Q&A About Cataracts and
Do you have a question about cataracts, cataract surgery, or intraocular lenses (IOLs)? Charles Slonim, MD, a member of the AllAboutVision.com Editorial Advisory Board, has answered the most frequently asked questions below.
To find the Q&As most helpful to you, please click on one of these subjects:
- Cataracts: Causes and Prevention
- Cataract Symptoms
- Children and Adults With Non Age-Related Cataracts
Before Cataract Surgery
- Deciding Whether and When To Have It
- Other Medications You're Taking
- Timing Between Cataract Surgeries
During Cataract Surgery
After Cataract Surgery
- Recovery, Precautions, Restrictions
- Cornea Transplant
- Light Flashes
- Light Sensitivity
- Other Problems With the Eyes, Vision or Intraocular Lenses
- Complications From Other Conditions, Such as Stroke, Heart Problems, Glaucoma, Menopause, Etc.
- Other Cataract Treatments Besides Surgery
- New Surgical Techniques, New Intraocular Lenses
- Miscellaneous Concerns
Dr. Charles Slonim, board-certified ophthalmologist and member of the AllAboutVision.com editorial advisory board.
Cataracts: Causes and Prevention
Q: Please tell me how I can avoid ever getting a cataract. And please don't say, "Die young." L.S.
A: I certainly won't tell you to die young. However, I will tell you that if you live long enough, you will, inevitably, develop an "age-related" cataract.
There are other factors that you could avoid in order to prevent cataracts that develop through non-aging factors and other conditions. For example, there have been studies that have shown a relationship between an increased risk of cataract development and exposure to higher intensities of ultraviolet light and exposure to high-energy radiation such as x-rays. There is also an association between the incidence of cataracts and high levels of oxygen. Cigarette smoking and tobacco chewing may induce cataracts at an earlier age. Cataracts can be drug-induced (e.g., steroids).
Cataracts are more commonly found in patients with certain diseases or conditions (e.g., diabetes). Cataracts can occur as a result of direct ocular trauma. Infants can be born with cataracts associated with maternal infections (e.g., German measles). Cataracts can occur as a result of other eye diseases and conditions (e.g., the intraocular inflammation called uveitis). Although you can't necessarily prevent all of these conditions, there a few scenarios that are potentially preventable and could potentially lower your risk of cataract development at an earlier age. Dr. Slonim
Q: I'm 26 years old, and I had cataract surgery on my left eye a month ago. My right eye is also affected by the same type of cataract, which is a posterior subcapsular cataract.
Since I learned a year ago that I have cataracts, I'm searching for a possible cause. I'm a biochemist, and I'm working in research, but unfortunately, not on cataracts. However, I read a lot on this subject, but I did not find any possible causes.
No diabetes, no traumatism, no drugs, no smoking, no steroids, but my father and my uncle had cataracts before 30 years old.
So I want to know if you have any ideas about the cause of these cataracts. Thank you. C.C.
A: There is one cause of cataracts that is frequently absent from the books, journals and websites that you are probably researching. The cause is "mother nature," and the explanation is far beyond the scope of this website. Sometimes we just can't explain why one person or group of family members develops cataracts. Dr. Slonim
Q: Is it possible for cataracts to form because of trauma to the head, as opposed to eye trauma? K.L.
A: Yes, traumatic cataracts have been known to form from significant head trauma without eye trauma being involved. Dr. Slonim
Q: While it's impossible to diagnose via e-mail, might it be possible that one of the symptoms of a cataract is slight double vision in the affected eye? Where can information be found about bifocal lens implants? Can an implant be replaced? (If a bifocal implant is too difficult to get used to.) Thanks in advance. G.
A: A cataract is one of the more common causes of monocular (one-eyed) double vision. You see a double image with one eye when the cataract breaks up the incoming light rays from the viewed image, which creates at least two different images.
Regarding "bifocal" intraocular lenses (IOLs), the term "bifocal" is really a misnomer here because it conjures up the image of a pair of bifocal glasses with the distance correction on the top and the correction for near vision on the bottom. This is not how the IOLs that offer both distance and near correction are designed. Therefore, these IOLs are not truly bifocal.
These types of intraocular lenses have basically two different designs. The multifocal IOL is most commonly implanted. This category has the largest number of available IOL designs manufactured by most of the IOL companies. The other category of this type of IOL is called the accommodative IOL (or accommodating IOL). Currently, only one brand of accommodating IOL is approved for use in the United States the Crystalens.
Multifocal IOLs are designed to offer the eye multiple focusing points within the IOL. When viewing a distant object, the brain chooses the focusing points that make that image sharply focused. When viewing a close-up object, the brain chooses the focusing points that make that near image sharply focused hence, the term multifocal because both images are simultaneously in focus.
The accommodative IOL works differently. When implanted correctly, it is able to change position forward and backward in the eye as the ciliary muscle contracts. The ciliary muscle is the muscle in the eye that previously changed the shape of the natural lens before it became a cataract and was removed. This change in the lens shape allowed us to focus on near objects.
By changing position in the eye in response to action by the ciliary muscle, the accommodating IOL performs the same task the natural lens did by changing shape it brings near objects into focus. The technical term for this is "accommodation."
Your surgeon determines which IOL design to use multifocal or accommodative based on a number of factors including your eye's anatomic suitability and refractive error, your reading requirements and your personal preference. Not all patients are good candidates for these types of IOLs, which also are referred to as "premium" IOLs.
In answer to your other question: Yes, an IOL can be removed, repositioned and/or exchanged. Removing an implanted lens does carry a significantly higher risk of potential complications than did the initial surgery to implant the original IOL. Dr. Slonim
Q: I am 77. For the past several weeks, my eyes have been watering almost non-stop. Is this a sign of cataracts? Thank you. G.
A: No. Cataracts cause a painless, progressive loss of vision and have nothing to do with tearing. Dr. Slonim
Children and Adults With Non Age-Related Cataracts
Q. Are congenital cataracts hereditary? K.P.
A. Depending on what study you read, about 0.03 percent (3 out of 10,000) of newborn infants have some form of a congenital cataract. About 20 percent of these have a family history of a congenital cataract. Dr. Slonim
Q: I am 38 years old and have just been diagnosed with subcapsular cataracts in both eyes. I have never taken steroids (the eye doctor asked me this). My mom had had cataracts for more than three years, and the doctor is not even thinking about surgery at this time. But my doctor has said that my cataracts are white (he says an unusual color), appear to be fast growing, and I will need surgery in about a year. He says my only hope is that my cataracts will progress at about the same rate so that they can be removed at the same time.
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I guess my questions to you are: What do white cataracts mean? Is there anything I can do on a holistic level, aside from 100 percent UV-blocking sunglasses which I went right out to buy to help slow down the growth? It might help to tell you that I live in the Phoenix area, where it is almost always sunny. I.B.
A: Very basically, "age-related" cataracts are a yellowish or grayish color as they develop. The clouding (or yellowing) involves the entire "nucleus" or inside of the lens of the eye. A posterior subcapsular cataract (PSC) is seen by the eye doctor as a whitish or grayish opacity on the surface of the back membrane (capsule) of the cataractous lens. Unfortunately, a PSC develops right in the center of a patient's visual axis. Therefore, even in its early stages, the PSC can be more visually debilitating than the generalized yellowing that occurs with an age-related nuclear cataract. That's why the PSCs seem to develop faster and require surgery earlier.
There is nothing that is scientifically known to reduce this process, unless the cataract is secondary to some other process (e.g., drug-induced). Obviously, discontinuing the secondary cause of a cataract would slow the process down. Your cataracts probably will not be removed at the same time (same day) but probably a few days or weeks apart. UV-blocking sunglasses may be better protection for the skin of your eyelids than they are for your cataracts. The human lens does, however, absorb UV light, which helps protect the retina. All currently available intraocular lenses (IOLs) filter UV light. Dr. Slonim
Q: Hello, Doctor. Our son was born with cataracts and had them removed when he was two months old. He is now 19. He has good vision out of his right eye, but with the left he does not see very well. He has been wearing contacts for the past 19 years; he wears Silsoft aphakic +23 with a base curve of 7.90. The other day he woke up with a very painful left eye. The doctor saw that he had an ulcer on the eye. This is the fourth time he has had these, once on his good eye. The doctor indicated that he could do an implant so he would not have to wear contacts. His thought was that the thick contacts were not letting the eye breathe and were contributing to this problem and over time it would get worse. He could lose vision out of both eyes.
What are your thoughts? Is this risky? Would it help his eyesight? Would it lower the risk of future ulcers? Thank you for any information that you could give us. S.R.
A: The thick, aphakic contact lenses that your son is required to wear certainly increase his risk of corneal infections. In fact, as you wrote, he has already suffered from these potentially vision-threatening conditions. When aphakic contact lens wearers start to have problems wearing their lenses, a secondary intraocular lens (IOL) implantation is an excellent alternative. This is not an option for a child, because the eye continues to grow and develop. Calculating an accurate IOL power in a developing eye is difficult. As an adult, the IOL power can be better calculated to last a lifetime. At age 19 and with his corneal infection history, your son is probably ready for an IOL. Your surgeon's suggestions sound very appropriate and timely.
All surgeries carry a certain amount of risk that will be explained to you and your son by his surgeon. Secondary IOL surgery (i.e., placing an IOL into an aphakic patient) should mimic his current level of vision with his contacts (barring any unforeseen complications). Secondary IOL surgery would certainly lower his risk of contact lens-related corneal ulcers. Dr. Slonim
Q: My three-month-old son was born with bilateral cataracts. He had surgery to remove the cataracts at four weeks and five weeks of age. The cataract came back in the right eye, and during the second surgery the doctor noticed he had a subluxed lens. She is not sure if it is a primary condition or secondary caused by the growth of the second cataracts. If it is a primary condition, can you tell me what would cause it? M.C.
A: The term "secondary cataract" is a bad one and actually refers to the clouding of the posterior capsule, which typically occurs very quickly after cataract surgery in infants and children. Sometimes the clouding occurs because a band of scar tissue (fibrosis) develops across the capsule. Once the "primary cataract " (i.e., the only lens) is removed, it does not grow back. It is not uncommon that some small fragments of the original cataract may have been left behind, which the body typically will reabsorb. Leaving a few fragments (cortex) behind commonly occurs in cataract surgery in both children and adults. Dr. Slonim
Q. I'm 24 years old. If I have a vitrectomy for macular pucker (eyesight at 20/50 now) then there's a significant chance of cataracts forming. Have you heard of this happening in young patients, and what do they do, because after cataract surgery you lose accommodation in that eye, right?
