Cataracts and Cataract Surgery

Cataracts and Cataract Surgery


What is a Cataract?


cataract 2


A cataract is a clouding of the normally transparent lens of the eye.


The lens of the eye, located behind the pupil and the iris, is normally clear. Like the lens of a camera it is used to focus images onto the retina at the back of the eye before they are transmitted to the brain. When a cataract forms, the images are not clearly focused onto the retina.


Anatomy of the eye
Anatomy of the eye


The clouding of the eye’s lens is usually caused by chemical changes associated with the normal aging process. However, heredity, infection, eye injury, increased UV light exposure, smoking, poor nutrition, and diabetes are other factors that can lead to cataracts.


Cataract-graphic clear vs yellow cataract lens


How common are cataracts ?

Cataracts are the leading cause of blindness among adults in the United States. They account for one out of every seven cases of blindness in people age 45 and older. Although most prevalent in adults, a cataract can occur in young people, and sometimes can be found in a baby’s eyes at birth.


cataract-with eye in cross section


Who is at risk?

As medical advances have succeeded in lengthening the human lifespan, more and more Americans are – and will be – entering the age group associated with the development of cataracts. It has been said that if we live long enough, most of us will develop a cataract.




What are the symptoms?


Problems driving at night

  • Cloudy, fuzzy, foggy, or filmy vision
  • Changes in the way you see colors
  • color differences bright vs dull
  • Increased glare from lamps, headlights or the sunglare at night headlights
  • Frequent changes in your eyeglasses prescription
  • Double vision
  • Distortion or ghost images in either eyeghost images


Since the symptoms usually develop gradually, most people don’t suspect cataracts. Routine eye exams by Dr. Duplessie can pick up the early signs of cataracts.


Treating cataracts: Can they be prevented?

The cataract may need no treatment at all if the vision is only a little blurry. A change in your eyeglass prescription may improve vision for a while.

There are no medications, eye drops, exercises or glasses that will cause cataracts to disappear once they have formed. When your vision interferes with your normal activities, cataract surgery should be considered.

Cataracts are removed with an ultrasound device. Surgery is the only way to remove a cataract.


cataract phacoemulsification - 2 handed


In cataract surgery, the cloudy lens is replaced with a clear artificial lens. The lens is permanent.


iols -4 diff ones





Today, cataract surgery is safe and very effective. Cataract surgery is the most frequently performed surgery in the United States. It is also one of the most consistently successful. Over 95% of cataract surgeries improve vision, but no surgery is risk free. Dr. Duplessie has performed over 10,000 thousand surgeries and specializes in the removal of cataracts.



A recent study in The Journal of the American Medical Association determined that patients with cataracts are nearly twice as likely to have a car accident.

cataract -car-accident





If you have Macular Degeneration, what are your chances of seeing better after cataract surgery?


Dr. Armbrecht, of The Royal Infirmary of Edinburgh, studied this question and concluded that most patients with mild to moderate degrees of age-related macular degeneration (ARMD) experienced significant improvements in their quality-of-life following cataract surgery.  Retinal disease can affect the final outcome of cataract surgery


Retinitis pigmentosa
Retinitis pigmentosa


Removal of the cataract allowed more clear, undistorted light to fall on the retina, so even damaged retina tissue could function better. Cataract surgery on most patients with mild to moderate ARMD is beneficial in improving their quality-of-life.


Dr. Armbrecht’s research team found that no surgical patients progressed from mild to moderate ARMD to severe “wet” ARMD following cataract extraction.


Pre-existing conditions:

Even if the surgery itself is successful, the eye may still not see as well as you would like. Other problems with the eye, such as macular degeneration, glaucoma and diabetes may limit vision after surgery.  Your retina may require treatment prior to cataract surgery.

diabetic retinopathy fundus photo


Even with such problems, cataract surgery may still be worthwhile. If the eye is healthy, the chances are excellent that you will have good vision following removal of your cataract.


What happens before surgery?


Once you and Dr. Duplessie have decided that you will have your cataract removed, a physical examination by your medical doctor is necessary so that Dr. Duplessie may be alerted to any special medical risks.


Your eye will be measured to determine the proper power of the intra-ocular lens that will be placed in your eye during surgery.

ultrasound ab_scan
Ultrasound to measure eye length for cataract surgery


Where is the surgery done?

Dr. Duplessie uses state of the art outpatient eye surgery; you will go home after the procedure.


Can the cataract return:

A cataract cannot return because the lens has been removed.


Will you need to wear eyeglasses after surgery ?

You will get an eyeglasses prescription two weeks after surgery, if you require one. There is a chance you may not require eyeglasses.


How is a cataract removed ?

Dr. Duplessie preferred technique is a quick vision, small incision, no shot, no-stitch, no-patch cataract surgery. The surgery is called Phacoemulsification, or phaco.


cataract phacoemulsification


Phaco-emulsification is the most advanced form of cataract surgery. Using an operating microscope, a microscopic incision is made into the eye. An ultrasound device is used to remove the cataract lens from the eye.


A plastic intra-ocular lens (IOL) implant will be placed inside the eye to replace the natural lens that was removed. Stitches are not typically required.

iol odd 4 haptic


Is there a special type of intra-ocular lens for me?


Dr. Duplessie uses the finest intra-ocular lenses available. There are three materials presently used for intra-ocular lenses:

  1. Polymethylmethacrylate (PMMA)
  2. Silicone, 
  3. Acrylic.


Today’s intra-ocular lenses are very safe and effective.

3 types of intraocular lenses (IOLs).


Monofocal Lenses: The most common lenses implanted in the eye. Worldwide this accounts for about 93% or greater of implanted lenses.


iol- monofocal




Multifocal Lenses have special features that correct your near, intermediate, and distance vision in the same lens. Multifocal IOLs provide your best chance at being free of glasses for the majority of activities. One in fifteen lenses implanted is a multifocal lenses. There is a premium charge for this lens as this lens is more technologically advanced and more complicated so the lens is a little more expensive.

Zeiss Multifocal lens



Toric Lenses: Toric lenses are designed for people with astigmatism. Dr. Duplessie can discuss whether a toric lens or laser is the most effective treatment to get rid of your astigmatism. Dr. Duplessie believes the laser is the most accurate way to get rid of astigmatism.


IOL toric zeiss



Multifocal Lenses:


Traditional IOLs are monofocal, meaning they offer vision at one distance only (far, intermediate or near). The new multifocal and accommodating IOLs offer the possibility of seeing well at more than one distance, without glasses or contacts.

The new diffractive technology — a design that responds to how wide or small the eye’s pupil might be — is able to provide near, intermediate and distance vision.

Clinical studies used to support FDA approval showed that 80 percent of people who received the lens didn’t use glasses for any activities .


Levels of Astigmatism – Is an Astigmatic Lens Needed?


A very common eye condition, astigmatism does not always require corrective lenses. Many people have some degree of astigmatism, but a minor level astigmatism is normal and requires no correction.


astigmatism ray diagrams on two eyes


Even if a person needed cataract surgery and had a minor degree of astigmatism, a toric IOL would probably not be necessary.


Blurred or distorted vision is typically experienced by patients with moderate or high degrees of astigmatism.


astigmatism-tree images


These patients can correct for the vision problem through the use of contact lenses or corrective eyeglasses or through refractive surgery.

Astigmatic patients with cataracts, however, can request the use of toric IOLs or laser to treat their astigmatism.





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