Cataracts

What is a cataract?

A cataract is a clouding of the lens inside the eye. Most cataracts occur as part of the aging process, but there are other causes as well. According to the American Society for Cataract and Refractive Surgery (ASCRS), more than half of all Americans over age 60 have cataracts.

What are the symptoms of cataracts?

There are several cataract symptoms, which typically occur gradually over weeks, months or even years. These include:

Cataracts do not cause discomfort, eye redness, itchiness or the feeling that something is "in" the eye (known as a foreign body sensation). These symptoms suggest some other type of eye problem may exist, not cataracts.

What are risk factors for cataracts?

The exact cause of age-related cataracts is not fully understood, but oxidative stress caused by unstable molecules called free radicals appears to play a significant role. Smoking and ultraviolet (UV) radiation are two sources of free radicals, and both have also been associated with a greater risk for cataracts.

Besides advancing age, smoking and long-term exposure to the sun's harmful UV rays, other risk factors for cataract development include:

What's involved in cataract surgery?

Cataract eye surgery is the only treatment for cataracts.

In cataract surgery, the cloudy natural lens is removed and replaced with an artificial intraocular lens (IOL) to restore vision. The surgery takes only about fifteen minutes and is usually performed under local anesthesia on an outpatient basis. Shortly after surgery, you can have someone drive you home.

The severity of your cataract and how much it affects your visual acuity and daily activities determines when to consider cataract surgery. If you have only a mild cataract that was detected during a routine eye exam, you may not notice any vision problems associated with it. In these cases, your eye doctor usually will recommend monitoring the cataract with routine eye exams and will not recommend cataract surgery until the lens opacity worsens.

Cataracts can change quickly, or they can remain relatively stable for months or years. Between exams, it's a good idea to check your vision one eye at a time by looking at a familiar distant object outside your home. If your vision in the eye with the cataract changes suddenly, see your eye doctor immediately to see if cataract surgery is indicated.

What types of intraocular lenses are available?

There are several types of intraocular lenses (IOLs) used in cataract surgery. Make sure you have adequate time to discuss your IOL options with your cataract surgeon prior to your cataract removal surgery.

Intraocular lenses available for use in cataract surgery include:

Aspheric IOLs

Aspheric IOLs gradually changes in power from the center of the lens outward, to more closely mimic the non-spherical shape of the eye's natural lens. Aspheric IOLs reduce a common optical error called spherical aberration and may provide sharper vision than conventional IOLs, especially at night.

Toric IOLs

Toric IOLs correct astigmatism as well as nearsightedness and farsightedness. If you have a significant amount of astigmatism prior to cataract surgery, a toric IOL may reduce or even eliminate your need for prescription glasses after surgery.

Accommodating IOLs

Accommodating IOLs have the ability to shift position slightly inside your eye during focusing effort, reducing your need for reading glasses after your cataract surgery. Crystalens (Bausch & Lomb) is one brand of accommodating IOL used in cataract surgery.

Multifocal IOLs

Like multifocal eyeglasses, multifocal IOLs have more than one lens power to help you see clearly at all distances. When used in cataract surgery, a multifocal IOL can reduce your need for reading glasses after the procedure. AcrySof IQ ReSTOR (Alcon), ReZoom (Abbott Medical Optics) and Tecnis Multifocal IOL (Abbott Medical Optics) are brands of multifocal IOLs that are approved for cataract surgery in the United States.

How long does it take to recover from cataract surgery?

Cataract surgery is one of the most frequently performed surgical procedures in the United States, and it typically is very safe and effective. Complications are rare, and significant complications occur in less that one percent of cataract removal procedures.

Most people recover from cataract surgery quickly and can return to their normal routine within a few days. Post-operative discomfort usually is minimal.

Your cataract surgeon will prescribe medications for you to use after surgery to keep your eye comfortable and to prevent infection and inflammation during your cataract surgery recovery.

After surgery, your eye will be covered with a protective shield and you will be instructed to wear the eye shield at bedtime so you don't accidentally rub or bump your eye during sleep.

You may see better immediately after your cataract operation, but expect it to take six to eight weeks for your eyesight to reach its best level of visual acuity. You may need eyeglasses after cataract surgery for optimum vision, but many people can see quite well without glasses for many tasks after cataract surgery. This is particularly true if you choose a multifocal IOL for your surgery.

What are the risks of cataract surgery?

Though complications during and after cataract surgery are rare, you should be fully aware of all cataract surgery risks before you sign a consent form for surgery.

Cataract surgery risks and possible complications include:

Ask your surgeon to discuss possible cataract surgery complications and your specific risks prior to surgery. And if you experience a sudden change in your vision or the appearance or comfort of your eye after surgery, contact your eye doctor or your cataract surgeon immediately.

How much does cataract surgery cost?

Your cataract surgery cost depends on many factors, including the type of vision insurance or medical insurance you have, the surgeon you choose, the type of intraocular lens you choose and the amount of your post-operative care that is included in the cataract surgery fees.

According to a report prepared by a leading eyecare industry analyst, the mean cost of cataract surgery in the United States in early 2009 was just under $3,400 per eye (if you had no insurance and paid the entire amount yourself). Cataract surgery with an accommodating IOL or a multifocal IOL cost approximately $4,000 per eye.

Medicare and many other insurance programs cover most of the cost associated with basic cataract surgery. But if you choose premium IOLs like those noted above, you will be required to pay the added fee for these lenses yourself.

When calculating your total cataract surgery costs, remember that you may need prescription eyeglasses or reading glasses after cataract surgery. Check with your insurance provider to see if the cost of these glasses is covered by your policy.

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