How do you cope with losing the accommodation? How many young people actually get cataracts after vitrectomies? What is the percentage? What can you do to decrease the chance of forming cataracts? What should you eat or not eat? Thanks. A.
A. There is a definite increased risk of developing a cataract after a vitrectomy. Yes, I have heard of this in young patients.
It is very difficult for a patient to wear a bifocal in one eye and not in the other. You might consider a multifocal intraocular lens (IOL) when you require cataract surgery. If you don't get a multifocal IOL, you might consider wearing a bifocal contact lens after your cataract surgery.
If you live long enough, you will get a cataract 100 percent of the time. If you are young and have a vitrectomy, you will get a cataract sooner. Your risk of developing a cataract is based on your early-age vitrectomy surgery.
Eat what you want: There is no scientifically proven dietary regimen that will reduce your risk. There are some drugs (e.g., steroids) that induce cataracts. Obviously, avoiding them reduces that risk. Dr. Slonim
Cost of Cataract Surgery
Q: I am trying to find out the approximate cataract surgery cost for my grandma who has no insurance. Could you guide me on this matter, please? Thanks. S.K.
A: Cataract surgery fees vary from doctor to doctor and from state to state. These fees include different components. First, there is the surgeon's fee, which can range anywhere from $1,500 to $2,500 per eye. Second, there is the facility fee, which could be a physician's office equipped to do cataract surgery or a free-standing ambulatory surgery center or the outpatient department of a hospital.
Facility fees can range from $2,000 to $5,000 and higher per eye. The facility fee usually includes the cost of a non-premium (not multifocal, accommodative or astigmatic) monofocal intraocular lens implant.
Finally, there is a premium IOL fee for those who choose to have these types of IOLs implanted. This fee includes the extra cost of a premium IOL along with the additional preoperative testing and counseling. You are better off contacting some cataract surgeons in your area and finding out what their individual fees are. Dr. Slonim
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Q: I am having cataract surgery in about a week, so I need an answer by Monday. The doctor I am using says he can replace my lens with a monovision lens or an expensive one, about $2,500 per eye. My insurance will not pay for the more expensive one. So when I am asking for the monovision, which should I ask for: the vision to see things better up close or better far away? Originally my eyes can see close but not far away. I would like to see both, but I can't. Which do you suggest I have put in? R.W.
A: Mother nature meant for us to have good distance vision without glasses and put on a pair of reading glasses after age 40 (presbyopia). It sounds like you have been nearsighted (myopia) all your life, so you needed glasses for distance and took them off for reading. Your surgeon can mimic your previous myopia or change it as mother nature had intended it. The decision is up to you, but I might suggest you try "mother nature's way." The majority of our viewing time is spent in the distance and not up close (unless your nose is in a book 24/7!). Dr. Slonim
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Before Cataract Surgery: Deciding Whether and When to Have It
Q: I am a 72-year-old female with cataracts in both eyes. My optometrist tells me that they are slow-growing. As an artist who loves doing intricate detail work, I am growing increasingly frustrated that, even though I've explained that my vision is blurred, I sometimes see double and I have trouble focusing. My optometrist doesn't seem to feel that it is time to have the cataracts removed. I have astigmatism and am wondering if this can also be corrected surgically when the cataracts are removed? A.V.
A: The time to have cataract surgery is when the cataract causes a decrease in your vision that interferes with your normal daily activities. These activities would include driving at night, reading, watching TV, artwork, etc. Just because you have a cataract doesn't mean you have to have it removed. When you complain about your reduced vision and your doctor says that he or she cannot make you a better pair of glasses, then it's time to seriously consider cataract surgery. It certainly sounds like you are ready. Cataract surgery is one of the most successful of all types of surgeries. The vision that is reduced as a result of your cataracts should be restored after successful cataract surgery. Depending on the amount of your astigmatism, it can also be dealt with at the time of surgery. I think your next eye exam should be with a cataract surgeon. Good luck. Dr. Slonim
[See also: free eye exams for qualifying individuals]
Q: My 70-year-old father has developed a cataract on his eye. He only has the one eye. At the age of two he punctured his other eye with a pocket knife. He has an appointment to see his eye doctor in a week. He is very nervous about something going wrong with his "only eye." Should this be a concern for him? I have talked him into getting this surgery, because he works second shift and drives home at night. His vision is so bad he shouldn't even be driving in the daytime, let alone at night. He "feels" his way home and says he couldn't drive a road he doesn't know. I don't want him to be scared into not having this done. W.H.
A: Cataract surgery in the only eye of a one-eyed patient is scary not only for the patient but also for the surgeon. There are complications that can occur even if the surgical procedure is done perfectly. The surgeon has no control over these complications (e.g., cystoid macular edema). When the patient's daily living activities are compromised by the reduction of vision due to a cataract, then the patient has to weigh the risks and benefits of surgery and "go for it" when the time is right. It is also a good idea to find a good surgeon! Dr. Slonim
Q: I have cataracts. At a recent eye exam, my doctor advised me to think about having cataract surgery. She says the cataracts are "yellow" (harder). I have decided to wait until September [three months from now] to have the surgery. She has stated that they will not get worse in that time. My question is, what is the difference if your cataracts are yellow? And is she right in telling me that they will not get worse in three or even six months? Thank you for your advice. B.H.
A: Age-related cataracts tend to be yellow in color. They tend to progress very slowly and should not become significantly worse in three to six months, as your eye doctor suggested. Dr. Slonim
Q: I was diagnosed as having a premature development of a cataract in my left eye. The symptoms were discomfort on a sunny day and a feeling that there was something in my eye. No pain, just something there. The ophthalmologist gave me a thorough exam and the diagnosis stated above. He said my right eye had the beginning of one, but it has not been noticed. Besides surgery, are there glasses I could wear or drops that would make it clearer? I also see halos around lights when driving at night. This has been causing me anxiety and of course a fear that it will progress quickly. What course of treatment should I take? The symptoms have been noticeable for about four weeks. V.M.
A: Your symptom of halos around lights is typical of cataracts. Your symptom of "something in [your] eye" is not a cataract symptom. You cannot alter the progression of your cataract unless, for example, it is drug-induced and you discontinue the drug. Therefore, accept the fact that the cataract will progress over time. Don't be anxious. Cataract surgery is one of the most successful of all types of surgery, with close to 2 million procedures performed every year. If your cataract is a rapidly developing type, then you'll just have to have the surgery sooner than later. Dr. Slonim
Q: Can you tell me about no-wait cataract eye surgery (until ripe to remove)? H.E.
A: I am not familiar with this term; however, some surgeons have the capability of performing cataract surgery in their own facility on the same day that they examine you. I'm guessing that this is the origin of the phrase "no wait." Dr. Slonim
Q. My 86-year-old father was diagnosed with a cataract in his right eye about five years ago. He lost all vision in the left eye due to a retina detachment about two years after cataract surgery. Three attempts were made to re-attach the retina, but none were successful. For this reason we were hesitant to have the cataract removed when it was originally diagnosed.
In 2001 it was discovered by a retina specialist that he had some lattice degeneration in the right eye, and at that time he received extensive laser surgery to repair the tears and weak spots of the retina. This was almost complete around the entire retina, except for a small area they could not reach with the laser, due to the cataract. Again we were hesitant to have the cataract surgery, due to the experience with the other eye, although the specialist insisted the laser probably decreased the risk of detachment, since it was done prior to removal of the cataract.
Now his vision is 20/100, with the cataract very advanced. He has scheduled the surgery. We may have made a judgment error in waiting so long. Does this now make the removal of the cataract more risky because of the maturity? If there are complications, he will be totally blind. Thanks for any input you may have. P.H.
A. With the newer techniques of cataract surgery, the more mature the cataract, the more difficult the surgery. Even the most experienced surgeon can have problems removing a very mature cataract.
All surgeries carry a certain degree of risk. After a thorough discussion with the surgeon, only the patient can make the determination whether the benefits of seeing better than 20/100 outweigh those risks. No one-eyed patient feels good about having the better-seeing eye operated on, especially when the vision in the other eye was lost after cataract surgery. No cataract surgeon likes to operate on a one-eyed patient.
Remember, your dad's detached retina occurred two years after his first cataract surgery. His retina specialist did improve his odds (reduced his risks of retinal detachment) by lasering his lattice degeneration.
This is a quality-of-life issue. If his quality of life is good with his reduced vision, then wait. If his quality of life is compromised as a result of his poor vision, then the risk/benefit ratio may be in his favor. Good luck. Dr. Slonim
Q. I am due to have cataract surgery in July, and I have to go to the hospital for the surgery. I was wondering if I am doing the wrong thing, since I thought I would have laser surgery. Is it that the severity of the cataract makes the difference in the surgeries? I know when I looked on my chart it read "cataract 40+." I am a 68-year-old woman who wears glasses, and the right eye has the worse cataract. I had glaucoma surgeries on both eyes last year. Thank you. M.H.
A. Chances are that your surgeon does his or her cataract surgery in the outpatient department of the hospital. This is commonly done and should not be a concern. Whether or not you are ready to have cataract surgery depends on your level of vision, the existence of a cataract causing your decrease in vision and whether this level of vision is affecting your normal daily activities. When in doubt, get a second opinion. Dr. Slonim
Before Cataract Surgery: Other Medications You're Taking
Q: My mom is having cataract surgery. She is on 13 medications due to a heart condition. She is considered too high-risk to have the bypass surgery she needs. (Blood vessels around the heart are too thready, possibly due in part to recently diagnosed diabetes.) She isn't mentioning this to the eye surgeon until the time of her scheduled surgery. Do I have to worry too much about this? Since they aren't giving her any oral meds, is there any worry of anything they're doing counteracting with her heart meds? She's very stubborn and refuses to mention it to the surgeon. Should I be considering making a call to him myself? (I know that's up to me!) L.
A: As long as your mother's medical condition is stable, her cataract surgery should not adversely affect her current oral medications. However, her surgeon should be made aware of all of your mother's medical conditions and medications. Withholding this kind of information from any surgeon prior to any kind of surgery is not appropriate and can have postoperative implications. Make the call yourself. Dr. Slonim
Q: I take Coumadin 3.5 mg daily, and my last INR was 3.0. Will this increase the risk of cataract surgery in any way? J.F.
