Cataract Treatments and Surgery in Washington, DC, and Maryland

• What is a Cataract?
• Cataract Surgery Preparation
• Cataract Surgery
• Intraocular Lenses
• Risks
• Surgery Center

What is a Cataract?

In the eye, the natural crystalline lens focuses light rays on the retina to produce an image. At birth, the lens is clear. With time, the lens starts to get cloudy and obstruct light. This cloudy lens is known as a cataract and can diminish vision. Fortunately, cataract treatments and surgery are available at our offices in Washington, DC, and Chevy Chase, Maryland, near Bethesda, to restore clear vision. By replacing the natural lens with an intraocular lens during cataract surgery, patients can reduce or eliminate their need for glasses or contacts following the procedure. Two exciting new bifocal IOLs are the ReSTOR® and ReZoom™ lenses.

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Types of Cataracts

• Nuclear Sclerotic Cataract – This is the most common type of cataract that occurs with aging. The natural lens becomes more dense and brownish in coloration.
• Posterior Sub Capsular Cataract (PSC) – This type of cataract may occur earlier in life than nuclear sclerosis. It is a plaque on the back surface of the lens. Patients with diabetes, radiation treatment, and trauma are more prone to develop this type of cataract.
• Cortical Cataract – Gray or white clefts develop in the lens.
• Combined Form – Many cataracts are a combination of the types of cataracts listed above.

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Cataract Treatments

Mild Cataracts

With mild cataracts, there is often a shift in your glasses prescription. Most patients become more nearsighted (myopic). This change may cause difficulty with distance vision as well as visual side effects such as glare with night driving. Often, a minor change in your glasses or contact lens prescription will improve your vision sufficiently so that you can perform your daily activities. It is important to realize that as the cataract progresses, your glasses prescription may need to be updated. At Eye Doctors of Washington, we recommend that mild cataracts be observed every six to 12 months.

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Vitamins

There are no medical remedies to reduce or eliminate cataracts. Recent clinical studies have shown that the use of Vitamin C may slow the progression of cataracts. We recommend the use of at least 100 units of Vitamin C. This amount is present in most daily multi-vitamin supplements. It is important to realize that excessive amounts of vitamins can be hazardous to your health. At the recommended dosage, Vitamin C is quite safe for most individuals. If you have any questions or concerns about the use of vitamins, you should contact your family physician or internist prior to initiating cataract treatment.

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Visually Significant Cataracts

At some point, changes in the glasses prescription will not be sufficient to improve your vision. The only effective cataract treatment is to remove the cloudy lens. Fortunately, modern cataract surgery is safe and effective with excellent results and minimal discomfort.

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Cataract Surgery Preparations

Preoperative Preparations

Cataract surgery is safe and effective and is performed in an outpatient setting at local surgical centers. During cataract surgery, the cloudy natural crystalline lens is removed and replaced with an implant or intraocular lens (IOL). Two exciting new bifocal IOLs are the ReSTOR® and ReZoom™ lenses, Intraocular lenses are made out of inert materials and should last indefinitely. They have been safely implanted for over five decades!

During your examination, your surgeon will help you decide which IOL, the ReSTOR® lens, or ReZoom™ lens is right for you. Your surgeon and the staff will then discuss the risks, benefits, and alternatives of surgery. They will answer all of your questions and do their best to alleviate your fears and concerns.

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IOL Calculation

IOLs come in different sizes and configurations. In order to choose the best type of IOL, a measurement is a performed. With an A scan, the length of the eye is determined by the same type of equipment used in fetal ultrasound-only on a smaller scale. EDOW uses the most modern ultrasound device available because minute differences in the measurement have a substantial impact on the IOL calculation.

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Limitations in IOL Calculations

Despite the wonderful advances with cataract surgery, it is also important to realize that the main goal of cataract surgery is to make you see better. Every effort will be made to reduce or eliminate your need for glasses; however, some patients will still need to use vision correction. It is important to realize that a 0.3 mm difference in A-scan measurement is equals to one diopter of glasses refraction. To put that measurement in context, 0.3-mm is less than the thickness of the letters on this page. EDOW uses the finest available technology for A-scan measurement to provide you the best possible care.

