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One of the most commonly performed surgeries that Dr. Hendricks and Dr. David perform at Medical-Surgical Eye Care, P.A. is cataract surgery. Cataracts are very common, especially in older patients, but they can be found in any age group.

A cataract is a clouding or an opacification of the normally clear crystalline lens of the eye. The lens of the eye functions just like the lens of a camera. If the lens of a camera is dirty or cloudy, then obviously the resulting photograph will be blurred or distorted. The case is the same if a patient has a cataract--the resulting visual acuity is decreased.

There are numerous types of cataracts and depending on the type, the visual symptoms will vary. The most common type of cataract is called nuclear sclerosis. Nuclear sclerotic cataracts are associated with aging and they usually take years or decades to develop. They can cause a decrease in visual acuity and night vision as well as an increase in glare problems. Early in the course of nuclear sclerosis, a change in glasses may be all that is necessary to treat the problem and sometimes a patient’s reading vision may actually improve without glasses. This is sometimes referred to as “second sight.”

A second common cataract is known as cortical cataract. This type of cataract again is associated with age but it is also very common in diabetics. Cortical cataracts can certainly cause a decrease in visual acuity, but significant glare problems are usually why these patients come in for evaluation.

Posterior subcapsular cataract is a third commonly encountered cataract type. These cataracts can be found in any age group. They are usually more rapidly growing, which means they can become problematic over the course of a few months to a few years. This type of cataract causes decreased visual acuity, decreased reading vision, and severe glare problems. Posterior subcapsular cataracts can be associated with previous eye trauma and with the long term use of coticosteriod medication.

The good news about cataracts is that they can be surgically removed and the visual problems are essentially cured. Cataract surgery has gone through an explosion of innovation and improvement over the past two or three decades. At one time it required a week long hospital stay and then patients had to wear those thick “Coke bottle” glasses which provided marginal vision at best. With today’s technology, the 15-20 minute cataract extraction with intraocular lens implantation procedure restores the natural vision almost instantaneously. It is truly one of the modern marvels in the field of medicine and surgery.

Today’s cataract surgery has a success rate of about 97-98%. Likewise, the risk is very low, with a complication rate of 1-2%. For these reasons, cataract surgery is one of the most commonly performed procedures in the Medicare population. For the same reasons, most ophthalmologists are inclined to offer cataract surgery sooner rather than later if the patient is having significant visual difficulties. One does not have to wait until the cataracts are “ripe” to have them removed. That is a throwback to the old days when the treatment was marginal and the risk was high.

There are other advantages to having cataracts removed sooner rather than later. Obviously the general vision improves, but patients will also experience improved color and night vision as well as in increase in contrast sensitivity. But there are two other important benefits. First, Dr. Hendricks and Dr. David always try to improve your vision without glasses. So if you have worn glasses for most of your life, there is a good chance you will be less dependent on glasses after cataract surgery. And, last but not least, once the cataract is removed, it is gone forever and it will not cause problems in the future. In other words, your vision should remain very stable for the rest of your life barring any other unrelated problems that may occur.

So what does the patient experience with the state of the art cataract surgery? The first step is to have a thorough eye exam to determine if you would benefit from cataract surgery. If so, then a number of tests are done to determine the power of the intraocular lens implant that would be placed in the eye at the time of surgery. Keep in mind that the cataract used to be a clear functioning lens that sharply focused light onto the retina, just like the camera analogy used earlier. If the cataract is removed, it has to be replaced by another lens or a patient would have to use the “Coke bottle” glasses or a contact lens to see clearly which is unacceptable by today’s standards. An intraocular implant is simply a small lens made of some form of plastic which now does the focusing that the cataract used to do. A lens power is chosen by Dr. Hendricks or Dr. David that will eliminate the need for glasses as much as possible.

The actual surgical procedure is performed at the Heart of America Surgery Center at 90th and State Ave. in KC, KS. This is a wonderful facility and patients rave about the care they receive there. You will be there for a total of about 2 hours although the cataract surgery lasts only about 10-15 minutes. You stay in your street clothes for the surgery and after checking in, the nurses will administer drops to dilate the pupil of the eye that is to have surgery. You will also be given an oral sedative. For the vast majority of cataract patients, there are no needles or injections used at all! The only anesthetic used is a gel that is put in the eye like a drop and this provides excellent anesthesia. It is applied numerous times throughout the procedure to provide total painlessness.

The patient is then taken to the operating room and the procedure takes about 10-15 minutes. The doctors operate through a microscope and the patient is instructed to continually look into the microscope light. The cataract is removed by a technique called phacoemulsification. This is a form of ultrasound in which a tiny needle vibrates at a very high frequency and breaks the cataract into microscopic pieces and then vacuums it out of the eye. The lens implant, which is foldable, is then inserted through the tiny incision. The incision is so small that no stitches are required for closure. After the surgery a clear eye shield is placed over the eye so the patient is able to start using the eye immediately. The surgical incision is so small that there is rarely any significant pain afterwards. There is about a 10-15 minute recovery room time where some simple instructions are given. There are no major restrictions and most patients go home and settle right back into their routine.

The patient is checked in the office the next day and given instructions for the use of antibiotic and anti-inflammatory drops which are used for about 2 weeks. It is not unusual for patients to have very close to their best visual potential on the first day, but if not, it will usually improve to that level within a day or two. If the patient is going to have the other cataract removed, this is usually scheduled for the next week or two. New glasses can be prescribed a week after surgery--most patients still need glasses at least for reading.

In summary, the state of the art cataract surgery that Dr. Hendricks and Dr. David perform at Medical-Surgical Eye Care, P.A. can truly be a life changing event. We continually strive to stay abreast of new trends which may improve the procedure or make it easier for the patient. Please call or email us if you have questions or if you would like to schedule an appointment.