by Wendy Strouse Watt, O.D.
Cataracts are a complication commonly associated with any retinal or vitreal surgery. When cells are released during surgery, they can attach to the back of the lens and grow, or proliferate, accelerating cataract changes. Many surgeons do double or triple procedures when doing retinal or vitreous surgery. An example of a double procedure would be retinal surgery and cataract surgery. An example of a triple procedure would be retinal surgery, a vitrectomy, and cataract surgery.
Cataract surgery involves implantation of a new lens to replace the original one, which has been damaged by a cataract. The cataract forms in the lens of the eye, directly behind the pupil. The lens is like an onion. All the layers are cells. On your skin, if the cells are old or die, they brush off. In the eye, the old cells have nowhere to go are compacted into center. Over time, the old cells turn yellow, like a sheet of tablet paper. When the light going into the eye hits the yellowing, it causes glare and the light can’t go directly into the eye. As a result, the prescription of the person’s lens in the glasses can change. Prescription changes can help to improve vision in the early stages of cataracts. Eventually, very little light can get into the eye, the vision will be significantly reduced, and no changes in prescription will improve the vision.
Before the surgery, measurements are taken to determine the power of the lens to be implanted. Many factors are taken into account, including the length of the eye and whether the preferred visual outcome for the eye is distance or near vision. Most people, today, have the second eye operated on in a short period of time following the first eye, sometimes doing the second eye as soon as three weeks after the first eye. The intraocular lens (IOL) is positioned behind the pupil. The visual outcome, in patients with no other ocular problems, is that one eye is set more for distance and one is set more for near. This way, the patient sees well at distance and near without glasses. Some may need extra correction for distance and/or near. In patients who have an ocular problem, such as macular degeneration, the vision can improve, but each case is individual. More power or magnification may be needed to improve vision than those without macular degeneration. By removing the yellowing that is decreasing the light going into the eye, more light can enter the eye and the images that hit the retina will be brighter and vision can increase. Also, as cataracts get more dense, it gets more difficult for the doctor to get a good view of what is going on in the retina. Cataracts can be removed to improve the patient’s view out and/or the doctor’s view in.