Cataract Surgery

Q: What is a cataract?

A: A cataract is a clouding of the eye’s lens. The formation of a cataract is a natural part of the aging process. This condition occurs because over time, natural proteins in the lens clump together, interfering with the normal vision process and causing vision to become cloudy or hazy. Aging is the most common cause of cataracts, but other causes include injuries to the eye, certain drugs and septic diseases such as diabetes. Unfortunately cataracts affect almost everyone in their 60s and beyond.
Photograph of an eye with a cataract

Clinical photograph of an eye with a cataract. This type of cataract is called a cortical cataract with opacities that resemble the spokes of a wheel.

Q: What symptoms do cataracts cause?

A: Signs that you may be affected by a cataract include poor night vision, dulled color vision, haziness, sensitivity to light, and halos and other star bursts around lighted objects, such as car headlights. However, some cataracts do not cause any symptoms until they are in their advanced stages, which is why Dr. Julie Lee recommends regular eye exams.
Cutaway view of an eye with a cataract

Cutaway views of the eye showing a clear lens (top) and one with a cataract (bottom). The cataract reduces vision by reducing the amount of light that can enter the eye.
Picture of how a cataract can cause light waves to scatter as they enter the eye.

This picture depicts how a cataract can cause scattering of light waves as they enter the eye. This leads to symptoms of glare in patients who have cataracts.

Q: What are my treatment options with cataracts?

A: In the earliest stages, cataracts can be managed with stronger glasses or bifocals along with improved lighting during everyday tasks. Once these conservative measures fail to improve your vision, it may be time to consider surgery. Surgery should be considered when your normal daily activities are being affected by the cataracts. The activities most commonly affected by cataracts include driving (especially at night), watching television, seeing the golf ball and, with advanced cataracts, reading and other near vision activities can be affected. Today, we have several options when it comes to correcting your vision with cataract surgery. Different types of intraocular lenses (IOLs) are available in order to help reduce glare, correct astigmatism, and, the newest types of IOLs, actually can correct both near AND far vision following cataract surgery. Both the ReSTOR® and ReZoom™ IOLs are designed to correct near AND far vision after cataract surgery. Please click here to learn more about this amazing new technology.

A photograph of eyes with various forms of cataracts

Cataracts can occur in various forms and arise from different causes including: congenital trauma, drug-induced and age-related.

Q: How are cataracts removed?

A: The most modern technique for removing cataracts today is called phacoemulsification. This method utilizes a small probe which is inserted into the eye and the probe breaks the cataract into small pieces which are then vacuumed out of the eye through the probe. Following this, a small, thin, plastic lens known as an intraocular lens (IOL) is implanted into the eye in the same position where the cataract once stood. The IOL now comes in different styles, such as the ReSTOR® IOL which can restore both distance and near vision, thus allowing the patient to avoid wearing glasses after the surgery. These lenses are now an option for Medicare patients. See below for more information about these revolutionary IOLs.

Q: What is a YAG posterior capsulotomy?

A: A posterior capsulotomy is a surgical laser procedure performed with a device known as a YAG laser. This procedure may be necessary after cataract surgery. Following cataract surgery, some patients experience the formation of scar tissue behind the intraocular lens (IOL). This affects approximately 10 to 30 percent of patients following cataract surgery and can occur within a few weeks or years after the procedure. This scar tissue formation may result in clouding and reduction of vision, thus necessitating a YAG posterior capsulotomy. A posterior capsulotomy is virtually painless and takes one to two minutes to perform. The eye pressure is checked following the surgery as there can be an occasional elevation of the pressure which can be treated with eye drops. Most patients notice an immediate improvement in their vision. A retinal exam is required one to two weeks following the surgery since in rare instances, the retina can tear or detach.

Cataract Surgery: Experiencing Better Vision

Being told that you have a cataract that will require surgery is frightening to many people. This is why Dr. Julie Lee and his staff are ready to answer all of your questions about what a cataract is and how it is removed in order to make the experience a pleasant one. We will let you know everything that is going to happen before, during, and after the surgery so that there won’t be any surprises. We always feel that a well informed patient will always have a better experience than a patient that is uninformed about what to expect.

