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Cataracts are clumps of protein that form on the surface of the lens, gradually obscuring vision until focusing through the affected eye becomes a struggle. Cataracts are a natural development of aging. The chance of one or more cataracts developing increases after a person passes 40 years of age, and roughly half of the population aged 80 or above have experienced cataracts. It is also possible to develop cataracts as the result of certain medical conditions.
There are two ways of treating cataracts: traditional (manual) surgery and laser eye surgery. Laser treatments are very popular, but they are not typically covered by most health insurance plans. Additionally, while they are generally quicker and safer than manual surgery for cataracts, the recovery period is roughly the same.
Choosing the right form of cataract surgery depends on your needs, your expectations, and a conversation with your doctor before you make any decisions.
What Are Cataracts?
The term cataracts refers to a clouding on the lens of one or both eyes. The lens is normally clear, a film of tissue that focuses light onto the retina at the back wall of the inside of the eye. The retina is where the light is changed into nerve signals that are then sent to the brain, what we perceive as sight.
The lens is made up primarily of water and protein, which is arranged in a way that lets light pass through it while also keeping the lens clear. But through aging, some medical complications like diabetes, or health behaviors like smoking, the protein can clump together and form a cloud on a small part of the lens; this cloud is a cataract. If left untreated, the cataract grows larger, covering more of the lens and obscuring vision.
People who have cataracts experience a loss in sharpness of vision, so their sight is often blurred. Small cataracts might go unnoticed or the person thinks the minor lack of focus in their vision is not a big problem. However, cataracts tend to grow (that is, the clumps of protein expand) to the point where vision gradually worsens. Without treatment, the cloudy area in the lens gets bigger and bigger, and vision becomes very dull.
This also changes the color of the lens, which in turns adds a brown-colored tint to vision. This, along with the blurriness, can make reading, driving, and other activities more difficult to carry out. Further problems include an inability to perceive correct colors.
Cataracts are a common and normal part of aging. More than half the people over the age of 80 in the United States will develop a cataract on at least one of their eyes, and the risk of developing cataracts increases after the age of 40. Most cataracts are the result of aging, but they can also form as a result of the use of certain drugs, health problems, trauma, or a side effect of surgery.
Additional factors that contribute to the development of cataracts include:
- Family history of cataracts.
- Increased exposure to sunlight.
- High blood pressure.
- History of injury, inflammation, or surgery to the eye.
- Radiation treatments.
- Excessive alcohol consumption.
- Long-term consumption of corticosteroid drugs.
Some people are born with cataracts already formed, or they go on to develop cataracts during their childhood. This condition is known as congenital cataracts.
Surgery for Cataracts: Laser and Traditional
In the past, cataracts were treated with traditional surgery, but the rise of laser eye surgery has led to more options for patients. Traditional surgery (also referred to as manual surgery or phacoemulsification) is very commonly performed in the United States, and it is very safe and effective.
In traditional surgery, the eye surgeon uses a scalpel blade to make a small, manual incision in the side of the cornea. A microsurgical instrument is inserted through the incision, where it reaches the lens, sitting behind the pupil. The surgeon uses the instrument to cut a circular opening in the lens, where a probe is inserted to apply ultrasound waves to break up the protein clumps that form the cataracts. The broken pieces are removed via suction, and an artificial intraocular lens is used to replace the part of the natural lens that was removed. The side walls of the incision made into the cornea will be filled with a liquid that automatically seals after the surgery, rendering stitches unnecessary.
With laser eye surgery for cataracts, a camera or an ultrasound imaging device is placed over the patient’s eye to create a digital map of its surface and gather exact information about the condition of the lens. This device transmits the information to a computer, which gives the laser the precise location, size, and depths of the incision to make. The surgeon makes the corneal incision and opens the lens with the laser. The laser then softens the protein clumps, after which the ultrasound probe (the kind used in traditional surgery) is used to further break down the cataracts so they can be suctioned out of the eye. As with manual surgery, the doctor will place an artificial intraocular lens into the eye and seal the incision so no stitches are needed.
