may not show up until many years later. Prior eye surgery has also been shown to increase the risk of cataracts formation. Those with a family history of cataracts run an increased risk of developing cataracts as do people that had developmental delays as a child, or were premature at birth. Being HIV positive, or of African-American heritage are both associated with a higher than normal risk of cataracts occurrence.

Finally, prolonged exposure to UV light from sunlight or even from x-rays, can increase the chance of cataracts formation. This type of cataracts is known as a radiation cataracts.

Symptoms of Cataracts
The most common symptom of cataracts is the noticeable blurring and worsening of vision. Other symptoms include the dimming and fading of colors, decreased night vision, problems with bright lights and sunshine, and in many cases, regular visits to the ophthalmologist for changes in glasses and contact lens prescriptions as vision worsens. Some patients report double vision in the affected eye although this symptom seems to decrease or disappear entirely as the cataracts grows. If an individual's eyesight grows progressively worse, it is best to schedule a visit to an eye specialist as soon as possible. They will be able to assist with a diagnosis of the problem and available treatments if required.

How do Age-Related Cataracts Form?

There are two major ways in which age-related cataracts form. Protein clumping and yellowing of the lenses. In the healthy eye, the lens is mainly made up of water and a protein called crystallins. These proteins are thought to act somewhat like filters allowing the light to enter into the eye and become focused on the retina. There is little time for repair to the lenses as they are in almost constant use. As an individual grows older, some of the protein found in the lenses begins to degenerate and clump, or gather, together. The gathering of this material blocks some of the light that would normally enter through the lens and hit the back of the eye, the retina.

A small amount of protein clumping may not affect the individual's vision noticeably. However, when enough protein clumps in one area, the amount of light entering the eye is decreased and the eyesight becomes progressively more blurry and cloudy. The majority of age-related cataracts are formed in this manner. The current theory is that the protein of the lenses is damaged by free radicals which in turn causes the proteins to clump. Free radicals can be neutralized with antioxidants but many people have too few of these in their bodies to control the free radical assaults. Antioxidants are found mainly in fresh fruits and vegetables. The second method by which age-associated cataracts form is the result of a yellowing or browning of the normally clear, transparent lens. The discoloration of the lens is a common occurrence in most of the population as age increases and is usually the result of a breakdown of lens proteins which leave behind a yellow-brown pigment. The pigment tends to aggregate together and cloud the region of the lens. Unfortunately, in some individuals the discoloration of the lens may cause everyday tasks to become more complicated. Those who suffer from cataracts of this type tend to lose the ability to distinguish the colors of blue and purple. This category of cataracts does not seem to cause blurring of shapes. Some researchers have also pointed to the possibility that age-related cataracts may form due to low serum calcium levels. Nonetheless, in many cases, age-related cataracts have no identifiable cause.

Other Types of Cataracts

Depending on the cause of the cataracts development there are several types, other than age-related cataracts, which have been defined. They are

secondary cataracts, traumatic cataracts, congenital cataracts and radiation cataracts. Secondary cataracts can form following other eye problems. Examples include an eye that was previously treated for glaucoma or a different eye problem or disease. Health problems such as diabetes can also cause the formation of secondary cataracts. Additionally, the excessive or prolonged use of steroids, including medically approved steroids, has also been linked to the increased risk of secondary cataracts development. In some individuals, cataracts may develop immediately or years after an event which causes damage to the eye. This is known as a traumatic cataracts and can occur due to blunt trauma to the eye or from exposure of the eye to alkaline chemicals. A penetrating eye injury is associated with quick cataracts development. If a child is born with a cataracts it is known as a congenital cataracts. In some cases this inherited condition may be insignificant enough to not interfere with vision, in which case it is left alone. If the cataracts does cause vision disturbances in the child the lens of the eye may be removed and replaced with a synthetic lens. The gene causing cataracts is dominant, meaning that the child need only inherit the gene from one parent to develop the condition. Other sources of congenital cataracts are specific illnesses or infections that the mother has during pregnancy. Rubella and its associated metabolic disorder, known as galactosemia, both increase the risk of having a child with a congenital cataracts. Additionally, children can develop cataracts at a young age from any number of other causes and these cataracts are also said to be congenital. The final category of cataracts is radiation cataracts. This type of cataracts may be caused from over exposure to ultraviolet sunlight and other forms of

radiation. Population studies have actually concluded that exposure to sunlight over a prolonged period of time could double the risk of cortical cataracts. Interestingly enough, cataracts which form in the nuclear area of the lens were not shown to increase in occurrence from UV exposure. 11 Moreover, patients who are taking any medication which causes skin sun sensitivity should be aware that the medication will more than likely also increases the sensitivity of the eyes to the sunlight. Drugs of this type include, but are not limited to, some antibiotics, allopurinol (used in the treatment of gout), psoralen drugs (used to treat vitiligo and T-cell lymphoma), and phenothiazine drugs (used for mental and emotional illnesses). 11

How Do Cataracts Affect an Individual's Life?

In those individuals who develop cataracts, any activity which requires clear and sharp vision may eventually become affected as the cataracts grow and allows less and less light from an image to be projected onto the retina through the lens. Even though cataracts usually develop over a long period of time, over the years the worsening of the condition may affect the ability of the individual to read, drive, see family members' faces clearly, cook, sew, or any number of activities that require clear eyesight. For those with yellowing/browning of the lens, their blue and purple color vision is affected causing problems when matching clothing, seeing pictures correctly and other activities associated with color. In some cases, cataracts patients see halos around lights. In others, the glare from car lights at night become bothersome and driving at night may be dangerous. Although far sight is affected more than near vision, if the

cataracts is bad enough, reading can become difficult as well. The independence so valued by many seniors may become severely limited in cases where cataracts are advanced enough to preclude or limit the enjoyment of everyday activities.

