My Doctor Online The Permanente Medical Group

Symptoms

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Common symptoms of a cataract include:

• A painless blurring of vision
• Glare or light sensitivity
• Frequent eyeglass prescription changes
• Double vision in one eye
• Needing brighter light in order to read
• Poor night vision that can, in some cases, present glare problems

Vision symptoms caused by a cataract vary from person to person and can include problems with driving, reading, or work.

Both eyes are often affected, usually one before the other. If one eye remains normal, you may not notice a cataract in the other eye. Pain, redness, itching, or headaches are usually not associated with cataracts, but may be signs of another condition affecting the eye.

Causes

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We don't know what causes cataracts. They usually occur as part of the normal aging process. Most cataracts progress slowly and can take months or years to develop before they affect vision. This process can be quite variable among individuals and we do not know why certain cataracts progress quickly and others slowly. For this reason, it is impossible to predict how fast a cataract will progress. Some factors that contribute to the development of cataracts include:

• Long-term exposure to sunlight
• Certain medical conditions such as diabetes and eye trauma
• Smoking
• Certain medications, mainly long-term use of oral or inhaled steroids

Studies have not been able to show that any medications, dietary supplements, exercises, or optical devices will help prevent or cure cataracts. However, protection from excessive sunlight may slow its progression. Therefore, we suggest that you wear sunglasses that filter out ultraviolet (UV) rays or clear glasses with an anti-UV coating.

Treatments

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Depending on the severity of your condition and your symptoms, treatment options may include:

Vision aids. In the case of an early cataract, it may be possible to improve your vision by changing glasses. Working with a good, bright light may help, and sometimes a magnifying aid is useful. In some people, cataracts develop very slowly and do not affect the quality of their eyesight significantly.

Surgery. Once a cataract begins to cause vision loss that affects your ability to continue with your daily activities or, in the rare case where it puts your eye at risk for other complications, it may be time to consider surgery. Cataract surgery is very successful for most patients and most patients experience improvements in their vision. However, we can’t predict exactly how much your eyesight will improve after surgery.

Surgery

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Cataract surgery is an outpatient procedure. You will be admitted into our outpatient surgery unit and, after your procedure and a short recovery period, go home the same day. You will need to arrange for someone to accompany you to the surgery unit and drive you home after the procedure.

Most of the time, the surgery is not painful, but you may experience minimal discomfort. We will give you medication to numb the eye either in the form of drops, or an injection. We will also give you mild sedation medication to help you relax during the operation, but you will be awake.

You will receive specific instructions about preparing for surgery and recovering afterwards, once your surgery has been scheduled.

Removing a cataract

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• During cataract surgery, the cloudy lens is removed using a method known as phacoemulsification. This method uses ultrasonic technology that produces sound vibrations too high for humans to hear. These vibrations break the cataract into tiny particles which are then suctioned out.
• Once the cloudy lens has been removed, we replace it with an artificial intraocular lens (IOL) implant. The implant helps your eye focus after it has healed. 
• We will measure your eye before surgery in order to verify the type of implant that is best for you. 
• Cataract surgery is performed using microsurgical instruments and a special operating microscope. Tiny sutures may be used to close the incision, but usually sutures are not necessary with modern surgical techniques.

The Intraocular Lens Implant (IOL)

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The intraocular lens, or "IOL," is placed in your eye at the time of cataract surgery and is designed to stay there permanently to focus the light entering your eye. If the natural lens were simply removed and nothing further done to focus light, your vision would be very blurry. Modern intraocular lenses block ultraviolet light to protect your retina.

In rare cases, an intraocular lens may need to be repositioned or removed months or years after surgery. Occasionally, an intraocular lens cannot be safely implanted at the time of surgery and glasses or contact lenses will need to be used instead.

We will measure your eye before surgery in order to verify the type of IOL that is best for you. Modern intraocular lenses may be monofocal, toric, multifocal or accommodative and we will help you select the type that is best for you.

