There are many causes of vision loss in older adults - glaucoma, macular degeneration, diabetic retinopathy - but one of the most common and easiest to treat is the cataract. About 90 percent of people over the age of 65 have a cataract.

What Is a Cataract?
A cataract is the clouding of the lens of the eye, which is located behind the pupil and is surrounded by a thin, clear capsule. The lens is clear at birth, but the eventual breakdown and clumping together of protein that is contained inside the lens causes the formation of cataracts.

The lens, along with the cornea (the clear surface covering the front of the eye), focuses incoming light onto the retina, the area in the back of the eye that transmits images to the brain. For the retina to receive a sharp image, the lens must be clear. If it is cloudy, the incoming light is scattered as it passes through, and the image is blurry.

Some of the factors that increase your risk of cataracts are:
• Age
• Diabetes
• Obesity
• Smoking
• High blood pressure
• Family history
• Excessive alcohol consumption
• Excessive exposure to sunlight
• Exposure to ionizing radiation (such as radiation used in X-rays and cancer radiation therapy)
• Previous eye surgery, injury or inflammation
• Prolonged use of corticosteroid medications

Symptoms of a Cataract
Some of the most common symptoms of a cataract are: cloudy or blurry vision; colors appearing faded or yellowish; the appearance of "halos" around headlights, lamps or sunlight; poor night vision, especially while driving; double vision in one eye; and frequent changes in prescription for eyeglasses or contact lenses. If you have any of these symptoms, check with your eye care professional.

Dr. Jean Tostanoski verifying calculations for LenSx Laser treatment.

What Should I Do If I Have a Cataract?
Just because you have a cataract doesn't mean it has to be removed immediately. Many people have small, age-related cataracts in their 40s and 50s, but the cataracts do not significantly affect their vision. In many instances, vision in these individuals can be improved with eyeglasses, brighter lighting or magnifying lenses. However, age-related cataracts grow slowly over time. When cataracts progress to the point where they cause vision loss that interferes with everyday activities, cataract surgery is the only effective treatment. In most cases, delaying surgery will not cause long-term damage to the eye.

Cataract surgery, which involves removing the cloudy lens and replacing it with an artificial one, is one of the most common, safe and effective operations performed in the U.S. Approximately 90% of individuals who have had the surgery report better vision afterward.

Traditional Cataract Surgery
During traditional cataract surgery, the surgeon makes a very small incision in the cornea using a hand-held metal or diamond blade and inserts a tiny, high-frequency ultrasound device to break down the cataract while a miniature suction device removes the broken-down lens. This process is called phacoemulsification. A new artificial lens, called an intraocular lens, is then put it its place. Intraocular lenses, which are made of acrylic, silicone or polymethylmethacrylate material, are permanent and need no maintenance. They can also be removed, if necessary. Cataract surgery is an outpatient procedure that takes about 15 minutes and is performed under local anesthesia. Most patients are able to return to normal activities within 24-48 hours, and full recovery can be expected in approximately two weeks.

Laser Cataract Surgery
Another type of cataract removal that is now available uses a technologically advanced option called the LenSx Laser. This image-guided laser performs several of the most difficult steps of cataract surgery, eliminating the need for a manual scalpel. Phelps recently became the first hospital in the Hudson Valley to offer cataract surgery using the LenSx Laser.

The laser captures extremely precise, high-resolution images of the eyes, which are used to plan and perform surgery to exact, individual specifications not attainable with traditional cataract surgery. In addition to creating more precise incisions, LenSx also reduces the amount of ultrasound time needed to dissolve the cataract, thereby lessening the possibility of damage to the cornea.

Most patients are candidates for the LenSx procedure. Exceptions include those with small pupils, certain corneal diseases and some forms of glaucoma. If you have a cataract that needs to be removed, your surgeon will be able to recommend the procedure that is best for you.



Jean Tostanoski, MD, is chief of ophthalmology at Phelps Memorial Hospital Center. Board certified in ophthalmology, she received her medical degree from Albert Einstein College of Medicine. She completed an internship in medicine at Norwalk Hospital, followed by a residency in ophthalmology at Bronx-Lebanon Hospital Center and a fellowship in ophthalmology at the Manhattan Eye, Ear & Throat Hospital. Her private practice, Hudson Valley Eye Associates, is at 24 Saw Mill River Road in Hawthorne, 914-345-3937.