Can Cataracts Be Prevented?

The statistics show that more than 20.5 million Americans are currently affected by cataracts. By the year 2020, it has been predicted that the number will skyrocket to 30.1 million as the age of the baby boomers matures. So, what can be done to prevent the development of cataracts? For starters, staying healthy and avoiding lifestyle habits that increase the risk of diabetes will subsequently decrease the risk of developing cataracts. Avoid environmental exposures which have been associated with cataracts formation such as prolonged use of corticosteroids, smoking and over-use of alcohol. To reduce the risk of radiation cataracts, wear sunglasses outside to protect the eyes from UV exposure. Choose sunglasses and eyeglasses which block out the harmful rays of the sun. This is especially true for children who do not understand the affect that over exposure to rays at a young age can have on their future eyesight. The Children's Memorial Hospital in Chicago now encourages parents to remind their children to wear sunglasses when they will be outdoors for longer than 20 minutes, especially if that time period falls during the hours of 10:00 am and 3:00 pm when the sun's rays are the strongest. Pregnant females should be aware that if they contract German measles, also known as rubella, during pregnancy there is an increased risk of the

child developing cataracts soon after birth. Therefore, some professionals recommend that women planning on having a baby ask their doctor for a rubella shot at least three months before becoming pregnant. This is an easy, but effective way to prevent cataracts in small children. A recent study published in the April 2004 edition of Trends in Molecular Medicine, suggest that calpain inhibitors may slow or even prevent the formation of age-associated cataracts. Calpains have been found to possibly be a major player in cataracts development by breaking down the essential proteins of the lens if left unchecked or unregulated. The possibility of a drug introduction which regulates or inhibits the activity of calpains could greatly decrease the risk of age-associated cataracts. 1 In 2000, an article published in the American Journal of Clinical Nutrition show two Harvard performed studies which claim that when an individual's diet is high in lutein and zeaxanthin rich foods there is a 19 to 22 percent less chance of developing age-related cataracts than those who do not incorporate these foods into their diets in high quantities. Lutein and Zeaxanthin are phytochemicals, a naturally occurring group of biochemicals that are classified within the carotenoid class of molecules. Phytochemicals give plants their color, flavor, smell and texture. 2 Foods which are high in lutein and zeaxanthin include green vegetables such as spinach, broccoli, collard greens, kale, mustard greens and peppers. Winter squash and eggs have also been found to contain high levels of these important cataracts preventing molecules. 2, 7 In fact, one study which compared the bioavailability of lutein in eggs, spinach and lutein supplements found that the highest rate of lutein which entered the bloodstream came after the consumption of eggs. 9 Researchers at Ohio State University have found evidence that lutein and zeaxanthin actually function to protect the eyes from the harmful effects of UV radiation, one of

the risk factors associated with an increased chance of developing cataracts. 3 A subsequent study published in 2005, also in the American Journal of Clinical Nutrition, states that eating a high quantity of fruits and vegetables may aid in the prevention of cataracts development due to the high antioxidant content found in these foods. 4 Virender Sodhi, a Medical Doctor and practicing Naturopathic doctor in Bellevue, Washington recommends a diet high in antioxidants both from food and supplemental sources to ward off the formation of cataracts. His suggestions include taking 600-800 IU of natural vitamin E, in the d-alpha tocopherol form, along with 1500 mg of vitamin C, 200 mcg of selenium and 25,000 IU of natural carotenoids daily. The carotenoids should be divided into three doses to be taken with meals. If the high dosage of Vitamin C causes loose stools, decrease the dosage. Add at least two servings of vegetables and fruits each day with the colors dark red, orange, yellow, blue and purple. With these suggestions, the diet will be very high in antioxidants, helping the body to fight off free radical damage, which can result in cataracts later in life. 5 For those individuals who have diabetes, the risk of cataracts occurrence increases tremendously as do other eye related problems such as glaucoma. A study published in 2003 recommends several supplements which may help to prevent or at least delay the formation of cataracts in diabetics. After studying rabbit lenses in culture and the damaging effect that high blood sugar has on them, researchers concluded that supplementation with Vitamin B-6 (pyridoxine) and N-acetylcysteine (NAC), may help to decrease the oxidation of proteins; a step which causes the formation of free radicals and the increase in cataracts formation risk. 6

In 2003, the costs associated with cataracts related health care, disability and surgery totaled $6 billion dollars worldwide annually. 9 As this number will only increase as the world's baby boomers hit the age of cataracts diagnosis, the implementation and subsequent education regarding preventative measures becomes ever more important.

Diagnosis
In many cases, the diagnosis of a cataract is fairly simple. However, in the prenatal population, although diagnosis is possible it is a bit more difficult. Ultrasounds have proven an effective method to detect cataracts in unborn children. It is imperative that they be detected early if present as cataracts in babies can result in blindness for life if not treated properly and quickly soon after birth. 8 The most common way for an age-related cataracts to be diagnosed is during a routine eye exam. Since cataracts usually develop over a long period of time, in many cases they will not even be noticed by the individual if they are not causing any extreme vision changes. This is why it is so crucial, especially for the elderly, to have their eyes checked by a professional on a regular basis. During an eye exam, performed by an ophthalmologist or optometrist, there are several tests which may be administered to check for the presence of a cataracts.

