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A cataract is an opacity or cloudiness of the eyes internal focusing lens. The lens is behind the pupil. It focuses light onto the retina at the back of the eye. Normally, the focusing lens inside a young persons eye is crystal-clear. As the aging process continues, that lens progressively can become less clear. As that cloudiness progresses, vision becomes less clear. |
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What are Cataracts?
The lens inside your eye is made of protein and water aligned in a very exact manner. In a normal eye, light passes through the eye’s lens and falls on the retina, forming an image. Over a lifetime oxidation disrupts that exact alingment of proteins making the lens more cloudy. As the cataract becomes more cloudy, light becomes more scattered so the image formed is blurred. Cataracts are part of the normal aging process (about 90 percent of people older than 65 years old have a cataract). Diabetes, UV exposure and some medications can produce cataracts sooner than expected based on age.
Early Cataracts: If you have early cataracts, Dr. Steensma will make every effort to provide you with the best vision possible. When it is no longer possible to make your vision good enough for your daily needs, he will refer you to Dr. John Davidson at the NVision Laser Center for cataract surgery. Dr. Davidson is one of the best Cataract surgeons in Ventura County. He has had more experience with the new advanced IOL's than any other cataract surgeon in the county. Most cataract surgeons still use the older fashioned standard IOL, not the new advanced IOL's.
Surgery is the only cure for a cataract. When the cataract is removed an Intra-Ocular-Lens (IOL) is implanted where the cataract was. The IOL replaces the patient’s natural lens and restores the patient’s ability to see.
The cataract is removed by making a small incision in the eye with a knife. Then the cataract is chopped up and sucked out of the eye with an instrument. The incision is so small, in most cases sutures are not needed. The entire procedure typically takes about 15 minutes and is performed under local anesthesia on an outpatient basis.
The four basic different types of IOL:
1. Standard Monofocal Lenses focus at one distance. Typically the lens used corrects the distance vision and the patient wears reading glasses. If the patient has much astigmatism glasses will be needed for both far and near vision.
2. Astigmatism Correcting Lenses (Toric IOLs) Patients with Toric lenses most likely will not need glasses or contacts, but they may still need reading glasses for close-up vision. Patients with astigmatism will also have sharper distance vision with Toric lenses than with standard lenses.
3. Presbyopic Correcting Lensess are like bifocals. They focus at distance and near. You still might need glasses at times. The two best at this time are the Tecnis and Restor IOL.
- Technis Multifocal IOL (AMO). This is a multi-zone diffractive IOL (focuses light by bending the light waves). The central zone is set for distance and the peripheral zone focuses at near but maybe a little too close for most people. It also corrects for spherical aberration to improve vision.
- AcrySof IQ Restore IOL (Alcon). This IOL utilizes both refraction and diffraction optical strategies and also corrects for spherical aberration. The design seems better for night time driving than the other designs. The near segment provides good vision at near point for most people.
4. Accomodating IOLs can change focus to focus at different distances, They can give you a range of distance, intermediate, and close-up vision, reducing or eliminating your need for glasses or contacts, including reading glasses. The Crystalens is the best of this type of IOL.
- Crystalens (B&L). This lens design allows the IOL to move forward and back changing how the eye focuses. It usually gives usable vision at distance and intermediate distances. The patient probably will need reading glasses for near tasks. If the patient has much astigmatism vision probably will not be adequate.
There are several other IOL designs currently being investigated for FDA approval.
Recovery: Most patients are able to return to their normal daily activities within 24–48 hours. Full recovery can take about two weeks, after which you can resume all your normal activities. Vision recovery can take up to three months.
Cataract Surgery Co-Management: Dr. Steensma will provide much of the pre-surgical and post-surgical care. Optometric participation is beneficial for the patient, the optometrist and the surgeon. For the patient, continuity of care is maintained and eye care becomes more convenient and accessible. Co-management affords Dr. Steensma the opportunity to maintain his role as primary eye care provider during and after the procedure. He will do the pre-op exam and help you to decide what type of IOL is best for you and then provide follow-up care after the surgery. The surgeon is allowed to work at his highest skill level doing surgery, not follow up visits.
Insurance: Medicare and private insurance will generally offer coverage only for standard monofocal lens implants. This means that patients have a choice of either improving close-up or distance vision, resulting on a continued dependence on glasses or contact lenses for their vision needs. The Astigmatic, Presbyopic Correcting and the Accomodating IOLs are not covered by Medicare but using these lenses helps patients reduce their dependence on glasses or contacts most of the time. The patient has to pay additional fees for these modern IOLs,
Commitment: If your vision is not as good as expected with a Premium IOL (Toric, Presbyopic or Accomodating) Dr. Davidson will do LASIK at no charge to make your vision the best possible.