Frequently Asked Questions

What is the right age to get LASIK?

Patients must be older than 18 years of age to have LASIK. In addition, they must have a stable refraction (the number that is used to measure the power of glasses or contacts). If both of these criteria are met, there is no “wrong” age to have Lasik. Reports have indicated that a growing number of people age 45 and older are having Lasik and other refractive procedures to reduce the need for reading glasses.


What causes Cataracts?

Most cataracts are simply due to age-related changes in the Lens of an eye. However, there are a number of other conditions/factors that contribute to the development of cataracts.

Diabetes– Unfortunately, individuals with diabetes develop cataracts more frequently and earlier in life.

Medications– Certain medications are known to cause cataracts. One of the biggest culprits here is corticosteroids. While many of us have never taken corticosteroids, they are used heavily in patients with Chronic Obstructive Pulmonary Disease (COPD), Rheumatoid arthritis, and various other inflammatory and infectious conditions.
Other medications that lead to the formation of cataracts include chlorpromazine and other phenothiazine medications.

Ultraviolet (UV) radiation– Unprotected exposure to UV radiation can lead to cataracts. It’s a good idea to always keep those eyes protected!

Trauma– Sharp trauma (entry into the eye) and blunt trauma can both lead to cataracts. Even something as seemingly harmless as “eye rubbing” has been shown to cause the early development of certain cataracts.

Smoking– There is a significant association between smoking and the development of cataracts. Just more reason to quit.

Alcohol– Studies have shown that patients with higher alcohol consumption have an increase in cataract formation compared with patients with lower or no alcohol consumption.


What will happen if I don’t get my Cataracts removed?

It is important to understand that every Cataract is different. Some cataracts are very severe and lead to blindness if they are left alone. Other cataracts may simply cause permanently blurred vision but never significantly impair the functions of daily living. Still others can cause increased glare, double vision, or lead to forms of Glaucoma. With this in mind, it is important to see a trusted eye-care provider who can counsel you on the best decision to make regarding cataract removal.


Do I need to discontinue blood thinners or anticoagulants (example: Coumadin, Plavix, Aspirin) for Cataract surgery?

Standard Cataract surgery does NOT require the patient to discontinue anticoagulants (blood thinners). You may continue taking these as prescribed by your primary care doctor. However, it is important to note that sometimes Cataract surgery is combined with Glaucoma surgery (or less frequently with Retina surgery). In these cases, it may be beneficial to temporarily discontinue blood thinners for the surgery. Please consult with your doctor before the procedure to find out.


When will I know if I need glasses after Cataract surgery/When can I get them?

1 month. Although recovery from Cataract surgery is incredibly fast and patients often see an improvement within days, it takes a month for the lens implant to settle into position and the eye to heal. All of this impacts the power of glasses. Therefore, it is important to check patients for glasses at 1 month to avoid giving a premature prescription.

Most surgeons also check patients at 1 day and 1 week after surgery to make sure the eye is healing well.

Cataract Removal

Thanks to advancements in technology, an improved understanding of the eye, and ground breaking surgical techniques, cataract removal is now safer than it has ever been!

How it works

To understand how cataract extraction benefits patients, it is important to understand what a cataract is. A cataract is a cloudy lens, which prevents patients from seeing clearly. Please check out the Cataract section under Quicklinks for a more detailed explanation and some interesting facts. Cataract extraction involves removing the cloudy part of the lens and (usually) replacing it with a clear lens which is developed specifically for your eye.

Process

Like any well designed procedure, Cataract extraction involves a series of steps that are performed one after the other. I will describe these steps below.

The first and most important step of cataract removal is making sure the patient is comfortable. Patients are laid on a bed with pillows and cushions which are positioned according to the desires of the patient and the doctor. Light medications are used to ensure the patient is relaxed and pain-free. Dilating drops are used to help dilate the pupil so the cataract can be taken out as easily as possible. Numbing eye drops are used until the patient’s eye is completely numb. This is supplemented with numbing medications during the procedure to make sure that the entire procedure is absolutely painless. To give you an idea of how effective this is, many patients are surprised to hear I’ve finished (or even started) the procedure since they could not feel us working on their eye.

Once the patient is comfortable, the patient’s eye is carefully cleaned and a drape is used to make sure it stays clean and the field is “sterile”, or free of any bacteria.

A microscope is brought into position and the remaining steps are performed under the magnified view which allows incredible visualization. The microscope also provides target lights for the patients to look at during the procedure.

The next steps of the procedure vary depending on whether you and your physician have decided on “laser” or “conventional” cataract surgery. Keep in mind that not all facilities offer “laser” cataract surgery and if you are interested in it, you may want to check with your doctor’s office before making an appointment.

I offer both “laser” and  “conventional” cataract surgery. I will go into the specifics of each before getting back to the steps of the procedure that are common to both. As far as which one is right for you, I tailor my treatment plans for each individual patient as any doctor should. With that in mind, I recommend every patient discusses any questions they have with their eye care provider.