A visual acuity test will measure how well the individual can see while standing at various lengths from the cue card. A slip lamp exam uses a specialized microscope to increase the magnification of the eye. The specialist can then examine the eye in detail and up close.

A tonometry test is a standard test which measures the fluid pressure inside the eye. The major finding in this test, if an increased pressure is detected, is the possibility of glaucoma.

A dilated eye exam dilates the pupil. In this manner, the specialist is better able to view the lens to check for the present of a cataracts.

Alternative (Natural) Treatment Options

In some cases, cataracts are mild enough to be treated naturally, with various herbs, exercises and other alternative therapies. Regardless, if an individual wishes to try this path, they should always speak to a doctor first as sometimes herbs and medically prescribed drugs can have serious interactions. Similarly, it is not wise to treat a serious condition without the experience of a trained specialist. The following information was extracted from Nutrient Protocols from 2001, written by Alan R Gaby, M.D. with contributions from Jonathan V. Wright, M.D. The alternative methods described below, used in a cataracts treatment protocol, are not based on clinical trials in humans, but rather on "animal research and human epidemiological studies". 12 However, as Dr. Gaby and Dr. Wright mention, there are several anecdotal reports of cataracts in early stages which have regressed with the use of some or all of the following recommendations.

Limit consumption of lactose-containing foods (milk products). In animal studies, galactose, a component of lactose, has been shown to promote cataracts formation.

A riboflavin deficiency has been implicated in cataracts development. Therefore, a supplemental dosage of riboflavin, 10-50 mg/day, may help treat or at least slow the progression of cataracts formation.

Quercetin

is

recommended in a

dosage of 500-1000

mg/day.

WARNING: Quercetin may increase the possibility of birth defects in pregnant women and is not recommended during pregnancy.

A supplemental dosage of 15-50 mg/day of zinc along with 2-3 mg/day of copper may help with cataracts.

Taking Vitamin C, 1000 mg, two times a day may help to decrease damage caused by free radicals, in turn helping to treat cataracts.

Supplementing the diet with Vitamin E at 400-800 IU/day plus selenium at 200-300 mcg/day has effectively cured cataracts in dogs.

200-600 mg/day of N-Acetylcysteine (NAC) along with zinc and copper may treat cataracts by working to destroy free radicals. 12

Other forms of natural therapies, although not backed by human studies, include Ayurveda, imagery, juice therapy and reflexology. The common therapy if using Ayurveda to treat cataracts is to bathe the eye with an eye wash made of triphala tea which can be found in most Indian pharmacies and some natural health stores. The tea is composed of a powder of three Indian tree fruits. The recommendation is to wash the affected eye in the steeped, cooled tea up to three times a day. 13 In imagery therapy, there are many images which may help to heal the cataracts. An image should appeal to each individual in order to work successfully. Different imagery sessions can be found in books, on tapes or

by seeking the expertise of a professional who works with imagery therapy. 13 Juice therapy is based on the body's need for additional antioxidants, vitamins and minerals with which it can fight the free radicals and damaging molecules that are attacking the protein of the lenses. However, most juicing experts agree that juicing therapy will only slow down the progression, not reverse the condition. 13 Reflexology has been used in some cases of cataracts therapy. The points used in reflexology hone in on the "eye, ear, neck, cervical spine, kidney and all of the points on the tops and bottoms of the toes, with emphasis on the pituitary and thyroid gland." 13 Foot reflexology charts and reflexology books are available to help locate the points which should be stimulated for cataracts treatment. 13 Finally, some acupuncturists claim that they are able to help in the treatment of cataracts by unblocking stagnant energy (Chi) within the meridians of the body. This increases the circulation of the blood throughout the entire body, possibly increasing the amount of nutrients that reach the area of the eye in need of extra antioxidants, vitamins and minerals. There is the possibility that with an experienced and licensed acupuncturist plus diet changes, cataracts may be reduced or at least the progression slowed or halted altogether.

Conventional Treatment Options

In earlier times, before conventional solutions had been perfected and introduced to the general public, many individuals who were diagnosed with cataracts went on to lead a life that included foggy and decreased vision. In

today's age of technology and advanced research, thankfully, there are more attractive options. If a cataract is causing minor vision problems, many patients will opt to better their vision through glasses or contact lenses. Eventually, however, when and if the cataracts begins to have a greater impact on the quality of life of the individual, there is the option of surgery. Glasses and contact lenses are an option for many individuals in the beginning, before the cataracts develops into a major problem. There are various contact lens types to choose from and may be more convenient for people who have an active lifestyle, work outdoors in the elements or do not like how they look in glasses. For some individuals who have had eye surgery in the past, contact lenses are the preferred choice over glasses, as glasses sometimes produce uneven vision for these people. However, in terms of conventional treatment, glasses and contact lenses are only temporary fixes for a cataracts problem. Once the cataracts or cataracts worsen and the quality of life deteriorates, and the cataracts can no longer be improved through the use of glasses or contacts lenses, the only other option is conventional surgery.

