Carolyn Shih: A clearer view: understanding and treating cataracts

Have you noticed that your vision is becoming a little hazy, like you’re looking through a foggy window? If so, you might be experiencing the effects of cataracts.

What, exactly, is a cataract? Imagine the lens of your eye is like the lens of a camera. It’s a clear, natural part of your eye that focuses light onto the retina, which is at the back of your eye. The retina then sends signals to your brain, creating the images you see.

A cataract is simply the clouding of this natural lens. It’s a bit like a clear camera lens becoming frosted over. This clouding prevents light from passing through properly, leading to blurry, hazy or dim vision.

Cataracts typically develop slowly and painlessly, so you might not even notice a change in your vision at first. As they progress, however, you may experience cloudy or blurry vision, the fading or yellowing of colors, an increased sensitivity to light, difficulty with night vision, halos around lights, frequent changes in your eyeglass or contact lens prescription, or double vision in one eye.

The most common cause of cataracts is aging, but other factors can also contribute to their development, including family history, medical conditions, previous eye injury or surgery, smoking, excessive alcohol consumption, or prolonged exposure to ultraviolet radiation from sunlight.
When cataracts begin to interfere with your daily life, making it difficult to read, drive or watch TV, it’s time to consider cataract surgery. It’s one of the most common and routinely successful surgical procedures performed today.

The surgeon makes a tiny incision in the eye, and then uses a special tool to break up and remove the cloudy natural lens. Then a new, clear artificial lens — called an intraocular lens, or IOL — is implanted in its place. The new lens becomes a permanent part of your eye and requires no special care.

With modern cataract surgery, you have options for your new lens. Your doctor will help you choose the best one to fit your lifestyle and needs.

Monofocal IOL: This is the most common type of IOL. It provides clear vision at a single distance, usually for distance (i.e. driving, watching a Broadway show). You will likely still need glasses for reading, using a computer and other close-up tasks.

Toric lenses (astigmatism correction): Astigmatism occurs when the cornea is shaped more like a football than a baseball, causing blurry or distorted vision. Toric IOLs have a special design that corrects both your cataract and your astigmatism in a single procedure.

Extended depth of focus lenses: These lenses create a single, elongated focal point to provide a continuous range of vision. They offer excellent distance vision and a solid range of intermediate vision — great for computer work or seeing a car dashboard — with a lower chance of nighttime glare or halos than other multifocal designs. You may still need glasses for very fine print.

Light adjustable lenses: These are the only IOLs that can be customized after they have been implanted. The lenses are made of unique, photosensitive material. After a few weeks of healing, your surgeon uses a special light-delivery device to fine-tune the lenses’ power to your exact visual needs (distance, near or a blend), eliminating any small remaining prescription errors. Once the optimal vision is achieved, the lens is “locked in” and the adjustments are permanent. This offers the highest level of precision and customization.

Femtosecond cataract surgery: precision with lasers: While traditional cataract surgery is very safe and effective, many surgeons now offer laser-assisted surgery. It uses a highly precise, computer-controlled laser to perform several key steps of the surgery that were traditionally done by hand with a blade. The laser creates the tiny incision, opens the lens capsule and even softens the cataract before it is removed. This allows for extraordinary accuracy and consistency, can lead to a more predictable outcome and a faster recovery, and is a safer procedure for certain patients.

Cataracts are a normal part of aging, but they don’t have to define your vision. With simple preventive measures and highly effective surgical options, you can look forward to a world that is once again clear, vibrant and full of light. If you have any concerns about your vision, don’t hesitate to speak with your eye doctor. 

Dr. Carolyn Shih is an assistant professor at the Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, and works at South Shore Eye Care, a member of the Northwell Health Eye Institute.