Also, it is important to understand if you are highly nearsighted or farsighted and develop a cataract in only one eye, the intraocular power must be calculated to balance with the unoperated eye. This is related to your need for eyeglasses in the unoperated eye. The difference in the correction between eyes cannot be too great. In those instances, it may cause an imbalance in your binocular vision. If this applies to you, it will be explained in detail by your surgeon.

The alternative to intraocular lens implantation at the time of cataract surgery is to omit the lens implant and for you to use a contact lens or eyeglasses to get clear vision after the surgery. Contact lenses require daily insertion and removal as well as periodic replacement. Vision through the contact lenses used after cataract surgery is magnified about 8 to 10 percent. Eyeglasses magnify vision about 25 percent. For these reasons, contact lenses or spectacles are no longer used except in unusual circumstances.

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Do I Need Additional Tests?

Dense Cataracts: If your cataract is very dense, the surgeon may not be able to visualize the back of your eye. Using a different ultrasound, a B-scan, the eye can be evaluated. This type of ultrasound displays internal anatomy of the eye, allowing for evaluation of the different structures. This test allows the surgeon to make certain there are no large abnormalities such as retinal detachments or tumors, which would preclude the need for elective cataract surgery.

Prior Refractive Surgery Patients (LASIK): For individuals who have had refractive surgery (LASIK, PRK, INTACS, or RK), extra testing will be required because these procedures flatten the cornea. This flattening makes the IOL calculation more challenging. Dr. Clinch and Dr. Kang specialize in these types of procedures. For these special patients, an extra visit will be required to the office. During that visit, several additional tests will be performed. These include:

1. Corneal topography – a map of the corneal surface
2. Repeat refraction
3. Hard Contact lens fitting with measurement of refraction

Dr. Clinch and Dr. Kang also request that you try to obtain your old medical records prior to refractive surgery as well as the operative and postoperative notes from your surgery.

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Preoperative Surgical Clearance

Many patients are concerned that they may be too old or ill to have successful cataract surgery. With the modern techniques utilized by the EDOW surgeons, almost all patients meet the criteria for these outpatient procedures. We have operated on many patients over the age of 100!

Prior to eye surgery, you will need to see your regular physician for surgical clearance. Our surgical coordinator will give you the necessary forms. Your physician will evaluate your overall heath and order some routine tests. If you do not have a regular doctor, the staff and doctors of EDOW can assist you with finding a doctor close to your home.

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Cataract Surgery

On the Day of Surgery

You need to arrive at the outpatient surgical suite no later than 45 minutes prior to the procedure. This affords the staff sufficient time to get you prepared for the procedure. You are given drops to dilate the eye and medications for relaxation. Cataract surgery usually takes about 10 minutes, but patients should expect to be at the facility for about one or two hours.

An anesthesiologist will be present during cataract surgery to administer intravenous medication through an arm vein to help you be comfortable. In addition, anesthetic drops are placed in the eye to eliminate pain or discomfort. This is called “topical anesthesia.” The surgeons at EDOW have published scientific articles on the effectiveness of this state-of-the-art technique. In some instances, several local injections are given through the eyelids that numb the area of the eye and prevent movement during surgery.

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The Procedure

Cataract surgery is performed with an operating microscope that magnifies the image of the eye, giving the surgeon the ability to remove the cataract with precision.

After adequate anesthesia is administered to calm and relax the patient, a small incision is made in the cornea. A round opening, a capsulorhexis, is made in the outer coating of the lens (the lens capsule). The inner hard central lens nucleus is then fragmented and removed in a finely controlled manner using ultrasound. This is called phacoemulsification. Once all of the inner lens components are removed, there is an empty capsular bag. The intraocular lens, ReSTOR® or ReZoom™, is then loaded into a cartridge and inserted into the capsular bag. Since the incision remains small, there is no need for stitches or a patch at the conclusion of the surgery.

The surgeons at Eye Doctors of Washington have performed thousands of surgical cataract treatments and are nationally and internationally recognized. We are delighted to further assist you with any information about cataract treatments and cataract surgery. Please feel free to contact our Chevy Chase, Maryland and Washington, DC, area offices serving Bethesda, Northern Virginia, and surrounding areas for more information.