Overview and History of Cataracts Surgery

Thankfully, in today's era of modern technology and advanced research, the need to go through life with blurred and foggy vision is no longer the only option. Cataracts surgery involve the removal of the affected lens and its subsequent replacement with a new, artificial lens that functions in an

almost identical manner as the original. The replacement lens is permanent and is called an intraocular lens. Before intraocular lenses were invented, the only option if the lens of the eye was removed was a) remain blind in the eye where the lens was extracted, b) use special cataracts glasses, or c) use special cataracts contact lenses. The glasses and contacts had to be made with extremely strong lenses to replace the extracted lens. Although theses two options were better than living blind, the glasses and contracts were uncomfortable and the glasses themselves very unattractive. Additionally, the visual improvement achieved with the glasses and lenses was negligible at best and caused various other problems such as distorted vision, troublesome far-sightedness and unusual depth perception. In 1949, after studying shrapnel wounds in the eyes of soldiers during World War II, British ophthalmologist, Harold Ridley, became the first surgeon to ever replace a damaged human lens with an artificial, intraocular lens (IOL). Over the next years many doctors disagreed with replacing the natural lens with a foreign, artificial lens and the age of IOL devices almost came to a standstill. However, over time, those who were convinced that IOL's were the wave of the future, continued inventing and experimenting. The original procedures and instrumentation were soon replaced by more advanced and higher quality materials and methods. Currently, the IOL's used in surgery are of excellent quality and results are outstanding. Dr. David F. Chang and Dr. Howard Gimbel recently published a book called Cataracts - A Patient's Guide to Treatment. The following list was taken from their book: "Characteristics of Modern IOL's"

Permanently fixed inside the eye

Made of a transparent material that should never cloud. No moving parts that can wear out Lightweight and flexible Not affected by physical activities or by rubbing the eye Cannot be felt within the eye Provide the best possible vision correction Do not require cleaning Do not change the appearance or comfort of the eye Can be folded for insertion through a small incision; it then unfolds to original size" 14

The modern day IOL's give patients the best possible natural results that an artificial lens can provide and are available in a large number of strengths. The strength required for each patient is determined before surgery and will correct for near or far-sightedness.

Types of Intraocular Lenses (IOL's)

Up to this point, most lenses are replaced with monofocal intraocular lenses. These lenses only provide clear vision at one distance, far or near. A majority of patients prefer to see well far and afterward correct their near vision with the use of glasses or contact lenses. With the advent of continued research, a second type of lens, the multifocal intraocular lens, was approved by the FDA in 1997 for use in cataracts surgery. This lens provides the patient with the ability to see both far and near, although far vision is still the clearer of the two. Unfortunately, not all

patients are eligible for this type of IOL. The doctor will assess the candidate before choosing the multifocal IOL as a replacement. Additionally, some patients that are eligible and choose this form of lens may still require some minor vision correction aid for certain activities that entail near and extremely crisp, clear vision. Fewer individuals however, need glasses and contact lenses when fitted with a multifocal IOL than if a monofocal IOL had been used. Overall, patients who choose the multifocal over the monofocal intraocular lens have expressed greater satisfaction with the increased quality of living that their cataracts surgery has provided them. 15 Since multifocal IOL's have such great prospects for overall vision, researchers continue looking for a way to produce an IOL that will be ideal for a majority of patients and will correct both distant and near vision with equal success. A current possibility that meets these standards is the accommodating IOL. In 2004, a new type of IOL, referred to as an accommodating IOL, was approved by the FDA for use in cataracts surgery. Candidates for this type of IOL are most often originally farsighted. The goal of this new IOL is to give patients the ability to see both near and far after cataracts surgery without corrective vision aids such as glasses or contact lenses. This lens is not entirely fixed in one position; it is somewhat moveable and changes its position in the eye ever so slightly as the eye attempts to focus on near or far objects. This differs from the monofocal and multifocal IOL's in that they are fixed in the eye and cannot change their focus. And, finally, for those patients who underwent surgery in the past for cataracts but were not fitted with an IOL at the time, there is now secondary surgery will allows for fitting of an IOL after a previous surgery. Depending on where in the eye the IOL is placed, there are several different names. An anterior chamber IOL is placed in front of the iris. Behind the iris

there is a capsular bag, if the IOL is placed here it is known as a posterior chamber IOL. In the past, the anterior chamber IOL was the preferred method, however, over time and with increased techniques, the posterior chamber IOL is now the most commonly used. 14

Actual Cataracts Surgical Process and Procedure

Who can get surgery? A patient is deemed a good candidate for cataracts surgery if the cataract has reached a stage where the resulting impaired vision is decreasing the individual's quality of life. Many patients believe that their cataracts must be "ripe" before surgery can be undertaken. This is not true. Any cataracts can be removed during surgery. In the past, it was preferred that patients wait until the last possible moment in case any problems arose during surgery that might later impede their vision. However, today, where cataracts surgery is done on a routine basis and is one of the most common outpatient surgeries performed; there is no need to wait until the cataracts reaches a particular condition. If the cataracts is impairing vision, it can be removed. Which power of lens should be used? Before the actual surgical procedure takes place, the doctor and patient must decide which power of lens will be most beneficial for the patient. With over 65 different powers, there will surely be one that fits best for each individual. The final power will be chosen based on several factors, one of the most important being the type of lifestyle the person leads. Do they need to read up close on a regular basis or is far vision more important? In some cases a patient may opt to have a different power lens placed in each eye.

