Marc A. Goldberg MD, Ophthalmologist
2000 South Wheeling, Suite 1010 • Tulsa, Oklahoma 74104 • (918) 584-4433
Corneal & Refractive Surgery • Advanced Cataract Surgery
Infectious & Immune Diseases of the Eye • General Ophthalmology
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What is a cataract?
Symptoms
Diagnosis
When to Have Cataract Surgery
The Cataract Surgical Procedure
Intraocular Lens Implant Options
Complications of Cataract Surgery
Outpatient Surgery
Convalescence
A cataract is a clouding or opacity of the crystalline lens, the focusing element of the eye. This natural lens is situated just behind the pupil. With the help of the cornea, it focuses the light rays on the retina. Technically speaking, any opacity of the lens is a cataract, but generally we usually only consider cataract removal when the clouding of the lens is sufficient enough to significantly reduce vision. Cataracts were named by the ancient Greeks. The white appearance of far advanced cataracts reminded them of the white waters or rapids and waterfalls which are also called cataracts. Today, however, only far advanced and neglected cataracts ever reach the stage of being white. [UP]
Cataracts cause blurring and dimming of vision. The pattern of clouding in a cataract can disperse light and can cause glare and halo symptoms, especially in bright sunlight and around headlights at night. Some people complain of a film over their vision making images on signs or on TV, for example, difficult to distinguish. Others complain of difficulty reading small print. Commonly the first symptoms from a developing cataract involve glare and halos around lights making night driving difficult. [UP]
In order to determine whether or not a cataract is the cause of a patient’s blurred vision, a complete eye examination is required. Such an exam includes examining the front part of the eye, including the lens, with a biomicroscope called a slit lamp, and examining the back part of the eye with an instrument called an ophthalmoscope. If a visually significant cataract is present, the diagnosis is usually straightforward. [UP]
Once a cataract starts to form, progressive visual impairment over time is commonly the rule. (Certain types of congenital cataracts may remain stable and are the exception to this rule.) The presence of a cataract on exam is not alone an indication for cataract surgery. Cataract surgery is generally reserved for patients whose cataract causes progressive visual blur or glare symptoms that negatively impact their activities of daily living such as reading, watching TV, or driving. [UP]
Dr. Goldberg utilizes the most current sutureless cataract surgical techniques including ultrasonic phacoemulsification. In this technique, a small incision is made at the edge of the cornea and the lens is emulsified (liquefied) & evacuated via a small ultrasonic probe. A clear lens implant is folded and inserted through the tiny incision to replace the removed cataractous lens. Stitches are usually not required. Visual results of cataract surgery are excellent with Dr. Goldberg’s technique. Over 95% of patients who undergo cataract surgery have significant improvement in vision with many or most patients achieving 20/20 to 20/25 vision post-operatively. Most patients can return to work shortly after surgery, and full activity including lifting, bending, and straining can generally be resumed within 2 weeks after surgery. Patients usually describe minimal to no post-operative pain which most often responds to simple Tylenol and or topical lubricants/tears. [UP]
An intraocular lens implant (synonyms: IOL/intra ocular lens/ lens implant) is almost always implanted at the time of cataract surgery – to replace the cataractous lens which is removed at the time of surgery. After assessing the visual needs of a patient, the surgeon generally chooses a lens style and power to meet the needs of the patient and optimize the patient’s post-operative vision. New-technology intraocular lens implants have been developed for the correction of refractive errors like astigmatism and presbyopia, allowing many patients to dramatically reduce or eliminate their dependence on glasses and/or contact lenses. If glasses or contact lenses are needed after cataract surgery, a pair of store bought “cheaters” for reading small print may be all that are required. If necessary or preferred, however, a prescription for glasses can usually be given in the first month post-operatively. [UP]
As with any surgery, there are potential risks and complications associated with cataract removal including infection, bleeding, lens implant complications, glaucoma or retinal complications. These complications however are quite uncommon, and truly sight threatening complications of cataract surgery are fortunately quite rare. Dr. Goldberg of course discusses the risks, and potential complications with all of his patients, and answers any of their questions prior to proceeding with surgery. [UP]
Almost all cataract procedures are done on an outpatient basis under topical (drops) anesthesia. One reason our patients do so well with outpatient cataract surgery is that it demands no more change in their daily routine than is absolutely necessary. [UP]
Most of the critical healing process after cataract surgery takes place over the first few weeks post-operatively, though significant improvement in vision usually occurs rapidly, and good vision may be achieved even the day after surgery in many cases. Follow-up visits are usually arranged for the day after surgery, at one week, one month, and three months post-operatively, to assure proper post-operative healing. Most patients are able to return to office type work in a few days and to more strenuous activity within a couple of weeks. [UP]