Cataracts

Cataracts


Dr. Kassels is a board certified general ophthalmologist who performs modern cataract surgery locally. No patching, no shots, no stitches, and no trip to Huntsville, Birmingham, or Nashville! Cataract surgery is one of the most common ophthalmology procedures and one of the most common surgical procedures period. He will personally check your eye after surgery. You can return to your regular eye doctor for your glasses and follow-up. Not sure about surgery yet? Dr. Kassels can offer a second opinion before you proceed with surgery.

The development of cataracts is unavoidable over time. The human crystalline lens is made of continually growing epithelial cells. It lies immediately behind the pupil and is about the size of an m&m candy. The capsule is the cellophane like “shell”, and the cataract is the chocolate inside. Slowly as the crystalline lens grows, it becomes less flexible. By the age of 45 the crystalline lens has lost enough flexibility (like a few other parts!) that reading glasses are needed. This loss of focus at near is known as presbyopia. Over time, as the lens cells become more crowded, the lens becomes hazy, foggy, and/or brown. Even today in this country, some people still go blind from their cataracts. But cataract surgery can restore their vision.


Usually cataract surgery is performed electively: when visual function limits work, leisure, or safe driving. Some patients need to drive for work or to taxi grandchildren. Some patients orchestrate their day to avoid being caught out after sunset. Some patients cannot see scores at games, see their television well, or read comfortably. Some stop hobbies like sewing or woodworking. Some are bothered by dingy, colorless vision. Occasionally cataract surgery is done as a part of managing glaucoma or retinal problems. Conditions like macular degeneration, diabetic retinopathy, or glaucoma may limit visual function despite cataract surgery.

Cataract surgery removes the clouded lens and replaces it with a prosthetic intraocular lens (IOL). The procedure is done as an outpatient--no hospital admission. An incision less than 3 mm (about one eighth of an inch) is made into the eye with a diamond or steel blade. The capsule is opened. The cataract is softened and aspirated out of the capsule in a process called phacoemulsification. An IOL is inserted into the capsule. The IOL is completely inside the eye and will never be touched again. Generally stitches and patches are not necessary. Most patients have functional vision and a comfortable eye the next day. Modern cataract surgery has evolved such that the vast majority of patients have successful restoration of vision. Most patients become much less dependent on glasses, especially for distance. This technique has been used for the past twenty years, or so. During this time cataract surgery has become extremely common and successful, even taken for granted.

In the operating room, Dr. Kassels uses a Zeiss Lumera operating microscope for superior visualization of the capsule and transparent structures which are less well visualized with older microscopes. He uses the Alcon phacoemulsification system for cataract extraction. He has access to many brands and types of IOLs. The standard monofocal lens can correct for distance or near vision, but not both. Even the “standard” IOL is continuously improved upon for power accuracy, compatibility in the eye, and visual performance. Private insurance and Medicare cover a standard IOL as an integral part of cataract surgery.

Presbyopia Correcting IOLs correcting IOLs (Acrysoft Restor, Tecnis multifocal, Crystalens, Tecnis Symfony) allow for good distance and near vision without readers or bifocals. These lenses can reduce one’s dependency on reading glasses. Advanced technology lenses are not covered by insurance. Additional out of pocket expenses apply. Not every cataract patient is a candidate. All options have some compromises. Individual results cannot be guaranteed.

Toric IOLs (Acrysof Toric, Tecnis Toric, Tecnis Toric) can correct pre-existing astigmatism at the time of surgery. The astigmatism correction is incorporated into the IOL. The IOL is carefully rotated to the ideal axis. A toric lens corrects astigmatism, but not for simultaneous reading and distance vision. Toric lenses also have out of pocket expenses. Individual results cannot be guaranteed.

Extended Range of Vision IOLs The Tecnis Symfony and Tecnis Symfony Toric are recently FDA approved IOLs from Abbott Medical Optics. The extended range of vision allows for seeing sharply at distance and intermediate distances, without gaps at "in between" distances. Some studies have shown a high degree of spectacle independence for reading. But expect compromises like wearing +1.25 readers for small print and seeing some degree of glare, rings, or halos with lights at night. An evaluation will determine if cataract surgery with any advanced technology lens is appropriate for you.

Multifocal Toric IOLs and Extended depth of vision Toric IOLs are the latest options that correct astigmatism and presbyopia (Acrysof Restor 2.5 Toric, Tecnis Symfony Toric). The cost is marginally more than the presbyopia correcting versions. The astigmatism correction is more precise than using laser astigmatism correction with a presbyopia correcting lens. Of course, a presbyopia correcting Toric IOL has the compromises of both the presbyopia correcting and Toric IOL. The new IOLs are exciting, but still not perfect.

Traditional phacoemulsification cataract surgery uses diamond or single use steel blades under 3 millimeters (about 1/8 inch). Femtosecond laser can now be used for cataract surgery. The femtosecond laser docks to your eye and a computerized ablation algorithm replaces the incision and a few manual steps. But, manual instruments are still required to remove the cataract from the eye and implant an IOL. The laser adds a significant cost. If you surf youtube, you will see Laser Assisted Cataract Surgery cases. Most of these infomercials show the surgeon using a blade or instrument for steps that the laser supposedly could do. Some patients, such as those with small pupils, are not candidates for Laser Assisted Cataract Surgery. A recent study showed no improvement in outcomes in Laser Assisted Cataract Surgery versus traditional surgery. For now, Dr. Kassels uses the gold standard: surgical stainless steel.

Alas, we have not found the fountain of youth! We cannot make your eyes like a teenager’s. Cataract surgery does not fix every other eye problem you might have like glaucoma, diabetic retinopathy, or macular degeneration. Like any other surgery, cataract surgery has risks. No guarantees can be made about individual results. Dr. Kassels will discuss your particular symptoms, goals, and risks as part of your cataract evaluation. Together we’ll judge the best time, technique and technology for you.