A computer generated print out, based on the criteria that is input by the doctor and patient, will calculate the proper power of lens for each patient. Unlike trying on glasses or contact lenses, there is no way to determine if the power that is chosen is the correct one, as IOL's can not be tried on before surgery. Therefore it is crucial that the doctor and patient both understand exactly what the desired outcome is so that the best choice can be made. Other medications Most surgeons do not require patients to stop or decrease their currently prescribed medication. However, this topic should be addressed and discussed well in advance of surgery. Eye Drops Patients are given special eye drops when they arrive for surgery, some may be given a few days before the procedure while others are administered only a few hours prior to surgery. There are various types of eye drops used. The first eye drop, an antibiotic, is applied to decrease the risk of infection by killing off certain strains of bacteria in the eyeball which are known to cause problems in this area. A second eye drop is used to reduce inflammation during and after the surgery. And, finally, a special eye drop is given which dilates the pupil allowing the surgeon to view the working field more clearly. Anesthesia Different forms of anesthesia, local, topical or regional are available for cataracts surgery. The specific type given to the patient will be based on

multiple variables; however, all forms of anesthesia work in such a manner that no pain is felt by the patient. One study published in 2001 studied patients that underwent cataracts surgery in both eyes. One eye was anesthetized using a local anesthesia while the other was given a topical anesthesia. In 78% of patients, the topical anesthesia was favored over the local. Most patients cited the fact that after surgery had concluded, the eye which was given topical anesthesia returned to normal more quickly than the one that had been given the local anesthesia. 16 Moreover, a 2005 study noted that after the use of topical anesthesia, there were less cases of diplopia (or double vision) reported than when regional anesthesia was used. 17 If a topical anesthesia is chosen for surgery it is administered through the use of eye drops. No injection is needed, adding to the benefit of using a topical anesthesia over a local anesthesia where the medication is injected via a small needle. The injection used in a local anesthesia has the potential to have minor side effects such as slight discomfort, swelling or bruising. This is another reason why many patients and doctors now prefer the topical eye drops. Regional anesthesia is almost never given unless the patient needs for some reason to be unconscious during the surgery. Examples include children or patients with mental/nervous disorders who cannot sit still or deal with the mental stress of surgery. Nevertheless, the surgeon and patient should discuss which anesthesia will be most advantageous to the patient, as each type provides both benefits and drawbacks, keeping in mind though that all forms serve the purpose of blocking out pain during the surgery and are extremely efficient in this

regard. One note however, is that under normal circumstances, topical anesthesia can only be used with small-incision surgery (please see An InDepth Look at the Cataracts Surgery Procedure for description of smallincision surgery).

Surgery is Safe, Fast and Easy Routinely, cataracts surgery is performed as an outpatient procedure. The patient usually arrives one to two hours before the scheduled surgery time. This period is used to prepare the patient for surgery; the required eye drops are administered, the patient is given a verbal explanation of what will occur, patient questions are answered, and the patient is then settled into a comfortable position ready for the surgery. The actual surgery only takes 20-30 minutes. The patient normally remains awake, although in some cases if there is need for sedation such as being overly anxious or fearful, a mild sedative can be given. The patient is asked to remain as still as possible and to inform the physician if any movement, such as an itch or a cough, is to be made. Typically, after surgery several post-op exams are performed to ensure that the lens was placed correctly and that the vision has returned to the eye. The patient is then given instructions for recovery and most often discharged from the facility within an hour or two post-op

An In-Depth Look at the Cataracts Surgery Procedure

How are cataracts removed from the eye?

There are currently two methods of cataracts removal. One is known as the small incision method and the other the large incision method. In the small incision cataracts removal process a very tiny incision is made in the cornea with the use of an extremely thin blade, usually made from a diamond. The slit is then widened slightly to form a circular opening. A procedure using a phacoemulsification machine is used to remove the inner nucleus of the lens. The phacoemulsification instrument is inserted into the small slit previously made and the end of this machine, made of a piece of metal probe, vibrates back and forth at a very high frequency (50,000 cycles per second) resulting in the emulsification (or breaking down into small pieces) of the central nucleus. The next step is to aspirate, or suck out, the broken up pieces of lens. A few other minor steps are completed in order to remove any left over sections of lens. At this point the intraocular lens (IOL) is placed into the region where the natural lens was just removed from. To insert the IOL, it is first folded, and then gently pushed through the circular hole that was originally made in the cornea. Once the IOL has been placed inside, it unfolds on its own and takes on the permanent shape as the new lens. There is no sewing or stitching required, the lens will remain in place. Finally, an eye drop solution of saline is added to bring back the correct intraocular pressure within the eye. Before more advanced methods had been developed, a majority of cataracts surgeries were performed using the large incision cataracts removal process. A larger cut was made, the cataracts removed in whole, without being broken up, an IOL placed into the region, and the eye was either stitched or sutured back up. Larger incisions entailed greater risks and an increased possibility for a longer recovery time. With the introduction of the small incision cataracts surgery, many of these problems have been eliminated. In

some cases, large incision cataracts surgery must still be performed but the surgeon conducting the surgery will discuss this option with the patient should it become necessary. Likewise, in cases where a cataracts must be removed from a child or baby, the process is similar to one of the above methods.

