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Occluded lenses in the eyes are known as cataractsCorrective cataract surgery can restore clear vision. 

Cataracts are generally perceived as a disorder of the elderly.  This is not true, as many people who develop cataracts are younger, even in their early twenties.  Causes are myriad, but a few can relate to organic diseases (such as diabetes) or, oddly enough, to lifestyle habits (such as smoking).  The severely nearsighted person is more susceptible to developing cataracts than a person with better natural vision.

The onset of a cataract is usually first noticed by a general blurring of close vision, and muddiness in the visual field.  Cataracts usually develop bilaterally, meaning both eyes are affected at the same rate of occlusion.  However, it is not uncommon for only one eye to develop a cataract initially; the second cataract may develop more slowly in the other eye. 

A visit to an ophthalmologist confirms the diagnosis.  During the examination the pupils are dilated, and a strong light with an optical magnifier is used.  The cataracts are plainly visible to the examiner. 

Cataracts are measured by specialists in terms of degrees.  Visual problems with lesser developed cataracts are overcome with corrective lenses.  A “ripe” cataract (one which affects lifestyle and cannot be compensated for with corrective lenses) is a candidate for surgical removal.  

The only real cure for this condition is surgery.  There are several different techniques in use today; which specific technique applies depends upon the protocols of the surgeon or the uniqueness of the case.  The fundamentals are the same in all instances, however: the occluded natural lens is removed from the eye and is replaced with an artificial lens, called an intraocular lens (IOL) or implant. Typical monocular intraocular lensCredit:

The surgery is done on an out-patient basis.  The patient is awake, supine, and aware of all activity.  The patient's alertness is actually necessary because, once the defective natural lens is removed, if the eye is not held stationary the vitreous humor (the jelly-like fluid filling the eye) can be lost by spillage.  Vitreous humor is present from birth and cannot be replaced.

A local anesthesia is introduced into the eye via drops.  A clamping device holds the eyelids apart (like that seen in the classic movie A Clockwork Orange).  Eye drops are administered to keep the surface moist throughout the procedure.  A small incision is made in the corneal surface near the pupil.  The natural lens is then pulled through this incision (either in one piece, or it is broken up into smaller pieces with ultrasound and pulled out).  The removal of Ultrasound destruction of occluded lensCredit: Relay Health (c) 2007the natural lens leaves a pocket in place for the IOL insertion.  The IOL (of which many types are available) is then folded and inserted into the incision and into the lens pocket.  It unfurls and is seated in front of the pupil.  Two spring arms (made of the same plastic materials as the new lens) apply pressure to the pocket lining and hold the lens in place.  If both eyes need the surgery, the second eye is usually done a few weeks after the first.

Recovery time is about two weeks.  The eye is painful for several days; prescription eye drops are needed daily.  The treating surgeon usually recommends the patient wear an eye patch.  Follow-up visits confirm proper seating of the IOL and define the patient’s visual acuity. Most patients will need reading glasses after such a surgery (dependent upon the type of IOL installed).  Patients who have both eyes done may choose to have an IOL in one eye for near vision and another made for far vision.  This is a discussion the patient has with the ophthalmologist before surgery.

Costs of regular monocular (single vision) IOL implantation are normally borne by one’s health insurance carrier.  Bifocal or other more advanced IOLs are generally not covered as they are considered cosmetic or for vanity.  The average surgery for cataracts costs between $3000 and $4000 per eye.  

Visual clarity after surgery is excellent.  The implant, however, leaves the pupil partially restricted.  It cannot constrict completely in bright light, leaving a hyper-sensitivity to extremely bright lights.  The patient may need reading glasses.  Otherwise there are no visual issues.  An interesting “side-effect": the implant catches and reflects light in an unusual way, leaving the patient who has had cataract surgery with a tell-tale “twinkle” in the eye. 


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