The Basics of Cataract Surgery: What You Need to Determine If You Need Cataract Surgery

Most people develop cataracts as they age. But how should you determine if and when you need surgery to have the cataracts removed?

A cataract is thin, wispy substance in the lens of the eye. The lens is the clear portion of the eye, right behind the pupil, that allows light through and focuses the light on the retina. The lens itself is like a clear bag filled with clear liquid. As a cataract develops, it turns creates a milky white film in the lens, distorting the light that is trying to make it through to the retina and the optic nerve. The exact location of the white film will determine what type of cataracts are diagnosed, but the treatment for them is all the same. Remove the lens and implant a new one, cataract surgery.

In the early stages of cataracts, people barely notice the development. It becomes a little harder to see the television or to see in dim light. Colors seem more washed out and glare, especially from headlights and street lights, begins to make it difficult to see at night.

Generations ago, the solution to this problem was to remove the lens and replace it with “Coke-bottle” glasses, very thick rounded glasses that got the glass to do what they couldn’t anymore. The lens had to be especially thick because it was outside of the eye and had to focus the light so far into the eye.

Then, more recently, the procedure for cataract surgery became quicker and had a shorter healing time. Science also developed a small plastic lens that could be put inside the eye to replace the cataract-laden one that was removed.
People sometimes still needed glasses, but not nearly to the degree or thickness required by their parents and grandparents. Most recently, manufacturers have invented new plastic lenses, one marketed under the brand name ReZoom, but there are other brands as well, that more closely resembles the natural lens in function.

Patients with successful ReZoom implants often discover they do not need glasses at all, or they only need reading glasses instead of bifocals or trifocals. The “miracle” of the ReZoom lens is that it adjusts to focus, like the natural lens did. The difficulty with ReZoom and other so-called multi-focal lenses is that they are very new and not yet covered by most insurances, including Medicare, the insurance paying for most cataract surgeries done in the United States.

But how do you determine if it’s time to have the cataracts removed?

Often, the key answer is to remove them when the eye doctor can no longer fit you with glasses that are strong enough to help you read fine print or see at night. Medicare and some commercial insurance companies have very specific guidelines, but many patients actually meet those guidelines long before they notice the effect that cataracts have on their vision. To meet Medicare guidelines for cataract surgery, a person must report to their doctor that they are unable to read fine print, like a newspaper or medication bottles, or must be having difficulty with glare. Often, it is the glare that people notice first. The filmy nature of the cataract acts on the lens like a smear acts on a window. Bright lights, especially at night, become fuzzy.
For many older patients, the first notice this when watching television in the evenings. Ladies especially also notice the difference in color perception caused by cataracts. This is one reason some older people need to look at colors in natural, bright light to determine if they match.

If a patient complains of these things, or if an eye doctor notices cataracts, the eye doctor will probably add a new battery of tests to the standard eye exam, including a brightness or glare test. To do this test, the eye doctor shines a bright light into the eye while a person is trying to read the eye chart. If the light severely affects how well they can read the eye chart, the patient is probably ready for cataract surgery.

Once an optometrist or your medical doctor tells you that you have cataracts and need to have them removed, it’s time to see an ophthalmologist, an eye surgeon. As with any doctor, the key to choosing a surgeon for your eyes is checking around.
Since there is rarely an emergency need to remove cataracts, take the time to check with friends and neighbors. This is such a common problem that chances are you know someone who has had cataract surgery. Then, ask them about their experience.

Ask if they felt rushed with the doctor or if the doctor took the time to explain the risks of the surgery. Ask if they felt pressured to have the surgery before they were ready. Ask if they would do it again with the same doctor. Once you have found a candidate doctor, ask more questions. How many times have they done this procedure? How long have they been doing this? What happens if something goes wrong?

Cataract surgery is very simple, usually involving a mild anesthesia to keep the patient calm and still during the procedure and then a local anesthesia to the eye. The entire process takes between 15 minutes and an hour, per eye, with most surgeons opting to only do one eye at a time.

Recovery time is very short. Most people are seeing better within a day and are healed enough to be examined for new glasses within about three weeks of the cataract surgery. There are very few complications from cataract surgery, but it is still surgery. Patients need to have confidence in their surgeon and know his skill level before committing their eyes to his hands.
For the more nervous, cataract surgery can often be postponed for months or even years before it becomes an absolute necessity. Generally, it’s a quality of life issue. Most people see significantly better after having their cataracts removed. The best option for deciding when it’s needed is to find an optometrist you trust.

The easiest way to determine then, once a doctor suggests you consider it, if cataract surgery is right for you is to ask yourself, “How important is it that I see better?” That, more than anything, should be your determining factor.

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