The Replacement IOL The replacement IOL, as discussed in the section Types of Intraocular Lenses, can be monofocal or multifocal. Regardless of the type, each one is centered in the eye upon replacement and is held there without any form of stitching or suturing. There are two flexible supports on each side of the lens which help to hold it in place within the eye through tension-loaded springs. Once the artificial lens is placed into position, there is no worry of it falling out or moving around within the eye. After Surgery Symptoms Some patients may find that they have some minor symptoms after surgery. This is common. Among the most commonly experienced symptoms are sensitivity to light and blurred vision - sometimes with halos around objects. Often patients will have watery eyes, or a feeling of sand being behind the eyelids. Eye redness may also occur and the dilation of the pupil may persist for one to two days after surgery. All of these symptoms will dissipate and disappear within a few days following the procedure. Recovery Instructions Most surgeons will run down the list of does and don'ts after surgery. The list will depend on the type of surgery that was performed and the health condition of the patient. In many cases there are few, in any, limitations. If small incision surgery was performed the patient will be given full permission to carry on normal, everyday functions. However, if large incision surgery was used there will be a greater number of

restrictions as the muscles and the walls of the eye may have been weakened. Straining, heavy lifting and bending should all be curtailed for the period recommended by the surgeon after large incision cataracts surgery.

Risks of Cataract Surgery

Cataract surgery has become one of the most common and well-perfected surgeries performed in North America. Its success rate is extremely high and side effects and risks extremely low. However, as with all invasive procedures, there will always be potential for problems involved. Possible complications consist of the following:

Endophthalmitis (an infection of the eye) High pressure in the eye Drooping eyelid Detachment of the retina Choroidal hemorrhage (bleeding that occurs behind the retina) Small fragments of lens which can become lodged behind the vitreous or back cavity of the eye.

Potential for loss of sight. Loss of the eye

One of the two most common side effects includes an inflammatory reaction in the eye where swelling can occur and the ocular region may be tender for a few days. This is easily treated with an antibiotic or anti-inflammatory drug. The second most common side effect is known as macular edema. This

is where there is fluid retention in the retina. Macular edema is more frequently seen in patients who already have a prior health problem such as diabetes. There are treatments for fluid retention as well; however, this problem usually resolves itself. The success rate of cataracts surgery (defined as having no serious complications and resulting in improved vision) with today's advanced methods and ultra-modern equipment is at an astonishing 95%. And, the risk of becoming blind with surgery for cataracts removal is extremely low. 18 For those few patients where surgery does not result in improved vision, there is usually a different underlying ocular condition such as age related macular degeneration (ARMD) or diabetic retinopathy. 19 On the flip side of the coin, there are great advantages in quality of life and safety issues related to the successful treatment of a cataracts. Patients report improved ability to drive, read, walk, and work, practice hobbies, engage in social activities and increase their self-reliance, self-confidence and independence. What to expect after surgery In some cases after surgery, the surgeon may require the patient to wear an eye patch for a specified time frame. This mainly occurs with large incision cataracts surgery but is possible with other forms as well. Additionally, most patients will continue with the anti-inflammatory and antibiotic eye drops for several weeks. Patients will return to visit the surgeon for a follow-up appointment within a day or two of surgery to assess the procedure and results. If stitches were needed after surgery they most likely will dissolve on their own requiring no additional appointment to have them removed. A majority of patients are able to return to a full schedule of activity to include physical

movement, reading, driving and watching TV within a matter of hours or a few short days. As the best vision resulting from the cataracts surgery won't usually show up until several weeks later (although the time frame varies extremely from individual to individual) the surgeon will more than likely request that the patient wait approximately four to six weeks before obtaining a new eye glass or contact lens prescription. People who have had cataracts surgery are pleased with the results obtained and site improved vision, enhanced views, and brighter colors. Many claim they can see better after surgery than they could before the cataracts ever formed. Will the cataracts return? A cataracts cannot return for one simple reason. The natural lens upon which the original cataracts formed is removed during surgery. However, some clouding may take place over a few years within the posterior section of the lens capsule itself. The cloudiness is a result of cells gathering in the middle of the capsule and preventing incoming light from hitting the retina. If this occurs there is a very simple and safe procedure which can be performed. The outpatient process for clearing up this minor problem is called YAG capsulotomy. It is painless and quick. YAG capsulotomy requires the doctor to make a small hole in the capsule with a laser beam to allow light to pass through. In the past, before YAG capsultomoy was used, a small incision had to be made and a tiny knifelike instrument inserted into the eye to cut a tiny hole into the posterior capsule. Today, however, as the hole is cut with a beam of light there are no knives or surgical incisions required. The light beam is directed to the center of the capsule, creates a small opening and clears the cloudiness.

Vision aids after surgery After surgery is performed many patients will still require glasses or contact lenses to bring objects into completely clear view. This is normal. However, in most cases the power of glasses or contact lenses required is less than what was needed prior to surgery. Additionally, after surgery the patient no longer feels as thought they are looking through a "cloud" or "fog". It is advised to wait at least a month before obtaining new glasses or contact lenses to give the eyes time to readjust and come back to a new "normal". Since some of the new artificial intraocular lenses (IOL) block UV radiation, in some cases it is not necessary to wear sunglasses after cataracts surgery - check with the surgeon. However, many people enjoy wearing sunglasses or feel more comfortable with them on. If this is the case, by all means, wear them. Complicated Cataracts In rare cases, cataracts may be more complicated to remove than the norm. An experienced and skilled surgeon however, will still be able to perform the cataracts removal surgery with few problems. A complicated cataracts may be one that is referred to as a mature brown cataracts. In this case, the cataracts has progressed to the point that it has hardened and become solid in the center. To remove this type of cataracts more force is required to break the cataracts apart. If the surgeon determines that the risk is too great for a small incision cataracts removal surgery, the large incision method will be considered instead.