A: Blood thinners increase the risk of bleeding complications associated with cataract surgery as it relates to the anesthesia that is given. Some surgeons anesthetize (numb) the eye using injections of anesthetic (e.g., Marcaine or Lidocaine), while others only use topical anesthesia (drops only). Some perform surgery using one or the other, depending on the patient. A few will still use the injections even with the patient on blood thinners. Topical anesthesia is done solely with eye drops (no needles). The eye is still capable of moving but doesn't feel anything. A retrobulbar (i.e., behind the eye) is an injection of an anesthetic placed behind the eye prior to the start of surgery. It is typically given with a 1.25 inch needle through the lower lid. This injection also anesthetizes the muscles that move the eye so the eye cannot move during the surgery. Peribulbar injections are given in two or three areas on the side of the eye with a shorter (5/8 inch) needle.
When injections are the preferred method of anesthesia, the surgeon would prefer that the patient stop all blood thinners for a certain amount of time. Topical anesthesia does not require the blood thinners to be discontinued. If the patient cannot stop the blood thinners for other medical reasons, then the surgeon may prefer to use topical anesthesia. If your surgeon doesn't perform cataract surgery under topical anesthesia, then you may want to find one that does. Dr. Slonim
Timing Between Cataract Surgeries
Q: If you have cataracts in both eyes, do you operate on both at the same time, or separately? And how much time is there between? Thank you. M.S.
A: Cataract surgery is performed on only one eye at a time. Timing between surgeries depends on your surgeon, sometimes on your insurance company and on how well the first cataract surgery healed. I am aware of some surgeons that will perform the second-eye cataract in as early as three days and others that will wait a month. Dr. Slonim
During Cataract Surgery: What To Expect
Q: I wear a hearing aid. Will I be able to wear it during cataract surgery?
Also, is it wise to have both eyes done at same time? A.
A: Depending on the rules of your surgery facility, your hearing aid will probably be left in your ear.
Cataract surgery on both eyes is rarely, if ever, performed at the same time. Most surgeons will wait a few days or weeks between surgeries. Dr. Slonim
During Cataract Surgery: Anesthesia
Q. What is the difference between topical and retrobulbar surgery? C.
A. These terms refer to the type of anesthesia used. Topical anesthesia is done solely with eye drops (no needles). The eye is still capable of moving but doesn't feel anything. A retrobulbar (i.e., behind eye) is an injection of an anesthetic placed behind the eye prior to the start of surgery. It is typically given with a 1.25 inch needle through the lower lid. This injection also anesthetizes the muscles that move the eye. Peribulbar injections are given in two or three areas on the side of the eye with a shorter needle. Dr. Slonim
Q. The eye doctor just told me I have cataracts. I am terrified of surgery and needles. Is there anything else to do? I am only 47 years old. I have been sick to my stomach since I was told. Are you asleep during the surgery? I don't know know who to go to, etc. S.M.
A. Cataract surgery is frequently performed under topical anesthesia (anesthetic drops only, no needles!). It is performed as an outpatient. Rarely does a patient require general anesthesia. Topical anesthesia is frequently enhanced with intravenous sedation. You probably won't even remember the surgery when it's over. You certainly won't feel it. Dr. Slonim
After Cataract Surgery: General Recovery, Precautions, Restrictions
Q. After cataract surgery, what is the typical recovery time? Can a long trip to Europe safely be taken, say, a week or two following surgery or should I wait until I return? I am a healthy 73-year-old. Thank you. F.B.
A: Travel depends on what occurs at the time of your surgery, such as possible difficulties or complications. Blurry vision can last a few days or weeks postoperatively. Your restrictions depend on your surgeon's postoperative instructions. You will need to put eye drops in your operated eye at least four times a day for two to six weeks. Some surgeons may say that you can't lift more than five to 10 pounds, while others no longer have this restriction.
Ask your surgeon for his or her postop rules. It is possible to go right back to your normal daily activities, depending on what they are. Driving depends on the level of visual acuity immediately after surgery. Technically, you could fly the next day, unless an air bubble is left in the eye after surgery, and then you would have to wait until that air bubble gets absorbed in four or five days. Pain is usually not a postoperative symptom. However, you may feel like you have a piece of sand in your eye (known as foreign body sensation) for a day or two. If the surgery is complicated, then there may be a few more restrictions. Good luck. Dr. Slonim
[Read our article on cataract surgery recovery for more information.]
Q. My grandmother is 93 and will be having cataract surgery in two weeks. How long will the recovery period last? I am planning to visit with her during this time and need to know how long she would need me. I live in Alabama, and she lives in South Carolina, so I need to know how to plan my time. Thank you for your prompt attention to my question. G.
A. The recovery period depends on the general health of your grandmother and the visual outcome of the surgery. Typically, in uncomplicated cataract surgery, she will require the use of two or three different eye drops to be used three to four times a day. There are very few restrictions to the activities of a 93-year-old woman. She will probably be restricted from swimming or scuba diving! If she can put her own eye drops in the operated eye, there will probably be little for you to do. Dr. Slonim
Q. After cataract surgery and the insertion of an artificial lens, can a person rub or massage the closed eye with a finger to relieve an itch, etc.? If so, must one be careful doing this for the rest of his life? K.D.
A. You have to be careful for the first four to six months after surgery, but after that a light rub to relieve an itch is not a problem. This also depends on what occurred at the time of surgery (i.e., any difficulties or complications, etc.). Dr. Slonim
Q. How long does it take after cataract surgery before you can drive and live a normal life? M.M.
A. This totally depends on the visual outcome of your surgery and if there were any complications. Under normal circumstances, you can resume your normal life within the week after surgery (usually a day or two). You can drive when your visual acuity meets the motor vehicle requirements of your state. Dr. Slonim
Q: How long is the recovery time from cataract surgery? How soon before I can return to work (as a general rule)? P.B.
A: Depending on what type of work you do, you could probably return to work the day after surgery. In general, many patients take the first week off. Dr. Slonim
Q: What is SOP for recovery from cataract surgery? How long until it's OK to bend over, lie on your stomach for three hours or more, or drive a car? M.H.
A: This depends on 1) your surgeon, 2) the technique of cataract surgery used and 3) the presence of complications, if any, that might occur. Most surgeons will see their patients the day after surgery and then a month after surgery. Some will also have the patient return one-week postop.
With the current advances in creating surgical cataract wounds, bending after surgery does not seem to be a problem, although many docs still ask patients to avoid deep bending for a week or so.
Sleeping on one's stomach creates the potential to put pressure directly on the eye, since you would be face down. This should not be done; however, most patients are asked to sleep with a plastic shield over their operated eye for a couple of weeks. This would prevent direct pressure from being placed on the eye.
Driving is only a function of the clarity of the vision postoperatively. When the postoperative vision meets the state requirements for "driving" vision, then the patient can resume driving if, of course, they feel comfortable behind the wheel. Dr. Slonim
Q: After cataract surgery, how might my physical activity be curtailed (walking, biking, driving, swimming, shopping)? I'm 68 and female. Can I attend a concert that evening (with surgery earlier that day), as long as others will drive me there? Thanks for the info. H.B.
A: Always consult your surgeon for the types of activities you can engage in after surgery. Typically, all of the activities that you listed, with the exception of swimming, would probably be allowed in the immediate postoperative period. As long as you have tickets to the concert, you should be able to attend. Dr. Slonim
Q. I am an endurance running athlete. I run or cycle every day and compete monthly in running events that are at least 26 miles long.
How does this affect my cataract surgery recovery? How soon is it safe to resume training and racing? I'm guessing that the elevated heart rate associated with this type of activity is important, as it may cause the blood vessels in the eye to dilate significantly?
I have not been able to find any information on this subject. I am 40 years old and very active with small children and a busy life. Thanks for your help! J.C.
A. Resuming your athletic activities will depend on your surgeon and the type of surgery that you have. Your elevated heart rate should have no adverse effect on your cataract surgery. Most surgeons will allow your cycling. Most will probably have you wait a week or two before running. Ask your surgeon what his or her postoperative instructions will be. Dr. Slonim
Q. How soon after surgery will my vision improve? I will continue to need glasses afterward, as I have an astigmatism. E.O.
A. Postoperative visual acuity depends on a lot of different factors, including the preoperative condition of the other parts of your eye. It also depends on how the actual surgery went and whether you had any complications. Depending on the amount of preoperative astigmatism, you may or may not require glasses after surgery. There are now intraocular lenses known as toric IOLs that correct certain amounts of astigmatism. These "premium" IOLs typically are not covered by medical insurance. Other options for the astigmatic cataract patient include limbal relaxing incisions (LRI) or astigmatic refractive surgery. If needed, the LRI procedure is performed immediately after the cataract surgery.
Limbal relaxing incisions are curved incisions made in the cornea at the limbus. This changes the shape of the cornea and can eliminate certain amounts and types of astigmatism. The preoperative testing helps the surgeon determine whether a patient is a good candidate for LRI. Any residual astigmatism that remains after cataract surgery can potentially be eliminated with a variety of astigmatic refractive surgeries such as LASIK or PRK shortly after cataract surgery. Dr. Slonim
Q: After surgery is it common to have a black eye? R.H.
A: This depends on the technique of anesthetizing the eye.
If your surgeon uses injections of anesthetic (e.g., Novocaine) to numb the eye, then you could possibly have a hematoma (black eye) from the injection.
If your surgeon uses topical anesthetics (drops) only, then you will not have a black eye. Dr. Slonim
Q: Once you have gone through cataract surgery, is the correction permanent, or can cataracts reappear? N.S.
A: Once a cataract is removed, it does not grow back. In the newer techniques of cataract surgery, a thin membrane called the posterior capsule is left in place at the time of surgery. The intraocular lens is placed just in front of this capsule. The capsule can become opacified over time. This can occur as early as a few months or many years later. As this capsule opacifies, the patient's visual acuity is reduced. The patient's complaints of reduced vision will be similar to those when the cataract was there. The opacification in the posterior capsule can be cleared in a few minutes using a YAG laser. Dr. Slonim
Q: Are stitches in the eye supposed to dissolve on their own? Is it normal for a stitch to cause irritation and have to be removed a year after surgery? A.M.