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Post Operative Care and Recovery

Once the procedure is complete the patient is taken to the recovery area. The staff will then instruct the patient and family members on the recovery process. While healing, the patient will need specially medicated eye drops. This is done with decreasing frequency over the first three weeks after cataract surgery. At that time, the eye is usually stable and glasses will be prescribed (if needed). A small amount of gradual healing may continue over several months, which may necessitate a minor change in spectacle prescription.

Please click here to obtain a copy of the pre- and post-operative instructions.

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Complications and Risks

Cataract surgery is a common procedure that is typically very successful. Like all surgery, however, there is a risk of problems or complications either during the operation or afterward. We make every effort to minimize the chance of problems or complications.

Many articles in the press tend to trivialize the risks of having cataract surgery. This is not appropriate. The surgery is not trivial. You should understand that this surgery should be undertaken only because your vision has decreased to the point where you are having difficulty doing things that are important in your daily life.

The serious complications of cataract surgery include bleeding, postoperative infection, severe corneal edema, retinal detachment, and even loss of vision or the eye. Fortunately, these happen very rarely. All of these complications occur at an incidence of far less than 1 percent in patients without a pre-existing condition. Less serious postoperative complications include drooping of the upper eyelid, transient elevation of eye pressure, transient corneal edema, clouding of the capsular bag, permanent irregularity or dilation of the pupil, and, occasionally, development of astigmatism (an irregular curving of the cornea). Most of these complications, with the exception of the shape of the pupil, are treatable.

The vast majority of cataract patients are pleased with the restoration of vision after surgery. Recent advances in cataract surgery have been one of the wonders of modern medicine and have contributed enormously to the quality of life for people.

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YAG Capsulotomy

Some patients will develop clouding of the capsular bag in which the lens was inserted. This is called posterior capsular opacification. It occurs in about 20 to 33 percent of patients usually months to years after the original cataract surgery. The usual symptoms are diminished visual acuity or glare.

Posterior capsular opacification is easily remedied with a brief, painless laser treatment. The laser treatment is called a YAG capsulotomy. Dr. Gaasterland holds patents and assisted in the development of YAG laser systems. This procedure is performed in the office and takes about five minutes. There is no convalescence required. Patients can return to full vocational and recreational activities immediately.

Complications from YAG capsulotomy are quite rare. The medical literature does report cases of retinal detachment, movement of the intraocular lens, and bleeding. In 10 years and thousands of cases, no serious side effect has ever occurred to any of the patients at EDOW from this procedure.

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Cost of Cataract Surgery

Fortunately, cataract surgery is covered by most insurance plans. The surgeons at Eye Doctors of Washington participate in most insurance plans. In the event that you do not have health insurance, or you choose to not use your insurance, EDOW has a payment plan that includes the following:

• Pre-operative consultation by the surgeon
• A-scan measurement
• Facility fee at Palisades Ambulatory Surgery Center
• Anesthesia Care
• Three months of follow up care (pertaining to the cataract surgery) by the surgeon and staff

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Surgery Center

The vast majority of surgeries are performed at two-eye center, Palisades Eye Surgery Center and Friendship Ambulatory Surgical Center. These ambulatory surgical centers specialize in eye procedures including cataract surgery. They have state of the art equipment. Each patient is under the care of an anesthesiologist. The centers are located at:

Palisades Eye Surgery Center
4818 Del Ray Avenue
Bethesda, Maryland 20814
Phone: 301-657-8200
Fax: 301-657-4121
Website: www.palisadeseyesurgercenter.net

Directions to the center may be downloaded by clicking here.

Friendship Ambulatory Surgical Center
5550 Friendship Boulevard, Suite 270
Chevy Chase, Maryland 20815
Phone: 301-215-7347
Fax: 301-215-7345

Directions to the center may be downloaded by clicking here.

If you are suffering from cataracts, contact one of our eye professionals today to find out if you can benefit from cataract treatments or surgery at our Maryland and Washington, DC, area locations serving Bethesda, Northern Virginia, and surrounding areas.

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