Cataracts are an opacification or cloudiness that develops within the lens of the eye. This is a normal part of the aging process that most people experience at some point. The lens is the part of the eye that focuses light on the retina and allows us to see things sharply. The lens functions best when we are younger because it is crystal clear. As we age, the lens slowly turns yellow, then brown, and sometimes becomes opaque and white. An analogy is a window that is never washed. As dirt accumulates, the window loses its clarity, and it is no longer possible to see through it. Similarly, sometimes a cataract progresses to the point that vision decreases.

Age is not the only cause of cataracts. Trauma or injury to the eye, certain medications such as prednisone or cortisone, diabetes and other less common medical conditions may also cause cataracts. Sometimes people are even born with cataracts. Cataracts present at birth may be small and harmless or may be large enough to interfere with vision.

A person with a cataract may notice problems such as blurred or distorted vision, glare from sunlight, headlights, or other lights, or trouble focusing on things. When these symptoms begin to interfere with activities of daily life, removal of the cataract may be recommended.

Cataract surgery is a precise and technically demanding procedure. Cataract surgery is micro-surgery, which means that it is performed under a high-powered operating microscope. This surgery is one of the most commonly performed surgical procedures in this country and at Miami Eye Center. It is also one of the most successful procedures. It is usually performed as an outpatient procedure, which means that you do not have to stay in the hospital overnight.

Dr. Gelber will first numb the eye with topical anesthetic drops. Next Dr. Gelber will make a tiny incision, approximately 1/5" in the cornea of your eye. This is called a "clear cornea" incision. He will then use an ultrasound-powered needle to liquefy and remove your cataract. This part of the procedure is called phacoemulsification. Researchers are experimenting with lasers to remove cataracts, but laser cataract removal currently offers no advantage over phacoemulsification.

When the cataract has been removed, Dr. Gelber will implant a new lens into your eye. This new lens (refractive multifocal lens or conventional monofocal lens) is made of acrylic or silicone. Most of the time a foldable lens is used so that the initial incision does not have to be enlarged. The advantage of keeping the incision small is a more rapid healing time and a quicker recovery from the procedure. Once placed into the eye, the lens is unfolded and placed in proper position.

Usually, no stitches are needed to close the incision in the cornea. Because the eye is so secure with this small incision, you will leave the operating room with no patch. In most cases you can resume normal activity as early as the next day. Drops will be prescribed to prevent infection and inflammation in the eye, and you will be given detailed instructions regarding postoperative follow-up examinations. Dr. Gelber is a recognized expert in no stitch cataract surgery and is available to answer questions about this exciting procedure.

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Cataract Surgery Decision Making

Most of us these days live full, active lives and hope to continue to do so well into our 80's. We watch our diet, exercise, take vitamins and try to stay current with new developments in health care. This effort we hope, will give us the lifestyle we are looking for.

As we "grow up" one of the milestones we can expect to face is the development of cataracts. This is not a disease but a normal part of aging. Just as a camera has a lens which focuses light on the film, so the eye has a lens which focuses light on the retina. The human lens is crystal clear through must of our lives but with time the lens becomes clouded. At this point the lens can no longer focus a sharp image on the retina. This clouded lens is called a cataract. As the cataract increases in density, it causes a loss of visual acuity and often glare. Ultimately, it will interfere with ones daily activities and when that occurs, it is time to consider surgery. This surgery involves removing the cloudy lens of your eye (cataract) and replacing it with a clear plastic intraocular lens (IOL).

We each have our own lifestyle and thus our own visual needs. You may have a strong recreational interest in flying your private plane or golfing, traveling with night driving or working at your computer. Each of these activities calls for a unique quality of vision. Throughout your life, your vision was something you were dealt; nearsighted, farsighted or astigmatism or a combination. Now that you have cataracts and will require surgery, you have an opportunity to select the type of vision you will have for the years ahead.   You can select a specific type of surgery with a specific type of intraocular lens to meet your visual needs.

You may be a person not bothered by wearing glasses and in that case a traditional (generic) monofocal intra-ocular lens (IOL) is a good solution. On the other hand you may take this as an opportunity to change your visual lifestyle. The ReStor, Tecnis and Crystalens are multifocal lenses which means that they can provide both distance and intermediate vision without the need for glasses. You can sit with a magazine in your lap in front of the TV and see both without glasses. Perhaps you have a need for exceptional night vision for driving or you have an interest in bird watching or fishing the shallow waters of Biscayne Bay. If these latter needs are dominant in your life then an aspheric IOL would be best for you. This lens neutralizes the irregularity of your cornea and delivers the very maximum distance and night vision.

The multifocal and aspheric lenses are referred to as Premium Intraocular Lenses. In order to properly place these lenses, additional testing such as corneal topography and pachymetry are required. Medicare as well as various HMO's have acknowledged that these new technologies come with added technical expertise and requirements and therefore additional expense. The various insurance payers have structured a system whereby there is patient-shared billing. That is, the costs for these advanced services are in part paid for by insurance carriers. If you have an interest in a Premium Lens, our surgery coordinator will review with you all the financial details based on your insurance situation.

The philosophy of one size fits all no longer makes the grade in cataract surgery. Thanks to the rapid development of technology surgeons now have the capability to customize the choice of intraocular lens implant to the visual needs of each individual. Unfortunately, not all surgeons have made the commitment to take full advantage of the spectrum of choices now available. At Miami Eye Center, our emphasis has always been and will always remain achieving the best possible results for our patients.

My staff and I have developed the experience to help our patients decide on the best option for them and then "make it happen." I have performed well over 15,000 cataract surgeries and I feel well qualified to provide an opinion regarding your particular situation. If necessary, I can systematically review your lifestyle issues and match the best lens to you. With our own ambulatory surgery center on the premises much of the inconvenience of the process is eliminated. And for those with no health insurance we can be flexible regarding the high cost of medical care.

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