A: It depends on whether your surgeon used dissolvable sutures or non-dissolvable sutures. Yes, sutures can be irritating and may have to be removed at a later date. If they have to be removed at one year, then they were non-dissolvable. Dr. Slonim
After Cataract Surgery: Cornea Transplant
Q: My grandmother's cataract operation has gone "wrong." The surgeon has now said she will have to undergo a cornea transplant. What is your opinion of this? S.L.J.
A: Without examining your grandmother's eye, I cannot give you an accurate response or diagnosis. A lot depends on what occurred at the time of the surgery, such as any difficulties or complications. There are some corneal conditions that predispose the patient to corneal problems after cataract surgery. One of these is called Fuchs' endothelial dystrophy. The cornea decompensates [cell density decreases] as a result of a lack of endothelial cells on the back surface of the cornea. These cells are vital to the health of the cornea. A successful corneal transplant should help restore the vision lost by the damaged cornea. When in doubt, get a second opinion. Good luck to your grandmother. Dr. Slonim
After Cataract Surgery: Floaters
Q: I recently had cataract surgery (one month ago) on both eyes. I am amazed at the improvement 20/20 in both eyes, and I don't have to wear glasses for the first time in my life. I am 64. I experience what I guess are floaters that I did not see before the surgery. Is this because I just could not see them before? Will they get less noticeable, and are they anything to worry about? Just looks like sand or grit. R.G.
A: You probably had the floaters before your cataract surgery and didn't see them. They are now noticeable after removing your cloudy cataract. They are harmless and frequently settle out over time. Dr. Slonim
Q: In February I had cataract surgery in my left eye. In April I had the right eye done. Everything was OK at first, and then my first eye [left eye] developed a cloudy shield and floaters. I went back and had the laser process done to the left eye. Now my right eye has the cloudy shield and floaters also. It is really irritating. I am scheduled to go back in three months to get the laser done on the right eye. I am a 70-year-old female. The doctor is an excellent surgeon. I checked him out. Is there anything that can be done to get rid of the floaters? Is this a common result of surgery for someone of my age? Is there anything I can do to reduce the number of floaters? S.C.
A: Your floaters are a common occurrence in someone of your youth. You probably had the floaters before your cataract surgery and didn't see them. They are now noticeable after removing your cloudy cataract. Your "cloudy shield" that you describe is your posterior capsule, which became cloudy after cataract surgery and required a YAG laser to open it. Opening this capsule with a laser can create a few more floaters. Once opened, the capsule remains open for a lifetime and does not have to be repeated. The floaters are harmless and frequently settle out over time. Dr. Slonim
Q. My mother had a cataract operation about six months ago. Her vision is much better overall, but she has had an obstruction in her eye since immediately after the operation. It is like a permanent floater, I guess. It is really, really distressing for her. Her doctor told her that this is fairly common and that it would dissipate. But now it's six months later, and nothing has changed. He is now telling her that she needs to get used to it, though he also mentioned to her that a risky operation could be another option. Your thoughts and advice would be really appreciated. A.H.
A. I am assuming that your mother has a vitreous floater, since you describe a "permanent floater." The inside of the eye is filled with a gel called the vitreous gel. The vitreous gel is about 99 percent water and 1 percent solid elements. These solid elements have a variety of shapes and sizes and can float in the water portion. When they float through your central or peripheral visual axis, you might be able to see them. They are especially noticeable on a light background or the blue sky. They are harmless and frequently settle out over time. When they remain centrally, it can be very disturbing to the patient. The surgery to try to remove a floater has significant risks, including the creation of more floaters. Some surgeons have actually tried lasering these floaters. This is fairly controversial among the eye care community. Dr. Slonim
Q: I am 32 and had cataract surgery seven years ago ( both left and right eye), and I just had a laser surgery done on my right eye because the scar tissue grew back too much and invaded my vision again. I am not happy with the laser results; it has been three weeks now, I still see many floaters and they honestly impair much of my vision too much to bear headaches and red eyes by the end of a work day.
Now I have the same issue in my left eye (clouded and blocked vision), and I can barely see between both of these issues. I am very scared to have my doctor do this same laser surgery on my other eye when I don't even see good enough out of my right eye yet.
Can you help? Suggestions? Advice? Any other surgery that I could do? Can there be another cut into the eye and cut out the scarring instead of it floating around like cobwebs like what I have now? There have been no improvements within these three weeks none at all since the moment immediately following the laser procedure. Thanks for the reply. S.L.
A: In the newer techniques of cataract surgery, a thin membrane called the posterior capsule is left in place at the time of surgery. The intraocular lens is placed just in front of this capsule. This capsule can become opacified over time. I have heard some surgeons refer to the capsular opacification as scar tissue, which sometimes makes it easier to explain to the patient. This clouding of the capsule can occur as early as a few months or many years later. As this capsule opacifies, the patient's visual acuity is reduced. The patient's complaints of reduced vision will be similar to those when the cataract was there.
The opacification in the posterior capsule can be cleared in a few minutes with a YAG laser. As the laser clears the cloudy capsule, some fragments of the capsule might hang around for awhile. These may act as "floaters," as they float around the liquid vitreous gel inside the eye. Frequently, these will settle out and disappear. Sometimes they can hang around for a long time. You may need more than three weeks.
Prior to the invention of the YAG laser, the eye actually had to be opened again in order to remove the cloudy capsule. An "open eye" procedure (i.e., with a surgical incision) carries a significant number of risks that do not exist with the laser. Your other eye may not have as many, if any, floaters after a laser procedure. Dr. Slonim
After Cataract Surgery: Light Flashes
Q: After cataract surgery, what would cause a patient to see flashes of light in one eye, six weeks later? R.C.
A: Flashes of light, even six weeks after cataract surgery, must be investigated immediately to rule out the potential for a retinal detachment or retinal tear. Call your cataract surgeon ASAP for an appointment. Dr. Slonim
Q: Once you have a cataract removed, does your eyesight restore to 20/20, or does it stay the same as before removal? Will the blinding starburst from oncoming headlights at night go away after surgery? I'm only 58 and have to drive. I've also been diabetic for 20 years. P.B.
A: Point sources of light (e.g., headlights at night) are scattered as they are focused through the opaque or cloudy cataractous lens. This "light scattering" causes the halos or starbursts around lights that you describe. Assuming that you have no other ocular conditions (e.g., diabetic retinopathy) that would limit your postoperative result, your "blinding starburst" should be reduced or eliminated after cataract surgery. Dr. Slonim
Q: I had cataract surgery one month ago. Recently I have started to notice temporary loss of vision or decreased vision and sometimes flashes of light. My questions are: 1) Is this normal, and will it stop after a while? 2) What is the cause of these problems? 3) What would be your advice? Thanks for your time and advice. L.
A: Any sudden change of vision or symptoms of flashes of light need to be addressed immediately. Call your surgeon and relay these complaints to him or her ASAP (even on the weekend, if that's when they occur). Dr. Slonim
After Cataract Surgery: Light Sensitivity
Q: Since my cataract surgery, my eyes are very light-sensitive. I wear sunglasses almost all the time, and my eyes tire easily. The surgery was just done last month. Is this a temporary condition? R.Z.
A: The transition from having a cloudy, cataractous lens that blocked incoming light rays from entering your eye to a crystal clear intraocular lens that now allows all the light rays to enter your eye can make you light-sensitive for a few weeks to months. If you still have some residual postoperative inflammation, then you may still experience light sensitivity. Dr. Slonim
Q. I had cataract surgery about four months ago and eight months ago in the other eye. Both operations went well with no real complications. But since I work as a full-time proofreader, I started to experience eye strain in both eyes as well as greater sensitivity to the light from my desk lamp at work. It seems that most people have cataract surgery after retirement, so the kind of side effects that I seem to be experiencing are probably not very common. Have you ever heard of similar side effects, and if so, can you suggest any treatments? J.D.
A. Light sensitivity after cataract surgery is common, especially in light-colored eyes (e.g., blue). Make sure your light source is coming from above and behind you and not from in front of you. Dr. Slonim
After Cataract Surgery: Medications
Q: My mother needs to undergo cataract surgery. She is 81 years old, but I am told that before and after surgery she will require six to eight weeks of drops (several different kinds). She is incapable of putting them in, and we live far away and work. Any idea of how true this is? Thank you. M.T.
A: Depending on the surgeon and the technique, uncomplicated cataract surgery patients are usually required to use anywhere from one to three different drops after surgery. Typically, an antibiotic drop is used to prevent an infection, and a steroid drop is used to reduce postoperative inflammation. Some surgeons use a nonsteroidal anti-inflammatory drop in addition to the others.
The drops are usually dosed four times a day, but occasionally during the first postoperative week, they may be used every couple of hours while awake. Other drops may be required if there were complications during the surgery. Dr. Slonim
Q: I had cataract surgery six months ago and still have a vision problem. I've been taking drops (Acular) twice a day now for six months, and my vision fluctuates. G.S.
A: There are a few possible late-onset complications of cataract surgery that can affect the vision four to six months after the surgery. One of these is called cystoid macular edema. This condition occurs in susceptible patients even after uncomplicated cataract surgery. The central portion of the retina responsible for our sharpest vision, the macula, develops some fluid-filled (edema) cysts.
A common treatment is the use of a nonsteroidal anti-inflammatory such as Acular. I am assuming this might be your presumed diagnosis because you are being treated with Acular.
Your surgeon may choose to obtain a fluorescein angiography where a dye (fluorescein) is injected into a vein. Using special photography, a series of photos is taken of your retina, looking for a leak of fluid in the macula.
Cystoid macular edema rarely causes permanent visual loss. The recovery is often a slow process that can take anywhere from two to 15 months to resolve. Dr. Slonim
After Cataract Surgery: Pain
Q: I recently had cataract surgery in both eyes, one week apart. I had spoken to other people who had the same surgery, and they said they had no problems. I went into this with the idea there would be no pain. I had an excessive amount of pain in both eyes. The doctor said my cornea was scratched and my pressure was too high after surgery. What causes pressure buildup and a scratch on the cornea? They put a lens bandage on the eye, which is now removed.
Also, he said I had young people's cataracts. What does that mean? Are there different kinds of cataracts? And why can't they give you pain medication, other than OTC Tylenol for the pain?
As you can see, no one wanted to give me any information. I am 67 years old and felt they should have been more forthcoming with information. Am I the only person who ever had this amount of pain? I began to think that I was at fault, somehow. My pain tolerance in the past has been excellent through many surgeries. Thank you for your answers!
