After-Cataract (Secondary Cataract)
When
the clouded natural lens is removed and a synthetic lens implanted,
it's impossible for cataracts to "come back." Sometimes, however, the
natural lens capsule, part of which remains in the eye to hold the
implanted lens in place, becomes clouded or thickened. This posterior
capsule opacity - which can develop months or years after your surgery -
is also called an after-cataract or secondary cataract. It is quite
common and affects younger patients more often than older patients.
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How To Regain Eyesight |
Fortunately,
the problem can be quickly and safely repaired with a five-minute
outpatient procedure called YAG laser capsulotomy. Your eye surgeon will
use an yttrium aluminum garnet (FAG) laser to make a small hole in the
back of the lens capsule, allowing light through. The procedure is
painless, requiring no incision or sutures.
When to Call Your Doctor
Get
in touch with your doctor right away or follow his or her emergency
instructions if you are concerned about symptoms that are more severe or
last longer than expected. These may include inflammation (pain,
redness, swelling), haziness, marked decrease in vision, nausea,
vomiting, excessive coughing, light flashes, or multiple floaters.
The Future of Cataract Treatment
As
baby boomers approach their mid-sixties, the volume of cataract surgery
is skyrocketing, as is the demand for even greater safety, convenience,
and visual acuity. Accordingly, researchers throughout the world are
investigating, testing, or introducing lens materials, surgical
techniques, and prevention methods that could revolutionize the
treatment of not only cataracts but also other eye conditions, such as
glaucoma, macular degeneration, and presbyopia. Here is just a sample of
cataract-related scientific work in various stages of development:
Cataract Prevention Strategies
- Formulation of chemical compounds to prevent or halt cataract development, which might also stop the progression of muscular dystrophy, traumatic brain injury, and Type 2 diabetes
- The
use of topical antioxidants to remove heavy metal ions from the eye,
with promising results, especially in the treatment of diabetic
cataracts
- Genetic research that could lead to gene therapy for cataracts and other eye disorders
Prevention of After-Cataracts (Posterior Capsule Opacification)
- Improvements
in IOL design and materials, such as development of a polyethylene
glycol coating that would prevent formation of opacities on the capsule
- Refinements in phacoemulsification techniques
Intraocular Lens (IOL) Improvements
- Development of an implantable lens gel
- Development
of IOLs whose focusing strength can be adjusted after cataract surgery
by applying the appropriate wavelength of light to change the lens's
shape
Also Being Studied
- Development of IOL injection devices, combined with new ultrasonic probes, for use in incisions as small as one millimeter
- Refinements in IOL power calculation
- Prevention of infection and inflammation by implanting a drug-delivery device in the eye
- A
two-stage cataract procedure, consisting of standard cataract surgery
followed by refractive surgery using a special laser to precisely adjust
the shape of the cornea
- Presbyopic corneal inlays, for improved near vision while retaining distance vision
Ophthalmic
researchers and optical scientists envision exciting possibilities for
safe, noninvasive ways to prevent and correct vision damage in people of
all ages. Some of the developments described above are many years away
from practical application. Others are just becoming available for use
by experienced and highly skilled eye surgeons.
One
thing is certain: Cataract surgery and lens replacement have made huge
strides in just the past few years. The procedure is safer and faster,
and the results more satisfying, than anyone could have imagined in the
days when, after cataract surgery, patients had to wear thick, heavy
eyeglasses to have any vision at all. If you have cataract surgery
today, and your surgeon has kept abreast of improved techniques and
materials, you can thank the pioneering work of scientists and eye
specialists for restored clarity of vision, independence, and quality of
life that you will appreciate as never before. To find out more, you can check out How To Regain Eyesight.
Normal Side Effects
For a few days after your cataract surgery you might experience a slight aching or tenderness of the eye. Only about 5 percent of patients are uncomfortable enough to take an over-the-counter pain reliever. Also normal and to be expected are itching, scratchiness, watering or dryness, and sensitivity to light.
As mentioned, you'll notice fluctuations in your vision for a few weeks or even longer, depending on the lens implanted and your own healing process. These changes should not be severe enough to interfere with your day-to-day activities.
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Removal Of Cataract |
Potential Complications During Surgery
In the clear-corneal phacoemulsification procedure, the incision is minuscule and no needles are used, making complications during surgery relatively rare. Complications such as rupture of the capsule, perforation of the eye, bleeding from the choroid, and damage to a nerve were much more common in past years, when cataract surgery was more invasive.
Retained Cataract Fragments
Very rarely, fragments of the cataract fall into the vitreous cavity, the space between the lens and the retina, and may have to be removed surgically to prevent inflammation.
Potential Complications After Surgery
Complications from cataract surgery occur in only a tiny percentage of patients. The risks are almost nil in the hands of an excellent surgeon. When rare complications do occur, however, a few can be serious and might require immediate medical attention.
Be sure to ask your doctor what you should do - both during and after office hours - if you have symptoms of potentially serious complications.
