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Cataract Surgery: A Guide to Treatment

Cataract Surgery: A Guide to Treatment

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Cataract Surgery: A Guide to Treatment

134 pagine
1 ora
Sep 10, 2015


Having cataract surgery? Nearly 3 million Americans who have cataracts removed each year. In fact, it's the most commonly performed surgery in the nation. And, the numbers are expected to increase--by the year 2020, nearly 30 million Americans will have cataracts. Even though cataract surgery is a common procedure, you may find yourself feeling anxious about an operation on your eye. Ophthalmologists Paul E. Garland, M.D. and Bret L. Fisher, M.D., have performed thousands of cataract surgeries, and they understand your questions and concerns. They answer questions such as: How long should you wait to have cataract surgery? What type of anesthesia is used? How is the cataract actually removed?
Sep 10, 2015

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Cataract Surgery - Bret L Fisher



If you’ve just learned that you have a cataract, you may be apprehensive about what happens next. Rest assured, cataracts are a very common eye problem, typically related to normal aging. We’re all likely to experience cataracts—the clouding of the eye’s lens. Fortunately, the vast majority of people who suffer from cataracts today can undergo successful outpatient surgery to treat them. In many cases, physicians can remove the cataracts and improve vision problems such as nearsightedness, farsightedness, or even astigmatism.

As cataract surgeons, we want to help our patients make informed decision about their cataract treatment. We wrote this book to help you understand how cataracts are removed and how your visual clarity is restored. We explain advances in technology and techniques that have made cataract surgery the most commonly performed operation in the United States. We hope that Cataract Surgery educates you about how cataracts are removed as well as give you peace of mind about your surgical procedure.


Cataracts: An Overview

Age-related cataracts are common. Most of us will develop them as we grow older. The American Academy of Ophthalmology suggests that by age seventy-five, 70 percent of adult Americans will experience the blurring and distorted vision associated with cataracts. Statistics suggest that by the year 2020, cataracts will affect more than 30 million Americans, a considerably higher number than the 20 million adults affected today.

But what exactly is a cataract? What are the symptoms? And what puts you at risk for developing them? It’s important that you pay attention to cataracts once they start developing because they can gradually, but significantly, reduce your vision and even cause blindness. The good news is that, thanks to modern medicine, cataracts are very treatable, and impaired vision can be restored.

What Is a Cataract?

The term cataract has ancient roots in the Greek and Latin terms for waterfall. That’s because centuries ago people believed the clouding in their eyes actually came from an opaque material flowing like water over their eyes. Indeed, a cataract is a clouding of the eye lens. As the cloudiness increases, the cataract can blur or distort your vision and cause colors to fade. If not treated, cataracts can lead to blindness. Most cataracts are related to normal aging, but they also can result from other issues such as trauma, sun exposure, or diseases. To understand how any cataract forms, it’s helpful to understand the makeup of the lens of your eyeball. The lens is made up mostly of protein and water. The protein is arranged in such a way that when light passes through it to get to the retina, it does so without distortion.

Eye Anatomy

As people age, however, changes in the eye cause protein to break down and clump together, creating a buildup that hardens and blurs your vision. More specifically, the lens thickens, becoming less flexible and transparent. At first, the clouding involves a small area, but over time it increases in size, density, and color, eventually engulfing the entire lens. Your vision is affected because the clumping scatters light coming through the lens in such a way that a sharply defined image can’t reach the retina. Your lens no longer has the ability to adjust appropriately to see up close or far away. Instead, everything you see is faded, distorted, or blurred.

How the Eye Works

The human eye works much like a camera. In a camera, an image passes through the lens and strikes the film, where it is imprinted into the film. In the eye, an image passes through the lens onto the retina. The image message travels through the optic nerve to the brain, where it is interpreted.

Types of Cataracts

Eye surgeons have different ways of classifying cataracts based on their location within the lens. The three basic types are nuclear, cortical, and subcapsular, as explained in the text that follows.

Other types of cataracts, which are not caused by aging, are named according to their underlying origin. For example, these include congenital and traumatic cataracts.

Nuclear Cataracts

Nuclear cataracts are the most common type of cataract. They form in the center, or nucleus, of the eye. They can start forming when you’re only in your forties or fifties, but they usually don’t significantly affect vision until you’re in your sixties and seventies. In fact, by age seventy most men and women have some degree of clouding. Nuclear sclerotic cataracts cause yellow tinting that can eventually harden into a dense yellow or brownish yellow center. Vision gradually deteriorates with symptoms ranging from blurring and seeing halos around objects to having difficulty in distinguishing color or contrasts.

Cortical Cataracts

Cortical cataracts develop along the edge (cortex ) of the lens. They begin as streaks of whitish, wedge-shaped growths that eventually extend, like the spokes of a wheel, from the edge into the center of the lens. Because of this pattern, light tends to scatter when it hits the lens, causing initial problems with glare. Although older adults can develop cortical cataracts, they’re a common problem in diabetics of all ages.

Posterior Subcapsular Cataracts

Posterior subcapsular cataracts form at the back of the lens, directly below the pocket or membrane that surrounds the lens. These cataracts begin as small cloudy areas blocking the path of light to the retina, causing light to scatter rather than remain focused. Symptoms include trouble seeing close-up for reading and sensitivity to bright light, causing severe glare. These cataracts tend to develop relatively quickly, in months rather than years. Although posterior subcapsular cataracts can be related to aging, they’re more commonly associated with diabetes and prolonged use of prednisone or other prescription steroids. And, they tend to be seen in younger patients.

Nuclear Cataract

A nuclear cataract is the most common type of cataract. It can cloud the entire lens

Cortical Cataract

A cortical cataract forms as a wedge on the lens and gradually extends spokes toward the center of the lens.

Posterior Subcapsular Cataract

A subcapsular cataract forms toward the back of the lens and interferes with incoming light.

Congenital Cataracts

Unlike cataracts that develop as part of aging, congenital cataracts are present at birth. Although they can be associated with another medical condition, such as Down’s syndrome, they also may be caused by genetics or a mother’s health during pregnancy. If a woman experiences an infection such as German measles, for instance, her baby may be at risk for congenital cataracts. Cataracts that develop later in childhood are sometimes referred to as pediatric cataracts. Although they may be tied to other health conditions, they also can be caused by traumatic injuries to the eye. Damage can take months to years to develop. Congenital and pediatric cataracts are relatively rare. They occur in approximately 3 out of 10,000 children.

Traumatic Cataracts

Traumatic cataracts are cataracts that result from traumas to the eye such as a blunt force, a penetrating injury, or exposure to certain chemicals. They can develop immediately or years later. The cataract forms at the site of the injury, which may involve the entire lens. As noted earlier, traumatic events to the eye are often the source of pediatric cataracts.

Immature and Mature Cataracts

Although most cataracts develop gradually, some individuals may experience rapid growth, particularly if several areas of the lens are affected. In either case, a cataract’s natural progression from immature to mature is such that at first the clouding is not visible to the naked eye. You likely won’t have noticed it because you aren’t having any problems with your vision. The only way your eye doctor knows the cataract is forming is through a comprehensive eye examination.

As time passes, cataracts can advance to a more

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