Cataract Surgery

Cataract Surgery:

As we age, the eye’s lens becomes thicker and discolored. Eventually, this clouding is classified as a cataract. Cataracts can affect the general clarity and crispness of vision. As a cataract develops, these symptoms become more pronounced. Often the cataract will cause glare and light scatter with bright light sources. Cataracts often contribute to difficulty with night driving as well as general clarity during the day.

Most cataracts develop slowly for many years. Often, your doctor will monitor your cataract growth to ensure that the cataract is not affecting you overall ocular health. Your doctor may update your glasses prescription annually, as it may slowly change as a result of the developing cataract.

Occasionally, some cataracts can develop more quickly, over the course of a few months. This is more common in poorly controlled diabetics, patients on certain medications (like steroids), and patients with a history of ocular trauma and some intraocular surgeries.

The doctors at Owasso Eye Institute provide routine exams to monitor for cataract development and also offer advanced, no stitch cataract surgery. Should cataract surgery be required, your pre-operative and post-operative examinations can be performed in our Owasso office, conveniently located in the St John Owasso Medical Building. Cataract surgery is performed down the hall in the operating rooms of St John Owasso Hospital as a quick, out-patient procedure. Typically the procedure takes less than 15 minutes and does not require anesthesia. With Dr. Marc Goldberg’s technique, the incisions are so small (2mm… less than 1/8”), that post-operative stitches are no longer required.

Typically, most cataract procedures involve the use of a high-frequency ultrasound device that breaks up the cloudy lens into small pieces, which are then gently removed from the eye with suction. This procedure, called phacoemulsification, allows for the smaller incisions. This newer technique allows for faster healing, with lower risk of complications.

After all the remnants of the cloudy lens have been removed from your eye, the cataract surgeon inserts a clear intraocular lens (IOL), positioning it securely behind the iris and pupil, in the same location your natural lens occupied. Post-operative medications are placed in the eye and a protective shield is placed over the eye to keep it safe during the early stages of your recovery.

Recently, a new laser, the femtosecond laser, has been FDA approved to create the initial 2mm (less than 1/8”) corneal incision. Additionally, these lasers can pre-treat the lens so that less phacoemulsification is required. In the hands of a skilled surgeon, the 1 month post-operative results of laser assisted cataract surgery versus standard cataract surgery appear very similar. Because laser assisted cataract surgery takes longer to perform than standard surgery and the femtosecond laser has significant costs associated with its use and maintenance, this option is associated with much higher out of pocket expenses for the patient. Your surgeon will discuss if this technology plays a role in your procedure’s success, as well as review the pros, cons, and costs of using the femtosecond laser.

In most instances, you will be required to use post-operative antibiotic drops and anti-inflammatory drops. These medications lower the risk of post-operative infections and also aid the eye during the healing process. Typically, one of our doctors will see you several times for post-operative visits to ensure the eye is recovering appropriately.

The goal of cataract surgery is to remove the cataract and get patients seeing better. Accomplishing this goal often still requires a combination of surgery and post-operative glasses to correct some remaining refractive power (nearsightedness, farsightedness, astigmatism, and the need for bifocals/reading glasses). However, in many cases, patients can become less dependent on glasses. This is because the intraocular lens (IOL) that is placed inside your eye often has a portion of your glasses power built into it. While it is often impossible to get 100% of your total glasses prescription via the IOL implant, your surgeon will discuss your different IOL options to minimize spectacle dependency.

When selecting your IOL, your surgeon will consider many factors including the health of the cornea, the health of the retina, the type of cataract you have, any history of eye trauma, any history of previous eye pathology, and the amount of refractive power your eye has pre-operatively. All of these factors affect how well you will see following cataract surgery and play a role in how dependent you will be on post-operative glasses.

The standard IOL that most medical insurances cover does not correct astigmatism. Uncorrected astigmatism can affect distance and near visual clarity. Most insurances also do not cover multifocal/accommodating IOLS that allow for some distance and near vision correction. Often, when the typical, standard covered IOL is used, the surgeon will opt to correct as much of your nearsightedness or farsightedness as he/she can with the goal of improving as much distance vision as possible. Any remaining refractive power, particularly the uncorrected astigmatism and near bifocal portion, is corrected via eyeglasses, if desired, postoperatively.

In patients with significant astigmatism correction, your surgeon may discuss the option of an astigmatic or toric IOL. These lenses can correct some of your astigmatism, with the goal of improving your uncorrected vision (vision without glasses). Again, these IOLs are associated with an out of pocket expense. These lenses also do not restore the eye’s ability to accommodate (see both up-close and far away). For this reason, most patients will still require near reading glasses with astigmatic, toric IOLs.

Multifocal or accommodative IOLs are now available for some patients. The goal of these implants is to decrease the post-operative dependence on near reading glasses/bifocals. These implants are not covered by medical insurances and usually required a large out of pocket expense. These premium IOLs are a compromise that emphasizes the convenience of being less dependent on near glasses, but unfortunately, not without sacrificing some distance optical quality. Multifocal IOLs usually decrease overall post-operative distance clarity to accomplish the increased near vision trade off. Additionally, these lenses are often associated with more glare and light scatter at night. Your surgeon might recommend avoiding these lenses if you desire the best possible distance vision or if you have moderate amounts of astigmatism, a history of eye disease, previous eye surgery, or previous eye trauma.

Our team of doctors have been providing cataract surgery services at Owasso Eye Institute since 2006. Prior to that, our physicians have worked together at their Tulsa location to ensure improved eyesight to thousands of Oklahomans. We sincerely hope you will consider trusting our team of experts for your cataract concerns and ocular healthcare needs.