Contact Lenses Care

The first step in restoring vision is to remove the cloudy lens surgically. This is one of the safest, most successful, and widely performed operations. Of the 400,000 to 600,000 cases performed annually in this country, over 90 percent succeed in helping to restore vision, thanks to improvements in surgical techniques and in the skills of ophthalmic surgeons.

The surgeon has a choice of several surgical approaches; the decision is based upon the type and stage of the cataract, as well as the age of the patient. The lens may be extracted by freezing the lens with a tiny metal probe that adheres to the cataract and removes it intact (cryoextraction). A relatively new method, ultrasonic phacoemulsification, employs a tiny titanium needle vibrating at forty thousand times per second that emulsifies the cataract, which is then aspirated through the same needle. The cataract incision may require several tiny sutures (in the cryoextraction technique) or only a single suture in the ultrasonic technique. The resulting postoperative condition of an eye without a lens is called aphakia; a person with aphakia is called an aphake. Aphakes are not blind as a result of surgery, but, because the normal refracting lens is gone, their vision is impaired (similar to what a normal person sees under water).

Cataract Eyeglasses

The next step in restoring sight is to provide a refracting lens to replace the normal crystalline lens which has been surgically removed. The traditional solution has been cataract eyeglasses. But these are heavy, and have thick “sunny-side-up” or “oyster” lenses that enlarge the visual image by 30 percent. Through these glasses the world looks strange and distorted. Peripheral vision is severely limited; the sensation is one of looking through a tunnel. Wearers often find that at first they spill things, or have trouble keeping their balance. Objects, such as doors, curve precipitously away or loom suddenly into view. The problem is compounded when only one eye has been operated on, and the patient has monocular aphakia. In this case only one eye receives the cataract eyeglass. It is almost impossible to correct monocular aphakia satisfactorily with glasses because the eyes can’t work together: the images are of vastly different sizes, resulting in a lack of fusion or binocularity. This problem lasts until the other cataract is removed and that eye receives its own corrective spectacle. Consequently this solution is very rare these days. The main advantage of cataract glasses is the ease with which they can be put on and removed, and that they are a familiar, unthreatening device.

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