Laser Eye Surgery for Cataracts: 5 Things To Know
- Laser surgery for cataracts is not covered by most insurance plans. The long history of manual surgery makes it a preferred option for insurance companies, and only a few programs have evolved to include laser surgery as part of their plans. Health insurance providers may only offer to cover part of a laser eye operation and only if certain criteria are met. Generally speaking, the development of cataracts as the result of the natural aging process would not fit this criteria.
- Laser treatment might be more effective. Lasers could be better at breaking up the protein clumps on the surface of the cornea, which would make laser eye surgery for cataracts a safer alternative than traditional treatment. A spokesperson for the American Academy of Ophthalmology said that “softening” the cataract creates a reduced chance of damage to the eye.
- Not everyone qualifies for laser eye surgery. If you have pre-existing mental health or medical conditions that affect the health of your eyes, or if you take certain medications, you might not be a good candidate for laser treatment. This means that an eye surgeon will not recommend you get laser surgery, your recovery from laser treatment will be longer and more inconvenient, or you might have persisting side effects and other problems with your vision after the treatment. Such restrictions do not exist for manual cataract surgery unless you have very specific medical considerations that make any surgery a prohibitive risk.
- They have similar recovery times. There is not a significant difference in how long it takes to recover from laser eye surgery for cataracts compared to traditional surgery. Vision will be sensitive for the first day or so after either surgery, and you should avoid using your eyes in low-light conditions, driving in poor visibility, or focusing your vision on precise tasks like reading small print. Within three days, your eyes should be free of cataracts and your sight free of blurriness. As long as you take care of your eyes, there should be no further complications four weeks after the surgery. This timeline is roughly the same for either form of treatment.
- Results are similar. Laser treatment does allow a surgeon to make infinitesimally more precise incisions in your cornea (and in less time), but research has not shown that laser-assisted cataract surgery offers fewer complications or even better visual results than manual cataract surgery. As recently as June 2017, the Ophthalmology and Therapy journal noted that “both methods are extremely successful and safe.” In either form of treatment, the ultimate outcome greatly depends on the experience and the finesse of the surgeon performing the operation.
How to Choose the Cataract Surgery That Is Right for You
In making the decision of whether to treat cataracts through traditional surgery or laser eye treatment, the determination will ultimately come down to what an individual patient wants from their surgery. Some patients simply want to replace a cloudy lens with a clear implant, and they are perfectly content to wear glasses to complement their improved vision. Others want the best possible vision they can get without glasses, and they are willing to pay more money to get that. Researchers writing in the Ophthalmology and Therapy journal suggest that the two forms of treatment do not have to be in contention with one another, and the relative newness of laser-assisted surgery is a good complement to the long history and widespread acceptance of manual cataract surgery.
As you weigh your options regarding getting laser eye surgery for cataracts, talk with your doctor about your vision needs, your resources, and your expectations for life after cataracts. This conversation will help you choose the surgical option that is right for you.
During the consultation, we will ask you about your eye health history and your medications, and perform some tests. You will then be examined by the surgeon who will discuss your treatment options. Your personal Patient Counselor will help you throughout the process.
Your Counselor can review payment options and schedule you for surgery and related appointments, such as pre- and post-operative exams. Prior to your procedure you will have a dilated eye exam, and you should discontinue wearing your contact lenses and begin taking eye drops as instructed.
Plan to be at the center for two to three hours the day of your procedure. ICL eye surgery is a fairly brief outpatient procedure. Your surgeon dilates your eyes, and gives you a local anesthetic to numb the area. A tiny incision is made, and the clear lens is slipped between your iris and your eye’s natural lens. The day of your procedure should be a day of rest.
Your Patient Counselor will give you detailed post-operative instructions and eye drop regimen for your recovery. After ICL surgery, you’ll need several follow-ups with your eye doctor. Visual recovery is rapid, and you can expect noticeable improvement within a day or two. Most patients are generally able to return to their normal activities within two or three days following their procedure.
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