Michael Pinnolis, M.D., Chief of Visual Services, discusses Cataracts and Cataract Surgery

Light is focused into the eye by a crystal clear lens that sits just behind the pupil inside one's eye.  If the lens becomes cloudy,  we say that the patient has a CATARACT. This loss of lens clarity can take several different forms.

• Hardening and darkening of the lens (nuclear sclerosis)
  

• A plaque may form on the back surface of the lens (posterior subcapsular cataract)
  
• Opacities that form in the substance of the lens itself (cortical cataract)
  
• Some combination of all three. 

No one yet understands why cataracts form. We do know that they can be seen more frequently in certain diseases, such as diabetes, but,  in general, the lens changes tend to be associated with getting older. 

At some point the lens becomes cloudy enough to blur the vision.  If the blurred vision becomes significant and interferes with reading, driving or other daily activities, then one may wish to consider cataract surgery. In the cataract operation, the cloudy, natural lens is removed and replaced with a small clear, plastic lens, called an implant. This picture shows the size is smaller than a dime. The lens power of the implant is chosen so that the patient may not need to wear glasses for particular tasks, such as driving or reading. However, the lens implant can not focus images at all distances, and glasses will need to be worn at certain times. 

A cataract is not harmful to the eye: in most circumstances it does not damage the eye. Therefore, there is usually no medical reason to remove a cataract. The decision to have surgery is based solely on the patient's ability to function and on their happiness with their current vision. 

CATARACT SURGERY

Cataract surgical techniques have improved significantly over the last decade. The surgery is very safe and highly successful at restoring clear vision. It is usually done in an outpatient setting, and the actual surgery usually takes less than 30 minutes. There are basically two types of cataract surgery performed in the United States:

Extracapsular cataract extraction (ECCE)	Phacoemulsification (small incision surgery)  sometimes mistakenly referred to as "laser cataract surgery".

Although both techniques have been shown in studies to produce similar visual outcomes, phacoemulsification surgery has become the most popular surgical procedure for cataract removal in the U.S. The small-incision procedure is faster, the recuperation time is shorter (hours rather than weeks), the anesthesia required is minimal, and the smaller wound can be closed with one stitch or no stitches. Most patients value the ability to read or drive the day after their cataract operation.  There are conditions in which extracapsular surgery may be more appropriate for a given patient. As always, the decision as to which procedure is best for you needs to be made in conjunction with your doctor. 

At  Harvard Vanguard Medical Associates, all of our surgeons are highly experienced in phacoemulsification (small-incision) cataract surgery.  We are committed to offering our patients the most modern surgical techniques available today. 

Harvard Vanguard Medical Associates Cataract Surgeons

COMPLICATIONS

Any surgical procedure involves the risk of complications, and cataract surgery is no exception. The decision to have cataract surgery should be made with that in mind. Although the vast majority of patients will suffer no untoward effects from cataract surgery, a few patients will experience complications. Such complications could impair your ability to obtain good vision after surgery and should be discussed carefully with your surgeon before any operative procedure.