Additional Information Regarding Cataracts Surgery

Cataracts surgery after Lasik

Although it is possible to have cataracts surgery after Lasik, it is much more difficult. In Lasik, the cornea of the eye is reshaped to enhance and correct vision. The problem is, after Lasik it is very hard to determine what power of intraocular lens (IOL) the individual will need during cataracts surgery. As people age, cataracts are a normal occurrence, for this reason, if a patient is over forty and their doctor recommends Lasik to correct the vision, it is advised to seek a second opinion to ensure that the problem is not actually being caused by a cataracts. Insurance and Cost Associated with Cataracts Surgery In most cases, cataracts surgery is covered by Medicare, PPO insurance and HMO's. In 2002, the most recent data shows that Medicare paid for 1.733 million cataracts surgeries in the United States. 20 Most insurance companies and Medicare will pay for the cataracts removal surgery once a patient's eye sight has deteriorated to 20/50 or less when tested on a standard eye chart. 20 The surgery and the IOL's however are different. In some instances insurance companies will pay the entire process as one bill, while in others there will be as separate cost for surgery and for the artificial IOL's. Additionally, some IOL's, such as the new accommodating lenses, are not covered by insurance companies. In this case the lenses must be paid out of pocket by the patient. It is best to check with both the insurance companies and the surgeon's administrative staff to ensure no misunderstanding of who will pay for what part of the procedure. Who performs the surgery?

A cataracts surgeon is a general ophthalmologist. An ophthalmologist is a medical doctor. This type of doctor has chosen to specialize in eye care to include surgery of the eye. There are general ophthalmologists who treat and diagnose eye diseases and problems and prescribe eyewear. General ophthalmologists can also perform surgery for common eye conditions such as cataracts. A specialist ophthalmologist has received additional training and experience in order to treat specific areas and diseases of the eye.

Cataract Surgery
Cataract surgery is one of the most common surgeries performed. It is a very quick and safe surgery and is relatively painless. Two types of anesthetic are generally used, those being an eye drop numbing agent or an injection given near the eye that numbs and blocks all pain in the region of the eye. Before the surgery the physician measures the cornea and the length of the patient's eye to determine the proper power of lens implant needed for successful completion of surgery. Once measurements are completed and the eye region is numb surgery can begin. The old clouded cataracts lens is removed and a new artificial one is implanted. The entire procedure normally takes less than an hour and is an outpatient procedure. Micro surgical techniques have enhanced the outcome of cataracts surgery and enabled recovery time and dependence on post surgery corrective lenses to decrease dramatically. Two types of cataracts surgery are Phacoemulsification and Extracapsular extraction. Phacoemulsification leaves

the outer-most layer of the eye's lens capsule in tact and removes the cataracts through a small, approximately 1/8 inch, incision where the cornea meets the conjunctiva. (The conjunctiva is the membrane that covers the white part of the eye and the inner part of the eyelid.) The surgeon then inserts a needle probe and uses ultrasound waves to emulsify (break apart) the cataracts and suction to remove the broken parts. Extracapsular extraction requires a slightly bigger incision and is performed when the cataracts is too hard or advanced to be emulsified by sound waves. The lens capsule is opened and the nucleus is removed in one piece and the softer lens capsule is vacuumed out, leaving the lens capsule in tact for support of the new lens. Once the cataracts has been removed a clear lens is put in its place. This lens is called an intraocular lens (IOL), is usually made of silicone or acrylic, and becomes a part of your eye. Some IOLs are rigid and require sutures, but many are flexible and can be folded and enable the use of smaller, selfsealing incisions. The shape of self-sealing incision takes into account the fluid in the eye, and when the cut is made, the shape of the incision creates a flap and seals itself shut. The benefits of this type of incision are proven by shorter surgery time, less recovery time, less vision adjustment time after lens insertion and less discomfort after surgery.

Cataracts Development
Cataracts are usually associated with the aging process. As a cataract ages the protein on the eye's lens becomes dense and opaque. Cataracts, when small, start as white and cloudy but as the protein on the lens ages it acquires a yellow or brown tint. While this tint itself doesn't lessen the sharpness of images seen it does make tasks having to do with color difficult as the tint effects what is seen through the lens of the eye. In advanced

stages differentiating between dark colors can become difficult if not impossible. The eye's lens consists mostly of water and protein. When a cataracts is formed it clouds the lens and reduces the light entering the eye. The first symptoms of a cataracts are a blurring around the ridge of the line of vision. The image it produces can be compared to looking through a window in winter that has frost around the edges. At this stage the cataracts is still small. While there won't be any real changes in vision aside from noticing the first symptoms, over time the cloudy area may get bigger as the cataracts increases in size. As the cataracts grows vision gets duller and blurrier. Development of cataracts is considered a normal part of the aging process. Roughly 70% of all people over the age of 75 have some kind of cataracts formation. Cataracts develop not only from age but also from an injury to the eye. A blow directly to the eye, the eye socket or an injury directly to the eye lens can create traumatic cataracts. These injury-acquired cataracts sometimes wait to show themselves until years later. A metabolic problem or diabetes can aid in the development of cataracts as well due to the changes and fluctuations in body chemicals and proteins. Cataracts can also be caused by long term use of certain oral steroids and medications such as those used to treat breast cancer (tamoxifen), medicines for the treatment of gout (allopurinol), and medication for the treatment of irregular heartbeat (amiadorone). Smoking has been linked to cataracts development. It has been found that the chemicals within inhaled smoke can be linked to the breaking down of the natural proteins in the eye. Exposure to radiation such as infrared and micro-waves have been associated with cataracts, as well as the use of alcohol.