Conventional Cataract Surgery

A “microkeratome” is used to create a cataract incision. Other microscopic instruments are used to create a “capsulorhexis”, or circular opening in the lens capsule through which the cataract can be taken out and a new clear lens can be inserted. While some of these terms may sound unfamiliar, the take home message is that special instruments designed for micro-surgery are used to gain access to the cataract. You will see how this differs from Laser Cataract Surgery just below.

Laser Cataract Surgery

A femtosecond laser (an incredibly precise laser designed specifically for eye procedures) is used to create a cataract incision. At the same time, the laser creates a “capsulorhexis”, the circular opening through which the cataract is removed and new lens is inserted. The laser can also break up the cataract to make it easier to remove and create “limbal relaxing incisons” , which are a wonderful way to treat astigmatism. All of this is done in less than a couple minutes. It’s safe to say the laser is a great multi-tasker!


The remaining steps of the procedure are common to both conventional and laser cataract surgery. Now that there is clear access to the cataract, ultrasound energy is used to break up the cataract and take it out. This process is called phacoemulsification.

With the cataract out of the way, a carefully selected intraocular lens or IOL is inserted into the anatomical position that will provide the patient with the best visual and functional outcome. The idea of a lens inside your eye may seem unusual to some patients. However, intraocular lenses have been in used for decades, with the first one implanted in 1949. Over the years, the technology of IOLs have grown by leaps and bounds as the material used and designs have been perfected. Each lens is custom selected for the patient based on a variety of measurements and careful discussions at the time of your visit. In addition to restoring 20/20 vision or better, IOLs are also designed to reduce (or possibly eliminate) your need for glasses and treat astigmatism. There are many options to choose from, which is why I’ll write more about them in the Premium Lens section.

Getting back to the last steps of the Cataract procedure, once the lens is in the place, they eye is carefully flushed out and the eye is inspected to make sure it is in great condition. Additional drops are given to help the eye heal and protect it from infection. This concludes the procedure and the patient is then to the recovery area for check out. They can then spend the remainder of the day in the leisure of their own home.

Pros

The obvious benefit of this procedure is permanent relief from the symptoms induced by your cataract. Classic symptoms of cataracts include vision that is blurred or foggy vision, washed our color perception, and severe glare among other things. Cataract removal can improve clarity of vision, increase contrast sensitivity and color perception and reduce symptoms of glare. To help understand how one procedure can accomplish all this, imagine that you’ve been looking through a dirty, stained window for years. Now imagine that window is replaced with a brand new window that is completely stain resistant. This analogy might help you visualize how much of a difference cataract extraction can make.

An added benefit to cataract extraction is treatment of refractive errors (Myopia, hyperopia, and astigmatism). The surgeon can chose a specific lens to treat whatever refractive error your eye has. As a result, many patients no longer need distance glasses after cataract removal, even if they have worn them their entire life! Some lenses even allow for distance vision and near vision. These are especially helpful for patients that wish to say goodbye to reading glasses. Please consult the Premium Lens sections for more detailed information about specialty lenses.

Cons

As with any other procedure under the sun, it is important to fully understand the risks before deciding on cataract surgery. These include infection, inflammation, and (in the worst case) loss of vision. With that said, cataract removal is one of the safest procedures in the world and most complications can be effectively treated.

Another disadvantage for younger patients requiring cataract removal is the need for reading glasses after the procedure. However, there are many solutions to this problem including Monovision and Premium IOLs, which allow patient to see clearly far away and up-close.

Cataracts

Fun facts

Cataracts are the leading cause of blindness across the globe.

They affect people of all races and ethnicities and occur in men and women equally.

To give you a glimpse of how universal cataracts are, here are some interesting figures:

  • In 2002, the World Health Organization estimated that cataracts cause reversible blindness in a staggering 17 million people. This number is projected to reach 40 million by year 2020!
  • In the United States, more than 20 million Americans over the age of 40 are affected by cataracts.

How Do I Know If I Have Cataracts?

Classic symptoms of cataract include vision that is blurry, cloudy, or foggy. You may also notice a film over your line of sight that prevents clear vision. Colors are often less vivid and may appear washed out. One of the most debilitating aspects of early cataract formation is its effect on driving. Cataracts can cause severe glare from oncoming headlights which can make night driving very dangerous. They can also cause a refractive shift (nearsightedness or farsightedness) which makes viewing signs, traffic, and turns in the road more difficult.

Cataracts typically start out very small and often progress slowly. Partly because of this, they often go undiagnosed for years until they begin to impair functions of daily living.

What Can I Do About My Cataracts?

Removal or “extraction” of the cataract is the only effective treatment. Luckily, advances in surgical equipment and technique have rendered cataract extraction one of the safest procedures in the world today. Ultrasound and laser technology have been mastered to painlessly and effectively remove cataracts and restore patient’s vision. Many patients are able to achieve 20/20 vision or better after cataract surgery and resume the activities they have neglected because of worsening vision. Facilitating this improvement in quality of life is one of the most gratifying aspects of the procedure and my job in general.

Cataract surgery is an outpatient procedure, which means that there are no overnight stays in a hospital. Patients arrive the morning of the procedure and go home afterwards to spend the rest of the day in the leisure of their own home.

For more on the details of cataract surgery and different options, please visit the section on Cataract Removal. This section provides some basic information on technique and different options for the procedure.