I am healing now, but my eyes still feel like they are full of sand. My surgeries were [11 days ago and four days ago]. They have said I may have to use these drops for a while. I see the doctor again [in five days]. My vision is excellent now, and I am truly grateful for that. I am also grateful I don't have a third eye. R.M.
A: When a surgeon reviews the risks and benefits of surgery with a patient, it is impossible to identify every possible problem that can occur. The good news is, "[your] vision is excellent." There are different types of cataracts. Some (e.g., nuclear sclerotic) are typically associated with the aging process and are slow in their development. Others (e.g., posterior subcapsular) can be seen at an earlier age or induced by certain drugs (e.g., steroids). These develop a little faster than the age-related cataract. It is easier for the surgeon to describe these as "young people's" cataracts (besides, it is more flattering to the elderly patient!).
During cataract surgery, the eyelids are kept open for the entire surgery, which causes the eye to dry out. Throughout the surgery, the surgical assistant is lubricating the ocular surface (i.e., cornea and conjunctiva) with a balanced salt solution. Occasionally, a dry spot will occur. Some patients with a history of dry eyes are more prone to these dry spots after surgery. Some patients with a history of corneal irregularities (e.g., basement membrane dystrophies) are more prone to these dry spots. During the healing process after the cataract surgery, it may take these dry spots a little longer to go away. The most common symptom associated with dry spots is the feeling that someone threw sand in your eyes.
One of the possible complications after cataract surgery is an increased intraocular pressure (i.e., secondary glaucoma). Usually this is transient, but in patients who are predisposed, this elevated pressure may be long-lasting or even permanent and will require treatment to reduce the pressure to a normal level. The surgeon cannot predict who these patients are going to be. Dr. Slonim
[Read more about glaucoma.]
After Cataract Surgery: Other Problems With the Eyes,
Vision or Intraocular Lenses (IOLs)
Q. I've recently had cataracts removed from both eyes. Since the surgery, my vision is very bad: fuzzy, cloudy. I cannot read with reading glasses. Nor can I see distance things very well: It is difficult distinguishing people's faces, numbers on the clock, words on the TV screen, numbers on the stove control panel. My doctor told me he was implanting a lens that corrects distant vision. I cannot see close or distant. Could it be that he didn't implant the proper lens? V.B.
A. At some point after cataract surgery, your surgeon or his or her staff will "refract" you (determine a prescription) for a final pair of glasses. This prescription may change during the healing process, so your surgeon will wait until your eye stabilizes. This can take two to six weeks.
The postoperative "refractive error" is calculated preoperatively when your surgeon made certain measurements to determine the power of a monofocal intraocular lens (IOL) that he or she wanted to insert into your eye. The goal is for the IOL power to give you a final refractive error as close to zero as possible. Therefore, no glasses for distance should be necessary.
If you and your surgeon chose to implant a premium "presbyopia-correcting" IOL to correct both distance and near vision, then you will need to discuss your current postoperative result with your surgeon. If you had a preoperative astigmatism that was not corrected by a monofocal or presbyopia-correcting IOL, then this residual astigmatism will need to be corrected with glasses, contact lenses or refractive surgery.
Some patients prefer to be a little nearsighted so they can still see near without glasses as they may have done before surgery. Other patients want monovision with their IOLs after cataract surgery. This means one eye is corrected for distance and the other for near. These options usually are discussed before surgery.
Sometimes the position of the IOL in the eye can change the final refractive error that was precalculated, especially with the premium IOLs. Depending on what occurred at the time of your surgery (any difficulties or cataract surgery complications, etc.), your final refractive error may be a little different from the surgeon's (and patient's) desired result. Your surgeon will wait for your final refraction to settle before giving you a final eyeglass prescription.
Continue to follow your surgeon's postoperative instructions and follow-up visit schedule. Dr. Slonim
Q. Before my cataract surgery, I had blurred vision when reading. I had no problem seeing at far distances. After the surgery, everything is blurred outside to about five feet. When I am standing up and looking at the floor, my vision is blurred. I can read without glasses. Is there anything that can be done to correct the new problem? My prescriptive lenses have been changed twice already. The surgeries were two and three months ago. P.M.
A. It sounds like you have some postoperative myopia (nearsightedness). Sometimes it takes a couple of months for the final "refraction" to settle. You may want to wait a couple months before getting your final prescription for glasses. Depending on the amount of postoperative myopia, your options are glasses, contact lenses, refractive surgery (e.g., LASIK) or an IOL exchange. The IOL exchange is reserved for worst-case scenarios and very high residual refractive errors. Obviously, this requires another surgical procedure with an increased risk of complications. Dr. Slonim
Q. I just had cataract surgery and correction of astigmatism in the left eye. There is a cut in the cornea that is giving me pain and problems with vision. Do both eyes have to be done to correct the astigmatism, or is it correctable with glasses for distance? Your answer will be appreciated. R.W.
A. The discomfort from the corneal incision that you had for your astigmatism (astigmatic keratotomy) should go away over time. You do not have the same procedure in the other eye. Your astigmatism should be correctable by glasses. Sometime very high astigmatisms are not corrected well with glasses if the other eye doesn't have a similar astigmatism; therefore, the astigmatic keratotomy may give you better postoperative vision. Dr. Slonim
Q. I recently had cataract surgery, and now my doctor says I have swelling in the back of the eye. Is this serious? Is it something that comes from the procedure not being done correctly? J.D.
A. It sounds like you are describing cystoid macular edema (CME). There are a few possible late-onset complications of cataract surgery that can affect the vision four to six months after the surgery. One of these is CME. This condition occurs in susceptible patients even after uncomplicated cataract surgery. The central portion of the retina responsible for our sharpest vision, the macula, develops some fluid-filled (edema) cysts.
A common treatment is the use of nonsteroidal anti-inflammatory drops such as Acular or Voltaren. Your surgeon may choose to obtain a fluorescein angiography where a dye (fluorescein) is injected into a vein. Using special photography, a series of photos is taken of your retina, looking for a leak of fluid in the macula. Cystoid macular edema rarely causes permanent visual loss. The recovery is often a slow process that can take anywhere from two to 15 months to resolve. Dr. Slonim
Q: I had a cataract removed two weeks ago. I had an IOL replacement. My prescription was +2.50 before the operation, and I'm now at + 4.50 after the operation. I still cannot see the big E on the eye chart. My eyesight is worse than ever, and I'm severely farsighted. Is this a permanent situation? I did have RK in this eye 20 years ago. Did my doctor miscalculate the power of the IOL? Can I fix this? A.
A: The calculation that determines the power of the intraocular lens (IOL) is dependent on two measurements that are made prior to the cataract surgery. The first measurement is the axial length, which is measured by an ultrasound instrument. The axial length is the length of the eye measured from the center of the cornea to the retina inside the eye. The second measurement is the keratometry reading. Keratometry readings measure the horizontal and vertical curvatures of the front surface of the cornea.
These two measurements (i.e., axial length and keratometry readings) are then entered into a sophisticated mathematical equation (via a computer program), and the IOL power is calculated. The mathematical equation is based on the measurements of hundreds of thousands of "normal" corneal curvatures and "normal" axial lengths. The IOL power calculation of an eye that is unusually long (highly nearsighted) or unusually short (extremely farsighted) does not have the same accuracy as for an eye of normal length. Likewise, the IOL power calculation of an eye that has had corneal surgery (e.g., RK or LASIK) does not have the same accuracy as for an eye with a relatively normal-shaped cornea. In other words, your measurements were probably correct, but your previous RK created a problem with the IOL power calculation.
Frequently, after finding an unexpected or unplanned refractive error after a cataract extraction with IOL implantation, the surgeon may consider removing the IOL and replacing it with one of a different power. Some surgeons will implant a second IOL in front of the first one (referred to as piggyback IOLs) to correct the postoperative refractive error. Dr. Slonim
Q: After having cataract surgery and lens replacement, if the wrong prescription of lenses is used, can they be removed and switched with a more appropriate strength? How risky a procedure would that be? A prompt reply would be very much appreciated. Thank you for your time. G.
A: Yes, an intraocular lens implant can be removed and exchanged. There are some additional risks of this kind of "exchange" surgery. Some surgeons, where possible, might choose to place a second intraocular lens in front of the first lens. This depends on the amount of additional correction that is required. Dr. Slonim
Q: I had cataract surgery two and a half weeks ago in my left eye. About four days ago I woke up to double vision. After about an hour or two the double vision clears up for distance but never goes away for anything I need to read. I have to close one eye to stop the double vision. It doesn't make any difference if I have my glasses on or off. When I eat the food on my plate, it is distorted. My eye is still quite red and burns when I put the drops in it.
The nurse in the doctor's office said to wait out the five weeks to see if it changes. By the way, I am writing this with one eye closed. Also, is it normal to see everything at a distance clear, but anything close a complete blur? Thank you. D.C.
A: There are a number of causes of double vision (diplopia). Sudden onset of double vision should be investigated immediately and not in five weeks. Since this occurred about two weeks after your surgery, it may not be related to the cataract surgery itself. There could be a neurological cause. Nonetheless, you should insist on being examined by your doctor ASAP. Dr. Slonim
Q: Is double vision common after lens replacement in cataract surgery? M.R.
A: Diplopia (double vision) is usually not associated with the actual cataract surgery, although it can occur as a result of anesthetic injections before surgery. Sometimes the muscles that move the eye (extraocular muscles) can be temporarily (usually) or permanently (rarely) damaged as a result of the injections to numb your eye prior to the surgery. If the refractive needs of your two eyes are significantly different (e.g., one eye is very nearsighted and the other is not), you could experience double vision. An uncorrected astigmatism in one or both eyes could cause double vision. These are just a few possibilities. When in doubt, get a second opinion. Dr. Slonim
Q: Three days ago I had cataract surgery. The first evening I started to develop an eye ache along with a headache. The next morning I returned to the doctor. I had cornea fluid pressure buildup. Over the course of the day I had three incisions made in the eye to relieve the pressure. Two special kinds of pressure relief drops were given to me to use three times a day to help in relieving the pressure until I go back for a visit on the fourth day.
My vision has been cloudier than before I had the surgery, with no improvement thus far. The doctor said I should see a slight improvement each day, but as I said, no improvement as of yet. My eye still goes through periods of watering, and sometimes it feels like something is in the eye when that happens. What do you think might be going on with the eye? Can I anticipate this cloudiness will go away soon?
