What is a Cataract?
Most people think that a cataract is a film or growth that is growing over the eye. It is actually the natural lens located behind the pupil that we use to focus that gradually becomes hazy or cloudy. It is essentially an aging process in the lens of the eye.
Cataract surgery involves removing the cloudy lens and replacing it with an intraocular lens. If the eye surgeon does not place an intraocular lens, the person would not be able to see well. There are now a variety of different types of intraocular lenses. There are the routine type lenses that have been around for 30 or more years. New lenses that are an aspheric design to better match the visual system of the eye can provide better vision. There are astigmatism lenses that can correct the patient’s astigmatism to give them good vision at distance without glasses. There are a variety of intraocular lenses that can allow a patient to see distance and read without glasses. The type of lens that is chosen is based on the patient’s desire to have freedom from wearing glasses, the costs, refractive error, and health of the eye.
Commons Reasons for Patients not Being Happy with their Vision after Surgery
Complications with the Surgery
Since there are over 1 million cataract surgeries performed in the United States every year, there are a wide varieties of complications that can occur during and after cataract surgery.
- Corneal edema
- Cystoid macular edema
- Retinal detachment
These are some of the more common complications.
Premature Cataract Surgery
Unfortunately, there some eye surgeons who perform surgery on patients who have no cataract present or very mild cataracts. These doctors tell their patients that they need to have cataract surgery, their cataract is becoming brittle and will damage the eye, if they don’t have their cataract done right away it will damage their eye, or it will be much more difficult to do the surgery later. These patients may not notice any improvement or maybe worse vision than they had before surgery even though there were no complications.
Residual Refractive Error
Patients have very high expectations following cataract surgery. Many of their friends report that they can see well without glasses. Doctors use very sophisticated equipment to measure the eye which determines the strength of the intraocular lens used during the cataract surgery. These tests are not 100% perfect in determining the power of the lens. There are many variables some of which are that everyone’s eye is unique to them.
The measurement of the curvature of the cornea is very important in determining the strength of the lens to be placed in the eye. Many people develop dry eyes as they age as well and this can cause errors in measuring the cornea.
Effective Lens Plane (ELP)
This is a new concept in improving the consistency of choosing the lens that will result in no refractive error or zero glass prescription after surgery. The positioning of the lens inside the eye after cataract surgery can effect how the lens corrects the light entering the eye. The effective lens plane can be affected by the size, shape, and centration of the capsulorrhexis. The capsulorrhexis is the circular opening made in the thin capsule that surrounds the lens. This is opened so that the cloudy lens can be removed and the capsule is then used to hold the intraocular lens in place inside the eye.
The femtosecond laser can now be used to make the capsulorrhexis in a precise manner as to size, shape, and centration. Recent studies using the laser have shown more consistent results following cataract surgery.
Visual outcomes following cataract surgery keep improving as new technology is developed. Make sure that you are confident in your eye surgeon. You don’t need surgery until you are unhappy with the quality of your vision. Your vision is starting to limit the things you need to do in your everyday activities such as reading, driving, work, or other things. Femtosecond laser assisted cataract surgery may improve the outcomes as it can provide a more consistent effective lens plane inside the eye. Your eye surgeon should help you pick the type of lens that will provide you with the results that you are looking to achieve.