Complications

In rare cases there can be complications to cataracts surgery. There can be loss of vision, bleeding, double vision and infection. Inflammation and fluctuating eye pressure can be a side effect of this surgery as well. While instances of side effects are documented it should be said that they happen rarely. Retinal detachment is a condition that occurs when fluid seeps through a tear in the retina. The seepage causes the retina to detach from the back of the eye. While cataracts surgery isn't the only cause of this problem it occurs in approximately one half of one percent of cataracts surgery patients. Retinal detachment also occurs in patients who have had previous eye surgeries and who are extremely nearsighted. Symptoms of retinal detachment are flashes of light or dark spots in the field of vision. Some of these symptoms occur naturally after cataracts surgery, but patients who experience them should contact their doctors immediately. Another symptom is a shadow that seems to move across part of or the entire field of vision. If this occurs the physician should be contacted immediately. Cystoid macula edema is decreased vision in the central part of the visual field due to swelling in the layer of nerve cells that covers the entire back part of the eye, called the retina. The macula is the part of the retina that responds to light in the central part of the visual field. After a cataracts surgery that has had no complications, the blood vessels in the retina can swell and leak and as the fluid accumulates the macula can swell. As time progresses after a cataracts surgery and the patient notices decreased vision he should contact his doctor and tests can be done, such as ocular coherence tomography, to determine the extent of the swelling. This condition can be treated by anti-inflammatory eye drops or injections of steroids to the back of the eye. In some cases vitrectomy surgery can resolve the problem.

Posteriorly dislocated lens material is the rare occasion that fragments of the cataractous lens have fallen into the cavity behind the membrane that surrounds the lens. A procedure called a vitrectomy can remove the particles and reduce swelling. Endophthalmitus is an infection inside of the eye. Symptoms include pain and excessive redness and swelling, sensitivity to light and perhaps loss of vision. Usually these symptoms reveal themselves within the first few days after surgery. Antibiotic eye drops are administered the day of surgery. In spite of this, 1 in 3,000 patients develop endophthalmitis. Choroidal hemorrhage is when the choroid, the web of fine blood vessels that supplies blood to the retina, begins to bleed during surgery. It usually occurs in older patients or patients who have high blood pressure or have glaucoma. A hemorrhage confined to a small area will have very little visual loss but if the hemorrhage is severe then significant visual loss can occur. Modern micro surgical techniques, however, rely on small incisions and so therefore the severity of hemorrhages has reduced dramatically. Secondary cataracts are cataracts that develop years after cataracts surgery. It is a condition that clouds the back of the lens capsule. This is part of the lens that wasn't removed during the first surgery and that supports the lens implant (IOL). This condition can also be called 'aftercataracts' and posterior capsule opafication. The problem is treated quickly and simply with a laser called yttrium-aluminum-garnet, or YAG for short. Cells have grown on the back of the lens and the laser is used to make a small incision in the lens to let light pass through. It is a quick painless procedure that usually takes less than 5 minutes to complete. The patient can resume normal activity within hours.

Recovery Expectations
The recovery from cataracts surgery is usually quick with little or no problems. If a phacoemulsification procedure was done recovery will be all the more quick and uncomplicated. With more standard cataracts surgery, the recovery time is still fairly short but due to the necessity of healing of sutures it is longer for a full healing process. Normally the patient can go home the same day as the surgery. The patient should be sure to make arrangements for a ride home as driving after eye surgery isn't possible. Bending and lifting are usually prohibited for a few days after surgery. Follow up visits with a doctor are normally the next day, the following week, and then a month after the surgery to see how the healing process is progressing. Sometimes an eye patch is prescribed for a day or two after surgery. There will be some discomfort and perhaps some leaking of fluid from the eye. Pressing on the post operative eye will cause damage, so the patient must take extra care to treat the eye delicately and wipe away any discharge with a clean tissue without rubbing or pressing. The ophthalmologist will usually prescribe a pain medication. A few days after surgery most if not all discomfort will disappear.

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Overview of The Eye and How We See Anatomy of a Cataract

Risk Factors Symptoms of Cataracts How do Age-Related Cataracts Form? Other Types of Cataracts How Do Cataracts Affect an Individual's Life? Can Cataracts Be Prevented? Diagnosis Alternative (Natural) Treatment Options Conventional Treatment Options Overview and History of Cataracts Surgery Types of Intraocular Lenses (IOL's) Actual Cataracts Surgical Process and Procedure An In-Depth Look at The Cataracts Surgery Procedure Risks of Cataract Surgery Additional Information Regarding Cataracts Surgery Surgery Development Complications Recovery Expectations Lasik Eye Surgery

Cataract Learning Center

Early day Cataract diagram

Section of the Eyeball to Show the Crystalline Lens System and Its Relation to Cataract a. Cornea; b. Iris; c. Lens; d. Zonula of Zinn; f. Ciliary Body; g. Canal of Schlemm; m. Retina; j. Choroid; k. Sclera; H. C. Hyaloid Qanal; 1. Maculat; o. Optic Nerve; w. Anterior Capsule.