P.S. Two weeks ago I had the right eye done, and it was a complete success. I was seeing 20/20 out of it the same day, with no complications. Thank you. R.R.
A: Without examining your eye, I cannot make an accurate diagnosis. When we operate on a patient with bilateral cataracts, we typically do the worse eye first. As you described, you had an immediate 20/20 result. There should be no reason why that same result isn't expected for your other eye, which originally was considered the better of the two. A surgeon cannot guarantee the results of any surgery, and that includes cataract surgery.
Your second eye may have been a little more difficult surgically. Cataract surgeons make every effort to reduce the risk of postoperative complications. An increase in intraocular pressure, clouding of the cornea and some eye discomfort are all known postoperative phenomena that can occur. These are usually transient and may require a few days or weeks to resolve. With such a great result after your first cataract surgery ("20/20 out of it the same day with no complications"), your surgeon had a tough act to follow. Allow a "tincture of time" to help in your healing process. Dr. Slonim
Q: I had cataract surgery for my right eye last Friday. I am feeling fine except for minor discomfort in my eye, and I see clearly floaters now. But my vision is not 20/20 as everybody talks about. I have to wear my old glasses to see far. Do you think that the doctor used the wrong lens? My second eye is scheduled for next week, and I am wondering whether I should go to some different doctor. Please advise me about it. My husband is not very happy about it and wants to say something to the doctor. Can my vision get better later on, or is this it? G.P.
A: You need to ask your surgeon why you need to wear your old glasses. For example, if you had astigmatism before surgery you probably still will have the astigmatism after surgery unless you had a premium astigmatic (toric) IOL implanted or had refractive surgery such as limbal relaxing incisions or LASIK to reduce or eliminate the astigmatism.
If you still have astigmatism, this may require you to wear astigmatic correction in the form of contacts lenses or glasses.
The calculations for intraocular lens (IOL) power are performed preoperatively to determine which type, design and power of IOL will best alleviate your nearsightedness or farsightedness and now, also astigmatism. Prior to your second surgery, you should have this discussion with your surgeon. When in doubt, get a second opinion. Dr. Slonim
Q: I had cataract surgery on both eyes, and now my vision is getting worse after less than a year. It seems to be getting cloudy again, and I don't see nearly as clear as I did when I initially had my surgery. What should I do at this point? Any help is greatly appreciated. I am a 65-year-old female. Thank you. C.S.
A: You may have a clouding of your posterior capsule, which will require a YAG laser capsulotomy (opening of the capsule). You may also have had a natural change in the refractive error of your eye and may require a small prescription or glasses to restore your vision. You may have developed cystoid macular edema (i.e., a swelling in the retina). Your surgeon should be able to tell you the cause of your reduced vision. If not, get a second opinion. Dr. Slonim
Q: I have had both cataracts removed this year, and as of now I have not been able to get lenses to fit, because I am seeing "double": two identical objects, sometimes side by side and sometimes vertical. The doctor said he did nothing during the cataract removal to cause double vision, and I should see a specialist about eye muscles. Any comment? M.C.
A: This may depend on the techniques of cataract surgery that were used. If injections of anesthetic were given around the eye to anesthetize the eye, there might have been some damage to one of the muscles that moves the eye. If topical anesthesia (drops only) was used, then this could not occur. Depending on how poor your vision was before cataract surgery, you might not have noticed some preoperative double vision until the cataract surgery restored the vision in both of your eyes. Double vision should be investigated to determine a cause and a plan of treatment. Dr. Slonim
Q: I had cataract surgery approximately six weeks ago, where the lens was replaced with a synthetic intraocular lens. This has slipped within the last week and was discovered only today. What are the chances of it being put back? I have had previous surgery on this eye for trauma, which required the eye to be "flushed out," and there are fewer muscles to hold the lens than normal. G.
A: Your previous trauma and surgery possibly loosened or damaged the zonules (tiny fibers) that support the crystalline lens (or cataract) in place. Intraocular lenses (IOLs) implanted during cataract surgery are inserted into the "capsular bag" in which the cataract or lens is held. This capsular bag is supported by these zonules. Frequently, the surgeon will not be able to detect this damage in eyes with minimal damage to the zonules. Inserting the IOL at the time of surgery may damage a few more zonules. Dislocation or "slippage" of the IOL during the immediate (i.e., days or weeks) or during the late (i.e., months or years) postoperative period can occur. If the IOL is still in the central visual axis, no further surgery is required. If the dislocation is starting to cause symptoms, then surgery to reposition the IOL may be required. Dr. Slonim
Q. I had cataract surgery due to steroid medication two and a half years previously after a liver transplant. For five days after surgery, my pupil remained very tiny; it would not change in size. After that, it changed to a more normal-sized pupil opening, but it remains in that position, not opening or closing in different amounts of light. Is this normal? Shouldn't my pupil be responding to light like my other, unoperated eye? I am supposed to have cataract surgery on my other eye in four days, and I'm worried about the same thing happening to the other eye. Is what I described to you normal? I would hate to have surgery done on the second eye if there's a problem with the first one due to the surgery. Thank you. L.V.
A. What you are describing is not uncommon. Depending on the difficulty at the time of surgery, sometimes the iris and pupil can be traumatized during the surgery. Sometimes the pupil has to be stretched in order to get the intraocular lens (IOL) implant in. As long as your surgeon has ruled out any neurological reasons for the pupil irregularities, there is probably nothing to be concerned about. Sometimes the position of the IOL can cause the pupil to act funny. Dr. Slonim
Q. After my cataract surgery I complained to the doctor that it felt as if my eyes were in a prison, particularly the lateral aspects. It is not painful, just a feeling of fullness or heaviness. E.M.
A. I am afraid that I have never heard a complaint quite like that. In order to perform cataract surgery, the surgeon puts a speculum between the eyelids in order to keep the eye open during the surgery. The speculum may cause a slight "stretching" of the outer corner of your eyelids. Perhaps this is the sensation that you are describing. I have had patients complain of a little tenderness in this area after surgery. It has always resolved on its own over time. Dr. Slonim
Q. I had my second cataract surgery yesterday. My first cataract surgery on my left eye was performed several years ago. There was immediate vision improvement after the surgery. However, following the surgery done on the right eye, the cloudiness appears to have disappeared, but there has been no improvement in focus. This was evident in my inability to recognize the eye chart letters and numbers beyond my pre-surgery capabilities. My surgeon has asked to see me for a second postoperative exam on the fourth day following surgery and has indicated follow-up visits for the next five weeks.
My question is, can I expect to experience vision improvement, and what can I expect in terms of follow-up procedures? C.K.
A. Depending on what occurred at the time of your surgery (any difficulties or complications, etc.), blurred vision on the first few postoperative visits can occur. Continue to follow your surgeon's postoperative instructions and follow-up visit schedule. Typically, these symptoms improve at each follow-up visit. Dr. Slonim
Complications From Other Conditions, Such as Stroke,
Heart Problems, Glaucoma, Menopause, Etc.
Q. Should I have cataract surgery? I'm being treated for iritis and am down to one drop of Pred Forte a day. One morning I forgot the drop, and my eye turned a bit pink. I'm wondering if I should cancel the surgery or not. L.A.
A. Cataract surgery should be considered when a visually debilitating cataract is interfering with a patient's normal daily activities. Be aware that there are added complications associated with cataract surgery in someone who suffers from a chronic iritis. Frequently these patients are "preloaded" with topical steroids for the week prior to surgery, and some are also placed on oral steroids for the week before and after surgery. Dr. Slonim
Q. My mother is in need of cataract surgery. However, her doctor said that since she has a congestive heart condition (even though it's under control with medicine), the procedure can't be done without permission from my mother's cardiologist. The eye surgeon said there would be danger of my mother having a heart attack and dying during the operation. This is scaring my mother and her children. Any comments? P.K.
A. There is also a danger of having a heart attack in a dentist's chair during a root canal. I also request that my patients with medical conditions get prior medical clearance from their medical doctors or cardiologists prior to any procedure where my anesthesiologist might give sedation. This is simply a precaution and should not worry your mother or her children. The risk of such an event occurring during cataract surgery is no different than it occurring during any other outpatient procedure done under local anesthesia. Good luck to your mother. Dr. Slonim
Q: My father is having cataract surgery in the morning. He had his first one done in 2001 and two weeks later suffered a thrombotic stroke, which left him with left hemiparesis. He has been on Plavix since 2001 and was told to continue taking it for this surgery. Is he at risk of another stroke, and what is the risk of hemorrhage related to the Plavix? C.
A: His first stroke is probably not related to his first cataract surgery, although they occurred two weeks apart. Your father's risk of stroke is probably related to other medical conditions and diagnoses that he has. His Plavix is being taken to reduce his risk of future strokes. The risk of a stroke without the Plavix is probably much greater than his risk of an ocular hemorrhage while on the Plavix. Dr. Slonim
Q: My mom has been lasered for wet macular degeneration. She now has cataracts. Is it possible for her to have her cataracts removed under these conditions? M.L.
A: Yes, and sometimes it makes it easier for the retinal surgeon to diagnose and treat the macular degeneration when the cloudy cataract is removed. Dr. Slonim
[Read more about age-related macular degeneration.]
Q: I have glaucoma and a cataract. Will I have good results? A.P.
A: The combination of these two conditions does not reduce the success of the cataract surgery. Cataract surgery will not alleviate your glaucoma. Your glaucoma can still progress whether or not you have cataract surgery. The results of your surgery usually depend on your surgeon and what happened at the time of your surgery. Dr. Slonim
Q: I am 67, overweight, and a diabetic. My glucose level is controlled by drugs, and my high blood pressure is controlled by drug. I am told by the optometrist that I have cataracts in both eyes. He says stronger glasses won't help me distinguish faces better or read road signs. If I decide to have the cataracts removed, will I be able to see well enough to go home after surgery? Is the surgery performed in a hospital? Given my medical condition, is there any reason not to proceed with this surgery? Finally, just the thought of cutting into my eye makes me very nervous and squeamish. Is this a common feeling, do you think? Thanks. J.B.
A: Cataract surgery is one of the most successful of all types of surgeries. Assuming that you do not have any other ocular problems (e.g., diabetic retinopathy, macular degeneration, etc.), cataract surgery should restore the vision loss that is directly associated with your cataract.