Before your surgery

One of the most important parts of cataract surgery is the preoperative evaluation. During your exam, Dr. Julie Lee will do a thorough medical evaluation of the eye which will include dilation of the pupils. This is done in order to evaluate the severity of the cataract and to assess the eye for any other diseases which may be present, such as glaucoma or macular degeneration.

Once it has been determined that you require cataract surgery in order to improve your vision, Dr. Julie Lee will provide a detailed explanation of how the surgery is performed and the risks and benefits of the surgery. At this point, he will also discuss the newest technologies available, such as the ReSTOR® and ReZoom™ advanced intraocular lenses to help restore near and far vision following cataract surgery. After this, an ophthalmic technician will perform preoperative measurements on your eyes in order to help Dr. Julie Lee pick the correct intraocular lens for your eye. The technician will also schedule a date and time for your surgery and answer any final questions that you may have.

Dr. Julie Lee and his staff are available to discuss any questions that you may have prior to your surgery, so please contact us or call (502) 447-7315 if you have any questions.
The Day of Surgery

Typically, you will need to arrive at the surgery center an hour to an hour and a half prior to your scheduled surgery. You will be examined by an anesthesiologist or a nurse anesthetist and an IV will be placed in your arm. Most patients will receive a mild sedative called Versed, in order to relax you. Your pupil will be dilated and anesthetized with eye drops in order for Dr. Julie Lee to perform the surgery. Following this, you will be taken to the operating room and you will be prepped for surgery.

The surgery itself will take 10 to 20 minutes. During the surgery, Dr. Julie Lee will give you simple instructions that are very easy to follow as you will be awake during the surgery. Some patients require more sedation during the surgery, and this will be determined by Dr. Julie Lee. Most patients do not experience any sensation during the surgery, but occasionally, some patients may experience a feeling of pressure on the eye. This only lasts for a few seconds.

When the surgery is completed, you will be taken to the recovery area and given instructions on how to care for the eye after surgery. The eye will be covered by a clear plastic shield for protection. The shield is usually removed about three hours after the surgery.

After Cataract Surgery

You will be able to return home about half an hour after the surgery. You will start using eye drops the afternoon of the surgery and continue using them for about three weeks following the surgery. You will use one kind of antibiotic drops and two kinds of anti-inflammatory drops. The antibiotic drops are typically stopped after a week and the anti-inflammatory drops are continued for three weeks. You will wear the clear plastic shield over the eye at night for about four nights in order to protect the eye. You will need to avoid any heavy lifting for about a week, but otherwise most people can return to normal activities, including driving, the day after surgery. Postoperative visits at Dr. Julie Lee’ office are usually at one day, one week, and three weeks after surgery.

AcrySof® ReSTOR® Lens

The AcrySof® ReSTOR® lens is designed to provide improved vision at all distances without aid from the muscles in the eye that normally control the lens. Instead, the lens distributes light coming into the eye as a function of pupil size. Four out of five AcrySof® ReSTOR® lens patients have reported never wearing glasses again, according to clinical studies.
How is the AcrySof® ReSTOR® IOL different from monofocal IOLs?

Monofocal IOLs are a traditional type of IOL that provides patients with only one focal point. Most commonly, these lenses only correct distant vision, although sometimes the patient wants their near vision to be corrected. This means that you will likely require glasses following surgery either for distance or near, and sometimes for both. The AcrySof® ReSTOR® IOL differs from regular monofocal IOLs in that it focuses at distance and near, decreasing your dependency on glasses at all distances.
What is the difference in cost between a traditional monofocal lens and the AcrySof® ReSTOR® IOL?

Insurance policies vary, but Medicare, supplemental insurance, and private insurance will typically still cover the basic cataract surgery procedure with a conventional, monofocal IOL. However, if you decide to have an AcrySof® ReSTOR® IOL implanted, there will be an additional cost that is not covered by insurance or Medicare. Medicare now allows you to pay the difference for the added benefits of the AcrySof® ReSTOR® IOL. This additional cost may be financed through CareCredit®, which can be set up through our office.