Infection
Fewer than one-tenth of 1 percent (0.1%) of cataract-surgery patients get endophthalmitis, a bacterial (or occasionally fungal) infection of the inner eye. Symptoms can include pain, loss of vision, and excessive redness. If not treated immediately, the condition might damage the vision. The usual treatment is injection of antibiotics into the eye. Rarely, vitrectomy - removal of the vitreous - is necessary to control the infection.
Retinal Detachment
In about one-half of 1 percent (0.5%) of patients, vitreous fluid seeps through a tear in the retina after cataract surgery, separating the retina from the back of the eye. Extremely nearsighted patients are at greater-than-normal risk for retinal detachment.
Symptoms include a shower of new floaters, much like a swarm of bees, in the vision, or extensive flashes of light, akin to fireworks. The most distinctive symptom is complete or partial loss of vision in the affected eye. Patients report feeling as if a curtain is moving across their field of vision.
Like infection, retinal detachment is a medical emergency. If you have symptoms of either, you should seek treatment immediately, day or night.
Inflammation
Slight inflammation within the eye is normal for a day or two after surgery. Very unusual is prolonged inflammation of eye membranes (uveitis) or the macula (cystoid macular edema, caused by accumulation of fluid in the retina). These can usually be managed using anti-inflammatory eye drops. Corneal edema, an inflammation of the cornea, may in extreme cases require a cornea transplant. Report any eye pain, tenderness, or swelling in your ophthalmologist immediately.
Lens Shifting
Rarely, the implanted lens shifts or rotates within the eye. It can be replaced surgically, although wearing thin eyeglasses usually solves the problem.
Incorrect Prescription
A capable, experienced eye surgeon will carefully formulate the prescription for your lens using measurements of the cornea and the length of the eye. This formulation is more difficult if you are extremely farsighted or nearsighted or if you've had LASIK or another type of refractive surgery - all of which underscores the importance of finding the best ophthalmologist available, ideally one who specializes in cataract surgery. If it turns out that the lens is too strong or too weak, the solution is to perform additional surgery to improve the focusing or rarely to replace it surgically. To find out more, you can check out Removal Of Cataract.
Vision Immediately after Surgery
Don't
be surprised if your vision fluctuates for several days as the eye
heals and the pupil returns to its normal size. Your eyesight might seem
to be getting worse, then better, off and on for a few weeks. As
mentioned, you'll notice fluctuations in your vision for a few weeks or
even longer if you have had an accommodating lens implanted. This is
normal and expected.
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Eye Surgery Cataract |
Inside
the eye there will be swelling and inflammation. These symptoms should
subside within a week, but each patient is different. Younger patients,
in theft fifties or sixties, and those with milder cataracts, heal more
quickly than patients who are older or whose cataracts were extensive.
Be assured, however, that the amount of time it takes your eye to heal
won't change the ultimate outcome.
You'll
see everything more clearly - including any preexisting floaters, those
little objects in the vitreous humor that float across your field of
vision.
So if occasionally you notice something that looks like a gnat hovering
at the edge of your field of vision, it's nothing to be concerned
about.
Results of Cataract Surgery
After
your eyes have healed and your brain and muscles have adjusted to the
implanted lenses, your world will be brighter and clearer. You'll be
able to focus better. Objects won't appear distorted-ghosting and double
vision, though possibly not eliminated completely, will no longer be a
problem. Colors will appear richer and more distinct. Contrast will be sharper.
You'll
see well enough to work, to move around independently, and to enjoy the
activities that you might have put on hold. You'll be less dependent on
eyeglasses - you might not need them at all. Ideally, you'll be able to
read the newspaper in good light. You probably won't be able to read
the tiny print on products such as sweetener packets without a
magnifying glass, but that's okay. Cataract surgery isn't a fountain of
youth, but it does improve your vision. Being in your sixties,
seventies, eighties, or nineties, and having the vision of a
forty-year-old, is an amazing thing in itself.
As
mentioned, your vision will fluctuate for a few weeks or longer,
depending on the type of lens implanted. Even so, within twenty-four
hours your eyesight will be markedly improved - so much so that you'll probably be eager to schedule surgery for the other eye at your follow-up visit to your doctor.
Cataract surgery is a low-risk procedure, and complications are rare.
Still, you should be aware of possible side effects and potential
problems.Risks and Side Effects of Cataract Surgery
The success of surgery is greatly dependent
on the skill and experience of your surgeon. It's important that you
make a careful, informed choice regarding your surgeon and that you
follow his or her instructions for aftercare, including follow-up
visits.
No
replacement lens, however sophisticated it might be, is as good as a
young, healthy, crystal clear natural lens. Though your vision will
almost certainly be better than before your surgery, it will not be as
sharp as a teenager's. Nighttime halos and glare, double vision, and
ghosting might not be eliminated altogether.
Even
so, by replacing a clouded natural lens - which is only going to get
worse over time - with a clear, durable, state-of-the-art synthetic
lens, you will see images more vividly than you have for years
(including those occasional dots in your field of vision - tiny
fragments known as floaters). You'll
enjoy greater independence and a wider range of activities. And all
this will be possible with less dependence - maybe even no dependence -
on eyeglasses. To find out more, you can check out Eye Surgery Cataract.