Cataract surgery is performed as an outpatient in a free-standing ambulatory surgery center, doctor's office surgicenter or hospital outpatient department. You should be able to go directly home after surgery, although you will not be allowed to drive yourself home. Depending on the surgeon and the technique, you may leave the surgery facility with a patch and a plastic shield over the operated eye or possibly just the clear plastic shield.
The medical conditions that you describe, if stable, should not prevent you from having cataract surgery. Your anxiety regarding having "your eye cut into" is very normal. Typically, a sedative is given just prior to the procedure. Dr. Slonim
Q. I have cataract surgery scheduled for three months from now. What is your experience regarding cognitive impairment following cataract surgery? I had an incident about two months ago in which I lost vision bilaterally. It was like a white flash; I don't know how long it lasted. I passed the "Mini Status" test; MRA and ECHO were both negative. I have been terribly frightened, because I've had what I call "missing moments," which were seconds in duration.
I need the cataracts removed, but I also need some guidance as how to prepare for unusual circumstances. The presurgical exam is scheduled for two months from now. I am 77 and live alone.
My medical history includes a bilateral knee replacement eight years ago and a triple bypass and angioplasty five years ago. Thank you in advance for your help. E.H.
A. Your cognitive impairment is a cerebral phenomenon, not an ocular one. There are certain cerebral vascular conditions that can cause visual loss. These conditions need to be investigated by a neurologist or a neuro-ophthalmologist prior to surgery. The cataract surgery, itself, should have no direct effect on your cognitive impairment. Dr. Slonim
Q. I had cataract surgery last year. Everything went well and there have been no real problems, though I may have had expectations too high as to the outcome. I chose to keep nearsightedness, understanding that I would (I thought) need glasses only for distance. I now need glasses for reading, too. I was surprised and somewhat disappointed at this final outcome. My doctor said it happens, but I couldn't get a straight answer as to whether it was unusual.
Now here's my real question. I am 50. Two weeks before the final checkup, I started taking a hormone replacement (Tibolone) for the symptoms of menopause. Shortly after I started taking it, I learned that these hormones can cause eye problems, although my gynecologist said she had never come across this problem in any of her patients. My eye surgeon also said he didn't think it was a problem, but I don't think he really knew much about it. I have stopped taking the medication for now, as I was worried about it causing any further deterioration of sight. Do you think this type of medication can have this type of effect on vision? Could this be why my vision dropped so much? C.
A. I am not aware of any correlation between your hormonal therapy and the changes that you experienced with your prescription after cataract surgery.
The goal of the cataract surgeon is to get a final result that will allow the patient the opportunity not to have to wear glasses in the distance. The postoperative "refraction" (i.e., need for glasses) was calculated preoperatively when your surgeon made certain measurements to determine the power of a monofocal IOL that he or she wanted to insert into your eye. One of the two measurements is called the keratometry readings, which measure the curvature of your cornea (clear outer covering of the eye). The second of the two measurements is the axial length, which is an ultrasound measurement of the length of your eye. Both of these measurements are crucial to the success of the operation. The goal is for the IOL power to give you a final refraction as close to zero as possible, and therefore, no glasses in the distance should be necessary. Obviously, you chose to remain nearsighted.
Sometimes there can be a residual refraction after surgery even if the preoperative IOL power calculations show that the eye should have ended up as "zero." A number of factors can influence this final postoperative refraction, such as how the IOL is positioned surgically, the anatomical relationships inside your eye, any preoperative astigmatism, etc. Restart your hormones without worrying about your eyes. Dr. Slonim
Other Cataract Treatments
Q: Are there any other options besides surgery to cure cataracts, such as laser? Thank you. E.R.
A: The only known treatment for cataracts is their surgical removal. Dr. Slonim
Q. Is there any new treatment? Is it always necessary to have surgery? E.W.
A. The only successful treatment for visually debilitating cataracts is cataract surgery (when the cataract and the patient are ready for it!). Dr. Slonim
New Surgical Techniques, New Intraocular Lenses
Q. I had cataract surgery on my right eye in 1997 before some of the new lenses were approved. I'm now facing cataract surgery for the left eye. Am I a candidate for Crystalens for the left eye? I would like to improve my near vision. C.P.
A: The Crystalens belongs to the class of premium presbyopia-correcting IOLs. It is the only accommodative IOL that is designed to change its position in the eye as the ciliary muscle changes during the act of focusing on a near object.
When implanted correctly, the Crystalens can change position forward or backward in the eye as the ciliary muscle contracts. The ciliary muscle is the muscle in the eye that would change the shape of our natural lens before it became a cataract. This allowed us to focus on near objects.
Not all patients are good candidates for these IOLs. There are other presbyopia-correcting intraocular lenses such as multifocal IOLs that are currently available. Your surgeon determines the choice of which IOL design to use, such as multifocal or accommodative, based on a number of factors including your eye's anatomic suitability and refractive error, your reading requirements and your personal preference.
A small percentage of patients do not do well with a presbyopia-correcting IOL in only one eye. Therefore, some surgeons choose not to implant these IOLs in only one eye. Other patients have no problems with a monocular presbyopia-correcting IOL.
Another option is monovision where, after cataract surgery, one eye is corrected for distance and the other eye is corrected for near vision. Your surgeon can try to determine if you are a good candidate for monovision by temporarily placing a contact lens with a reading power over your eye with the cataract to see how you do.
When in doubt, get a second opinion. Good luck. Dr. Slonim
Q. I am 61 years old and have been wearing multifocal spectacles for some years but find it difficult to read now, and my eyes get tired frequently. I have a mild case of cataract in one eye, and my doctor recommends an intraocular implant. I've been reading up about the various multifocal lenses on the web, but I'm not sure which is the best for me. If cost is no object, which lens do you recommend? Thank you for your time. T.S.
A. Currently there are a number of FDA-approved presbyopia-correcting intraocular lenses (IOLs). Tens of thousands of cataract patients have had these "premium" IOLs implanted, which gives them both distance and near vision without glasses.
Your surgeon chooses which IOL design to use (multifocal or accommodative) based on a number of factors including your eye's anatomic suitability and refractive error, your reading requirements and your personal preference. Not all patients are good candidates for these types of IOLs.
Rather than recommend a specific IOL, I suggest that you find a good cataract surgeon who implants presbyopia-correcting IOLs and follow his or her recommendations. For the overly cautious, I usually suggest taking the extra time and effort to visit two such surgeons to possibly hear two different points of view. Good luck. Dr. Slonim
Q: I have been diagnosed with a cataract, PCS, in my left eye that requires a replacement lens. My right eye also has a cataract, but not requiring lens replacement right now. (It will in the foreseeable future.) I am a 54-year-old male, married, no other medical problems, and still very active (10- and 12-year-old boys to keep up with). My question concerns the type of lens that I should choose. I know there is a choice of a single vision IOL or multivision IOLs (Crystalens, ReZoom, Tecnis and ReSTOR). Can you review the pluses /minuses of the different IOLs and under what circumstances I should choose one type or brand of IOL over another? E.D.
A: All of the "premium" presbyopia-correcting IOLs that you mentioned (and others) have undergone extensive clinical studies in order to obtain FDA approval. The main advantage of the premium IOLs is the opportunity to see both near and far without glasses. Most cataract surgeons who implant these IOLs will prefer one design more than the others and will receive extra training prior to implanting them. The cataract extraction surgery itself will be the same.
Tens of thousands of cataract patients have had these premium IOLs implanted, which gives them both distance and near vision without glasses. The choice of which IOL design to use, such as multifocal or accommodative, is determined by the surgeon based on a number of factors including the eye's anatomic suitability, refractive error reading requirements of the patient and patient desires. Not all patients are good candidates for these types of IOLs.
Rather than recommend a specific IOL, I suggest that you find a good cataract surgeon who implants presbyopia-correcting IOLs and follow his or her recommendations. You also might want to consider visiting two such surgeons to possibly hear different points of view. Dr. Slonim
Q: What do you think about AquaLase? M.A.
A: The AquaLase is an instrument that uses a new technology for performing the emulsification (i.e., the breaking up) of the cataract in order to facilitate its removal. Instead of the tip of the surgical instrument using a mechanical vibration with ultrasound to break up the cataract, the AquaLase tip uses water pulses or micropulses. Since the AquaLase is so new, comparative data to determine which technology is better is not yet available. Dr. Slonim
Q: I am a 62-year-old male and have been diagnosed with a nuclear cataract in my left eye. My ophthalmologist said that if he replaced the lens in one or both eyes I would still need glasses (my vision is not poor). He also said that if he replaced it with this "superlens" (called IQ ReSTOR), I would never need glasses again. However, the superlens costs an addition $2,500 per eye! Why wouldn't a regular IOL correct my vision if done in both eyes? J.W.
A: Your postoperative result depends in great part on your preoperative refractive error.
The conventional or regular (as you referred to it) intraocular lenses (IOLs) are monofocal, which means single vision. The power of the lens is precalculated for each individual. Typically, a power is chosen to give the patient the best possible distance vision (as Mother Nature had intended). Reading vision will require reading glasses.
As you mentioned, premium presbyopia-correcting IOLs are available but at a premium "superlens" price. Patients with astigmatism may still require glasses to sharpen the distance. Now astigmatic or toric IOLs are available, but also at a premium "superlens" cost.
Patients who have worn monovision in contact lenses one eye for distance and one eye for near may choose to have their surgeon implant monofocal IOLs that continue to give them monovision without the "superlens" cost. Most medical insurances cover monofocal IOLs.
IQ ReSTOR, which was FDA-approved in 2005, is just one of a number of multifocal IOLs that are now available to cataract surgeons.
Insurance companies typically have an allowance for the cost of the conventional monofocal IOLs. Therefore, patients are not charged for these IOLs. But the high costs of these new multifocal or accommodating IOLs are not covered by Medicare or other insurers.
In 2005, a national Medicare coverage policy was released stating that Medicare would reimburse the surgical facility the usual and customary fee for a conventional monofocal IOL. But beyond normal charges, the patient would be responsible for paying extra fees associated with the premium presbyopia-correcting or astigmatic IOLs. The prices for inserting these IOLs will vary from surgeon to surgeon and from state to state. Dr. Slonim
Q: What is monons vision? M.H.
