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Tuesday, October 18, 2016

Cataract Surgery

     Cataracts are the leading worldwide cause of vision impairment and blindness and are common in older people. By age 80, more than half of all Americans either have a cataract or have had cataract surgery. 
     A cataract is a clouding of the lens of the eye but for the retina to get a sharp image, the lens must be clear, otherwise vision becomes blurry. 
     With aging and exposure to ultraviolet light, the protein fibers of the lens become oxidized and clump together. which causes the lens to become increasingly cloudy. The lens has no nerves or blood vessels and is dependent on the liquid around it, the aqueous humor, to get nutrients and remove waste products. This fluid is connected to a vascular network and contains very high levels of certain antioxidants that help nourish the lens as well as absorbing and detoxifying harmful substances. Lack of these antioxidants can cause cataracts to occur more frequently. 
     Medical professionals claim surgery as the only option for treating cataracts while some advocate that there are natural remedies, there are no reliable scientific studies to verify the claim. However, three of the most effective substances for maintaining good eye health are alpha lipoic acid, phytonutrients and lutein. In the US many eye doctors recommend their patients take PreserVision AREDS 2 Formula
     If there are cataracts in both eyes the surgeries are usually performed several weeks apart. The longer a cataract develops, the more it hardens and in advanced stages, a more developed cataract can be difficult to remove so it's usually safer to remove a cataract sooner rather than later; in most cases. However, an individual should not undergo surgery unless they are experiencing blurred vision caused by the cataract. If cataracts are allowed to develop for long periods of time, they can cause inflammation or increased intraocular (within the eye) pressure that can lead to glaucoma. In this situation it is extremely important to remove the cataract to prevent loss of vision from the resultant inflammation or glaucoma. 
     Prior to surgery several measurements of the eye will be taken to determine the lens prescription. As far as the patient is concerned this is a rather benign procedure. 
     Two very small incisions (one about one-tenth of an inch and one about one thirty-second of an inch) are made in the cornea and a viscous material is injected into the front part of the eye to help maintain its shape during surgery. 
     The surgeon then creates an opening in the sac that holds the lens in place and the lens is separated from the lens capsule using a balanced salt solution. Then an ultrasound probe is used to break the lens into small pieces and suck it out of the eye. 
     After the lens is removed, additional viscous material is injected into the lens capsule to hold it open and make room for the new artificial lens. The folded artificial lens is inserted into the capsule where it unfolds and the viscous material that maintained the shape of the eye during surgery is removed. The two incisions usually self-seal and do not require stitches. 
     The actual surgery takes about 15-20 minutes. First, the patient lies on a table and the eye is flushed with several washes and drops. An IV tube is placed in the back of the hand and just prior to surgery the patient gets a slug of anesthetic which takes effect in a very short period. The after surgery one wakes up, gets dressed and is treated to a cup of coffee or orange juice and graham crackers then goes home. 
     Most patients see very well the day after surgery. During the first week the patient must keep the eye covered with an eye shield when napping or sleeping. It is also recommended that the patient refrain from bending with the head below the waist, lifting more than 10 pounds and antibiotic and anti-inflammatory eye drops are used in the weeks after surgery to help prevent infection and control inflammation.
     The only side effects can be a scratchy and itching eye for a couple of weeks and an increase in the amount of eye floaters. Over a period of time they may becomes less noticeable, but likely will never go away entirely. But, the floaters were probably present before surgery but not noticeable; after surgery the increased light entering the eye makes them more noticeable. 
     When it comes to lens, there are several choices. Both eyes will have near vision and glasses will be required for distance vision. Both eyes will have distance vision and reading glasses (the cheap drug store variety usually work fine) will be required. Note that if you have astigmatism obtaining perfect 20/20 vision is not likely, but it should be very close.
     There are two other options, but careful thought should be given before selecting one of them. First, one eye has a lens for near vision and one eye has a lens for distant vision. This means that no matter what the activity, vision in one eye will be blurred. But, like in Lasik surgery, over a period of time the brain adjusts and the blurred vision is lest noticeable. If one is unable to adapt to this, the only options are 1) another surgery to replace on of the lenses, 2) Lasik surgery to "correct" the vision in one of the eyes, and 3) glasses. 
     The other option, which insurance normally does not cover and costs around $1,500 per eye, is an "adjustable" lens where the lens is actually attached to the eye muscles. This surgery takes longer, perhaps an hour and a half. I know of two people who had this type of surgery and in both cases their vision was excellent for 4-6 weeks, but then they noticed the vision in on eye becoming blurred because the lens had "settled in" slightly crooked. As a result, a second surgery was required to correct the situation. 
     My own cataract surgery, which was performed back in March-April, resulted in 20/20 vision with glasses required only for reading...and eating. I don't like my food looking blurry because a while back while in a restaurant I ate a hair that was in my food because I didn't see it. Hence, the glasses go on when eating.

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