Procedures

Cataracts

Cataracts are a universal aging change of the natural lens in the eye. The lens of a normal eye is clear when we are born, but by the time we are about 60 years old, most of us have at least a slight clouding of the lens. We look through the lens to see (it focuses light rays on the retina inside the eye, much like the lens in a camera focuses light on the film), so clouding of the lens makes it harder to see clearly. If there is only mild clouding of the lens, or very mild cataract, the vision may not be affected enough to warrant treatment.

Cataract Vision

As cataracts process and get denser, vision becomes more affected. This is generally a gradual visual change. A sudden change in vision is NOT typical of a cataract. Symptoms of a cataract can include blurred vision, darker or dimmer vision, needing more light to read or do other activities, glare, greater difficulty with night driving, or a general decrease in quality of vision.

Cataract Treatment

Treatment for cataract-related vision changes begins with a thorough eye exam, including dilation of the pupil to make sure that there are no other eye problems causing loss of vision. Once the ophthalmologist concludes that the cataract is the source of the visual complaints, there are several options. Often a glasses or a contact lens prescription update will improve the vision enough that the patient sees well and is content with his/her vision.

If the vision is not satisfactory with a prescription update, then cataract surgery is an option. This is a decision that depends upon the needs and wishes of the patient; cataract surgery can be delayed or avoided if preferred by the patient. Most patients with a visually significant cataract, however, choose to pursue cataract surgery. This is especially true since this procedure is relatively quick, painless, and typically has a brief recovery time.

About the Cataract Procedure

Dr. Wyse performs cataract surgery at Glenbrook Hospital in Glenview and at NorthShore Surgicenter in Lincolnwood. She has performed thousands of cataract surgeries. The procedure itself typically takes 10 to 15 minutes, and patients are usually at the hospital or surgicenter for about 3 hours. Patients are given sedation and topical drops (no shots) to make the procedure very comfortable. Patients who are anxious can receive extra sedation so that they essentially sleep through the procedure. Afterwards, patients can usually resume most of their regular activities and return to work within 1 to 2 days.

Dr. Wyse performs state-of-the-art, cataract surgery using the most advanced equipment and techniques. This minimally invasive, small-incision, no-stitch cataract procedure is called "clear cornea phaco-emulsification under topical anesthesia." This technique allows for rapid recovery after the procedure with very little downtime.

Surgery involves removal of the natural lens of the eye, which has become cloudy over time, and replacement of the lens with a clear lens implant (most commonly made of acrylic). A microscopic incision is made in the cornea, and ultrasound is used to break up the lens into small fragments. The lens fragments are then removed, leaving the capsule that surrounds the natural lens in place to hold the new artificial lens (the intraocular lens implant or IOL). This is all done under topical anesthesia (meaning eye drops rather than shots), and with intravenous sedation to make it a very comfortable experience for the patient.

Standard Lens Implants

Traditionally, after the cataract is removed, the natural lens is replaced by a standard or single focus intraocular lens implant (standard IOL). This lens improves the patient's distance vision, but reading glasses or bifocals may still be required to view things closer than arms length. Alternatively, the patient may choose a single focus lens implant (standard IOL) that provides focus at NEAR distances, and will therefore still need to wear glasses for distance.

Patients who wish to use standard lens implants may choose to have one eye corrected for distance vision and the other eye corrected for near vision. This is called MONOVISION, and does result in some loss of depth perception, but can make patients somewhat more independent of glasses.

Even with Monovision, however, glasses may be needed for those patients who wish to have both eyes clear at distance for night driving or other distance activities, as well as both eyes clear for near for prolonged reading. For this reason, we tell patients who choose Monovision that they will likely have to get glasses, but will likely not need to wear them for many activities. We do discourage Monovision in patients with a history of vertigo or balance issues.

With any of the above options with standard lens implants, the patient will need glasses or contacts for clear vision at least at some distances.

Premium Lens Implants

One of the most exciting changes in cataract surgery in the last 10 years has been the introduction of a variety of special replacement lenses called "Premium" lens implants (Premium IOLs), such as Alcon AcrySof ReSTOR® Lens and Crystalens®. These more advanced lenses are designed to allow patients to be more independent of glasses. Measurements of the eye using the most technologically advanced, state-of-the-art equipment are taken in the office to determine if one of these implants would be appropriate for the patient's eye.

Premium IOLs

Based on these measurements and the wishes of the patient, we can identify the best lens choice for the individual. This is an interactive process between the patient, Dr. Wyse, and our staff, and we understand that patients may have questions and need clarification. You will find our staff knowledgeable and accessible.

Multifocal Lens Implants: these premium lenses are designed to give patients a range of vision including distance and near so that objects are clear at both near and far without glasses. While complete independence from glasses is not always achievable, there is generally much less glasses dependence than with the standard lens implants, and many patients rarely wear glasses after cataract removal. Several of this type of multifocal or accommodating lens implants are available, and Dr. Wyse and our staff can discuss with you which lens is best for you given your lifestyle, ocular measurements, and goals.

Toric Lens Implants: these premium lens implants are designed to correct astigmatism so that patients can be more independent of glasses or contacts. Astigmatism is an irregular shape of the eye that can be corrected by glasses, contacts, or surgery. Astigmatism is detected during preoperative measurements of the surface of the eye (not just the glasses or contact lens prescription).

Patients who have significant astigmatism are often not good candidates for Multifocal lens implants, as their vision may be blurred by the residual astigmatism that the multifocal or accommodating lens cannot correct. In this case, a Toric lens implant is recommended instead to correct the astigmatism, thereby allowing more independence from glasses or contacts. While a technique called "Limbal Relaxing Incisions" can be used instead of a Toric lens to treat astigmatism, the Toric lenses are preferred since they are more accurate. Again, special measurements of the eye are needed to determine if you would benefit from this type of Premium lens implant; Dr. Wyse and our staff will discuss this option with you.

After Cataract Removal

After the procedure, most patients can resume their normal activities within a day or so. Dr. Wyse is available by pager 24 hours a day should any concerns or questions arise. Patients are seen for follow up the day after and about a week after the procedure.

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