A: I believe you are referring to monovision. This is a treatment for patients (typically over 40 years of age) who wear glasses for distance and now require reading glasses (bifocals), or for someone who never required glasses in the distance and now requires reading glasses (readers). In either case, the patient is fitted into contact lenses where one eye is fitted for distance vision and the other eye is fitted for near vision. Patients who have worn monovision in contact lenses (one eye for distance and one eye for near) may choose to have their cataract surgeon insert IOLs that continue to give them monovision. Dr. Slonim
Q: Hi Doc. Are the new IOLs called Crystalens any good? My ophthalmologist says they don't work. But he doesn't or is not licensed to do that kind. The one doctor in town who does the Crystalens says they're great. I guess each has a conflict of interest. I would like an impartial third party's opinion. Thanks. J.L.
A: The Crystalens belongs to the class of premium, presbyopia-correcting IOLs. It is an "accommodative" IOL that is designed to change its position in the eye as the ciliary muscle changes during the act of focusing on a near object. When implanted correctly, the Crystalens has the ability to change position forward and backward in the eye as the ciliary muscle contracts.
Tens of thousands of these lenses have been successfully implanted into cataract patients, which allows them to see both distance and near vision without glasses. Not all patients are good candidates for these IOLs. Other presbyopia-correcting IOLs, such as multifocal IOLs, also are available. Your surgeon will determine the choice of which IOL design to use, based on a number of factors including your eye's anatomic suitability and refractive error, your reading requirements and your personal preference.
Rather than recommending a specific IOL, I suggest that you find a good cataract surgeon who implants presbyopia-correcting IOLs and follow his or her recommendations. Most surgeons who implant the Crystalens also implant the other presbyopia-correcting multifocal IOLs. They will implant the Crystalens only if it is the right lens for you. Otherwise, they will choose a different IOL. If you are overly cautious, I would suggest taking the extra time and effort to visit two such surgeons to possibly hear two different points of view. Dr. Slonim
Q: Is the IQ ReSTOR lens approved for non-cataract patients? If so, would the clear lens be removed or the multifocal lens be placed in front of the natural lens? T.K.
A: The IQ ReSTOR lens is meant to replace the cataractous lens. I am not aware of any surgeon implanting them into non-cataractous (i.e., nearsighted, presbyopic) persons yet. They would be placed in the position where the original lens was. Dr. Slonim
Q: I've heard both "good and bad news" about the latest type of IOLs being used in cataract surgery. The good news is, they correct for both distance and reading, eliminating the need for glasses. On the negative side, I've heard they can produce a glare that interferes with good vision and sometimes need to be replaced after the initial surgery. What is your opinion about these newer lenses, and do they work as well on patients with astigmatism? H.S.
A: All of these IOLs have undergone extensive clinical studies in order to obtain FDA approval. The main advantage of the premium presbyopia-correcting IOLs is the opportunity to see both near and far without glasses.
Tens of thousands of these lenses have been successfully implanted into cataract patients, which allows them to see both distance and near vision without glasses. Not all patients are good candidates for these IOLs. The choice of which IOL design to use (multifocal or accommodative) is determined by the surgeon based on a number of factors including the eye's anatomic suitability, refractive error, reading requirements of the patient and patient desires.
Even under the most ideal cataract surgery procedures, a small percentage of patients can have the postoperative glare that you described. For them, a technically successful surgery results in an unhappy postoperative visual outcome.
The presbyopia-correcting IOLs do not work as well on patients with uncorrected astigmatism. There are astigmatic or toric IOLs now available to astigmatic patients, but these do not correct presbyopia. People with astigmatism who desire a presbyopia-correcting IOL can consider astigmatic refractive surgery such as limbal relaxing incisions or LASIK in conjunction with their presbyopia-correcting IOL. Dr. Slonim
Q. Which is the best and most successful method for cataract surgery used today: laser or non laser? D.A.
A. Currently, lasers are not used to remove cataracts. There are a couple of laser-assisted cataract extraction instruments that are under clinical investigation. The vast majority of state-of-the-art cataract surgeries are non-laser procedures. Dr. Slonim
Q: I am a volunteer in Dallas. I work with a low-income woman with no family. She is going to have cataract surgery on her "good eye" in a couple weeks but insists on having her lens removed and not replaced with an artificial one. She wants to wear the old thick glasses afterwards. She has no vision in her other eye, and I'm not exactly sure why. She is worried because her mother had some problem with her cataract surgery 25 years ago, had a stroke rather soon after the operation and later died. I can't imagine there was any connection, but could you give me some "expert" advice to pass along that might convince her to have the "modern" surgery? I think she is just very afraid of negative consequences. A.L.
A: I am actually surprised that your friend could find a surgeon in Dallas who is willing to perform cataract surgery without implanting an intraocular lens (IOL). Obviously the patient has the right to refuse an implant, but this would be below the standard of care. Your friend would probably experience more problems without the IOL then if she had the IOL implanted at the time of cataract surgery. There is a significant amount of visual rehabilitation required with the old-time thick cataract glasses. These create a lot of distortion to one's vision. A lot has occurred since your friend's mother had cataract surgery 25 years ago. It would not be fair to compare the IOLs of today with those of a quarter of a century ago. The choice is hers, but I will be surprised if she can find a surgeon that will honor her wishes. Good luck to her. Dr. Slonim
Q: Today I went to see a doctor about a mass on my eye. She said that I have pingueculae. She also said that I have a star-shaped cataract on my eye. I am only 30. Are these two things related? Is this something that may progress quickly? L.
A: A pinguecula is a harmless, degenerative change of the conjunctiva located on the surface of your eye. A cataract is an opacification in the lens inside your eye. The two are not related. Typically, both are slowly progressive, although some varieties of cataracts can progress rapidly. Dr. Slonim
Q: If you have cataracts, can you have LASIK surgery for nearsightedness? P.L.
A: Yes, as long as you meet the surgical criteria for LASIK, it can be performed after cataract surgery for the nearsightedness (myopia) that you still have. Dr. Slonim
Q: My mother is having cataract surgery in a few weeks. My concern is that she has an indoor cat. What do we need to do about this situation? I have heard animals can cause eye infection. R.S.
A: Not being a cat person, I will not tell you what I think should be done with the cat. Nonetheless, having an indoor cat should have no effect on the outcome of your mother's cataract surgery. Just don't let the cat scratch your mother's eye. Good luck to your mother. Dr. Slonim
Q: I am a 75-year-old with cataracts in both eyes. I have always been nearsighted and have some astigmatism. I can read fine up close by taking off my glasses; in fact, it's easier to read with my glasses off. I also have early-stage macular degeneration.
I am trying to decide whether I should choose a lens with it focused for near vision, which would be the type of vision I have had for years, or whether to choose a lens focused for distance vision. They say it's my choice, and I'm not sure what to do.
My main problem now is that glare bothers me, especially driving at night. My reading vision is getting a little blurry, and my doctor said this could be the computer and not the cataracts. Your opinion would be appreciated. B.S.
A: Unfortunately, I agree with your surgeon: The choice is up to you. Having never worn glasses for distance but only readers for near, I can't imagine not having clear vision in the distance. You, obviously, have the opposite opinion. By the way, distance vision is used much more than reading or near vision in a normal daily life.
The only suggestion I give to my patients with this same dilemma is to review the amount of time that they have to put glasses on (for distance) vs. how much time they spend with their glasses off for near vision. Your surgeon can offer you the opportunity to spend less time in glasses. The choice is yours. Dr. Slonim
Q: I had cataract surgery 20 years ago, and I was wondering what method was used. I am scheduled for an MRI next Tuesday, and I am not sure if the implant that was used has any metal on it. The procedure was done by Dr. Milton Miller in Upland, California in 1985. Any information you can give me would be greatly appreciated. G.N.
A: I am unable to tell you what method or implant your surgeon used. You might try contacting his office. I am unaware of any implants that ever contained metallic components during that time period. Some very early implant designs did. Your eye doctor should be able to look at your implant under high magnification and tell you what kind you have. See your eye doctor prior to your MRI. Dr. Slonim
Q. I am writing in reference to patients who have had cataract surgery and are being referred to our facility for an MRI. Are there any contraindications for these patients to have an MRI (any body part)? Are they OK immediately, or do they need to wait six to eight weeks? Please write back with any advice to help clarify this situation. We definitely want to follow a professional opinion and keep our patient safety up to date. Thank you in advance. D.M.
A. There are no metallic parts in the currently available intraocular lenses. MRI scans can be performed immediately after surgery if necessary. Some surgeons may not want their patient in a face-down position for about a week. Dr. Slonim
Q. Can you go blind if you don't remove cataracts? S.
A. Untreated cataracts can bring one's level of vision to legal blindness. Fortunately, if the level of vision is solely due to the cataract, then the pre-cataract visual acuity should be restored after cataract surgery. Dr. Slonim
Q. I developed a cataract about seven weeks ago, and it is now ready to be removed. Why did it develop so fast? I am 59 and female. I had a bad accident to my eye when I was about eight years old. Is there any connection? H.S.
A. Trauma can cause a cataract that can be rapidly progressive. If a traumatic cataract occurred at the time of your injury 50 years ago, I doubt it is associated with your current "rapidly progressive" cataract. Your seven-week-old cataract may have been present for awhile, but only recently recognized or described. Dr. Slonim
Q. At my check-up with an optometrist I found out I have "early cataracts." She said it's not a problem until I have some symptoms. I am 56 years old. Should I go to an ophthalmologist to get another opinion? The optometrist said to take six to ten mg of lutein. My vitamin packet has a small amount. I take lots of antioxidants. Thank you. S.
A. I agree with your optometrist that, until you have symptoms associated with your cataracts, they should not present a problem. There is no solid scientific proof that lutein or the antioxidants help prevent cataracts or slow their progression. These supplements have been shown to benefit patients with macular degeneration. Dr. Slonim
[Read more about eye nutrition.]
Q. My mom has a very deep cataract, and the doctor wants to have a retina surgeon on standby when doing her cataract surgery in the event that the retina falls away into gel. If this should happen, she has been told she would have to return to the hospital the following day to have retinal surgery. Can you please expand our information on this occurrence? Thanks in advance. I should mention that my mom is 88. K.
A. Performing cataract surgery on a dense, hypermature cataract (I'm assuming that's what you meant by "deep") is technically more difficult even with the state-of-the-art techniques and instruments. There is a higher risk of complications. One of those complications is a retinal detachment. Your mother's surgeon is just taking extra precautions in the unlikely event that your mother does have a retinal detachment after surgery. Dr. Slonim
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