Cataract

What is a Cataract?

Cataract Surgery is one of the safest procedures in modern medicine.

A cataract is a clouding of the natural lens inside the eye. The light that enters the eye must pass through different structures in the human eye before reaching the retina where images are formed.

First the light passes through the cornea and then passes through the pupil formed by the iris. All light that passes through the pupil must then pass through the lens where it is focused upon the retina, As the natural lens of the eye becomes cloudy, it does not permit light to pass through it as well as it did when it was transparent. The natural lens is made of a strong, transparent outer covering or capsule filled with a clear lens material made of protein.

It is when this clear inner lens material begins to change color and opacify that a cataract forms. There are three main ways in which this lens protein becomes cloudy, and these three types of cataracts are shown below. As with any camera or optical system, when the lens material starts to become cloudy, the incoming light rays are distorted or blocked before reaching the retina at the back of the eye. As the cataract develops, it becomes harder for a person to see clearly, usually first affecting night driving or the ability to read small print.

Nuclear Sclerotic Cataract Posterior Subcapsular Cataract Cortical Cataract

Diagnosing a Cataract

To properly diagnose cataract it is important to get a full dilated exam. During this exam a slit lamp will be used to assess the front half of the eye to determine if these structures are normal and if a cataract is present. The eye is dilated to enlarge the pupil and allow a view of the retina. Using high magnification lenses the retina is also evaluated to determine if other problems are present that may be affecting vision or may reduce visual potential
even after successful cataract surgery. A useful tool often used in our office to help evaluate the retina before cataract surgery is the Zeiss stratus
OCT III which uses a laser to resolve structures in the retina to a resolution of about 10 microns. This device is state-of-the-art, and is also useful for evaluating early glaucomas.

Treatment Options

Only in the rarest of circumstances such as severe eye trauma is a cataract surgery urgent. Generally speaking, a cataract surgery is an elective surgery. More patients are getting second opinions about their cataracts and taking a more active role in choosing when they are removed. Gone are the days when patients are told to have a cataract removed because it is “ripe.” Rather, patients should choose to have a cataract removed when diminished vision interferes with their quality of life. The elective nature of cataract surgery also allows time for patients to seek recommendations from friends who have had cataract surgery and find a surgeon with expertise in cataract surgery.

Removing a cataract: PHACOEMULSIFICATION

Phacoemulcification, or phaco. No-Stitch Cataract Surgery

The Technique:

Modern cataract surgery has advanced significantly over the past few decades. It is no longer a one hour surgery, requiring multiple stitches, injections of anesthesia behind the eye, and relatively long recovery periods. Modern approaches to cataract surgery have improved steadily and Dr Phillips has been specializing in these newer small incision techniques for over a decade.

At the time of surgery, patients receive light sedation from the anesthesiologist. Patients often sleep through the 15 to 20 minute procedure, depending
upon your sedation preferences and your response to anesthesia. The eye will be numbed completely with topical anesthetics.

A thin probe is inserted through a small incision on the side of the cornea (the clear, dome-shaped surface that covers the front of the eye). Over the past decade these incisions have decreased in size, and now our incision is only 2.85 millimeters wide, or about the size of a standard font size in a newspaper. Dr Phillips has been using specially pre-calibrated diamond knives exclusively for the past ten years to make these incisions. They create a precise incision in the eye that is bloodless and requires no sutures to close the wound. For this reason, the surgical technique is called “suture-less” cataract surgery and this is the technique of choice for Dr Phillips.

Once the incision is made into the eye, a small phaco tip is placed in the eye which vibrates at a high rate of speed caused by high frequency sound waves.
The ultrasonic vibration breaks the cataract into fine pieces, which are suctioned out of the eye through the phaco tip. After all the cataract material is removed, the lens capsule is left intact and the artificial lens is carefully placed inside. The artificial lenses are clear and about the size of a dime. They are
able to enter the eye through such small incisions since they are flexible and can be rolled up much like a scroll of paper. Once injected into the eye they unfold within the capsular bag and begin focusing light on the retina.

The cataract being removed by the phacoemulsification probe, entering the eye through the small 2.85 millimeter corneal incision. Once fully removed the capsule is polished and a new clear intraocular lens is inserted in the eye. The capsule is a delicate structure as thin as 4 microns,which is about half the size of a single red blood cell. Once inserted into the eye through a smalltube called an inserter, the new lens unfolds into its natural shape and begins focusing light onto the retina.

MULTIFOCAL LENSES:Restor and Rezoom Lenses

During U.S. clinical trials, the results with ReSTOR were impressive:

  • 80% of patients reported that after lens implant surgery with ReSTOR lenses, they no longer needed glasses or contact lenses to see clearly at all distances.
  • 94% said they could drive and read the paper without contacts or glasses
  • Nearly 94% were so satisfied that they would have the procedure again.
Rezoom Lens Restor Lens Restor Lens, close-up showing surface modifications

Dr Phillips is certified to implant both the Restor (Alcon) or Rezoom (Advanced Medical Optics) multifocal lens at the time of cataract surgery. These lenses have a multifocal effect which may increase your range of focus after cataract surgery and reduce your dependence on reading glasses.

Multifocal lenses have surface modifications on them which allow distant and near objects to be focused simultaneously. This is in contrast to the standard monofocal lens which is more commonly implanted, where there is only one point of focus for the lens.

While these multifocal lenses have the advantage of possibly reducing your dependence on reading glasses after cataract surgery, there are disadvantages such as possible increase in night glare when driving as well as increased cost for these deluxe lenses.

Dr Phillips feels these lenses are best suited for patients who are willing to trade some quality of night vision for a greater range of focus. A typical patient,
for instance, would be an avid golfer who wants to play golf and read his score card without glasses and who only does minimal night driving. There are
other factors to consider, and these would be discussed at the time of your cataract consultation. In general, however, these lenses are not covered by private insurances or Medicare, and there are additional fees both for purchasing and implanting these lenses. Dr Phillips’ personal approach is to be conservative with these multifocal lenses, and personally select a group of patients who will be happy with the results.

One other important aspect to maximizing the results with these multifocal lenses is the ability to treat post-operative refractive errors such as nearsightedness or farsightedness that can occur after cataract surgery. Laser surgery is sometimes required after implantation of these multifocal lenses to enhance their function and realize their potential. In other words, multifocal lens implantation at the time of cataract surgery is best done in an office with expertise with LASIK and PRK techniques.

Why Choose Phillips Eye Center?

Our patients have come from as far away as Burma, China, Taiwan, Europe, and South America for cataract surgery at our Center.  Among our local patients are physicians, lawyers, actors, and a local US Congressman.  Dr. Phillips has performed cataract surgery on three of his former professors who have taught cataract surgery at USC for decades.

After thousands of cataract surgeries, years of instructing other physicians, and numerous local, national, and international lectures on cataract surgery, Dr Phillips has established excellence in cataract surgery as the primary drive of his professional career.

If you are seeking treatment for cataracts, we feel our Center offers a unique blend of surgical expertise and state-of-the-art equipment.

Cataract Surgery FAQs
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