If you are interested in finding out more about the benefits of the AcrySof® ReSTOR® IOL or in an explanation of your policy coverage, please contact us or call our office at (502) 447-7315.
How You’ll See with the AcrySof® ReSTOR® IOL

Near Vision: This refers to focal points that are typically 16 inches or closer to your eyes. This is typically referred to as “reading vision.” This would include reading such items as newspapers, phonebooks, and medicine bottles. With the AcrySof® ReSTOR® IOL, you are able to read quickly and easily without the need for reading glasses in most instances. In an independent study, AcrySof® ReSTOR® IOL patients were tested to see how well they read paragraphs of decreasing font size in comparison to patients implanted with a standard IOL. While only one of 13 patients with standard IOLs could read letters the size of newsprint,four out of five AcrySof® ReSTOR® IOL patients were able to read letters the size of newsprint without glasses!

Better vision for different lighting: The AcrySof® ReSTOR® IOL delivers excellent vision in varying lighting conditions. In bright conditions, the central apodized zone of the AcrySof® ReSTOR® IOL produces light waves for both near and distant visual stimuli. In reduced lighting when the pupil is more dilated, such as when watching a movie in a theater, the outer refractive area of the IOL produces greater visibility for clearer distance vision.
How does the AcrySof® ReSTOR® IOL work?

The normal eye – accommodation: Accommodation is the ability we are born with that allows us to change the shape of the natural lens in our eye in order to focus on objects at various distances. However, around the age of 40 we begin to lose the ability to accommodate, causing us to depend on reading glasses or bifocals in order to focus on near objects.

The AcrySof® ReSTOR® IOL-An Apodized Diffractive IOL:Fortunately, because of new technology, we now have the ability to restore the loss of accommodation which occurs with aging. The AcrySof® ReSTOR® IOL employs a patented design called Apodized Diffractivewhich has been used for years in telescopes and microscopes. This design uses a gradual tapering of the diffractive steps from the center of the IOL to the outer edge of the lens creating a smooth transition between the areas responsible for near, intermediate, and distance vision. In the design of the AcrySof® ReSTOR® IOL , the apodized diffractive portion of the IOL, which is responsible for near vision, is located in the center of the lens. This takes advantage of the fact that the pupil gets smaller when you are attempting to read, thus you will be looking through the apodized diffractive portion when reading. The outer portion of the lens is dedicated to distance vision, taking advantage of the fact that the pupil is typically larger when focusing at distance and in low light.
Clinical Results of the AcrySof® ReSTOR® IOL

Freedom from glasses for 80% of patients: During clinical studies of the AcrySof® ReSTOR® IOL, results showed that four out of five patients implanted with the AcrySof® ReSTOR® IOL reported never wearing glasses following cataract surgery. This compared to only 1 out of 10 implanted with a traditional, monofocal IOL. These results demonstrated the highest level of freedom from glasses ever shownin an IOL clinical study. Also, when questioned following the implantation of the AcrySof® ReSTOR® IOL, 94% of patients were so satisfied with their quality of vision that they would have the AcrySof® ReSTOR® IOL implanted again.
Is the AcrySof® ReSTOR® IOL right for me?

This is a decision that you should reach only after a thorough discussion with Dr. Julie Lee. You should consider all the risks and benefits of the IOL, and because of this, Dr. Julie Lee always allows you plenty of time to make your decision. Very often he will not schedule your surgery at the time of your office visit in order to allow you to think it over at home and to discuss it with your family members. Frequently, certain activities in which you participate will help you make the decision. For example, if you do a lot of reading, and you don’t want the hassle of reading glasses anymore, the AcrySof® ReSTOR® IOL may be an excellent choice for you. However, if you do a lot of driving at night, the AcrySof® ReSTOR® IOL may not be the best choice, since some people experience halos at night with the lens. Whatever decision you make, Dr. Julie Lee and his office staff will be ready to answer all of your questions regarding cataract surgery and the AcrySof® ReSTOR® IOL. Please contact us or call (502) 447-7315 if you have any questions about the AcrySof® ReSTOR® IOL.