A monofocal lens can focus images in the far distance, intermediate distance, or near distance but not all three at the same time. For example, with a monofocal implant selected for clear distance vision, you usually still need glasses to read fine print. If we select a monofocal lens to allow you to read up close without glasses, you will still need glasses to see clearly in the distance. Sometimes, depending on your individual needs and preferences, one eye can be corrected for distance and the other eye for intermediate or near. This is called monovision. This approach can make you less dependent on glasses, although it may mildly compromise a depth perception. Monofocal lenses cannot correct for astigmatism.

A toric lens can help correct an astigmatism, a common condition where the curvature of the cornea is irregular, causing blurred vision. The lens can help reduce your dependence on glasses for distance vision, although you will still need glasses for reading unless a monovision approach is used. We can help you decide if you are a candidate for this lens. This lens is not covered by your health plan benefits and is subject to an additional fee.

A multifocal/presbyopic lens is designed to focus on more than one zone simultaneously to reduce your dependence on glasses. This lens has several rings to help focus light at near and distance. This lens is not covered by your health plan benefits and is subject to an additional fee.

Accommodative lens. This lens is hinged to work in coordination with your eye muscles to mimic the way your eyes naturally focus. This allows the lens to move backwards and forwards to help the eye focus at various distances: near (reading), intermediate (computer) and distance. This can reduce your dependence on glasses, although you may still need them for the sharpest vision. This lens is not covered by your health plan benefits and is subject to an additional fee.

Risks

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As with all surgery, complications can occur. There is a small possibility of bleeding, infection, inflammation or other complications including glaucoma, retinal detachment, and retinal or corneal swelling that could limit or decrease your vision.  

The natural lens of the eye is located in a capsule, known as the posterior capsule. When we remove the cloudy lens we leave this capsule in place to hold the intraocular lens in position. Sometimes a clouding of the posterior capsule may form months or years after successful cataract surgery. This clouding may cause symptoms of blurred vision similar to the original cataract.

Fortunately, blurred vision caused by a clouded capsule can be cleared with a quick and painless laser procedure called "YAG capsulotomy," performed in the clinic. 

If you are experiencing blurred vision long after cataract surgery, let us know.

After Your Surgery

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• The sedation medications may make you feel a little groggy after the procedure. We recommend that you have someone available at home (or nearby) for the first night after surgery, to help with your medicines.
• Your eye will need time to heal and adjust so that it focuses in coordination with the other eye.
• You may notice that, at first, colors seem very bright, but as you heal you will get used to improved color vision.
• Your pupil may still be dilated for a few days after the surgery. This will make your eyes more sensitive to light and blur your vision.
• Many people drive better after cataract surgery because their vision eventually becomes clearer than before surgery.

Lifestlyle Changes and Management

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In order to drive a private vehicle, the California Department of Motor Vehicles (DMV) requires that you can see 20/40 with both eyes tested together or at least 20/40 in one eye and 20/70 in the other eye. If your vision is less than this, you may be able to get a restricted license, which usually means you cannot drive on highways, or at night. If you are already scheduled to have cataract surgery, the DMV will often extend your license for up to 3 months. 

The DMV makes the final decision about your driving vision. We can only record what the eye examination shows and cannot make any driving recommendations to the DMV.

Your Care with Me

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If you think you have blurry vision caused by cataracts, call the Optometry department to make an appointment. If your optometrist believes that you would benefit from surgery, he or she will facilitate the process of scheduling an appointment in my department. If appropriate, she or he might call me or one of my colleagues while you are in the office so we can all discuss your care together. If we decide you need an appointment with me after that discussion, we can often schedule it the same day or soon thereafter.

During your first appointment, I will perform a comprehensive eye examination. I will administer eyedrops to dilate your pupil so that I can clearly see the structures in your eyes. Your pupils will remain dilated for several hours, so you may wish to bring someone who can drive you home after your exam.

I will ask about your medical history and the vision symptoms that you have been experiencing. We will discuss treatment options, and together we will create a treatment plan that is right for you.

If I recommend surgery and you agree that it would be the best approach, we will discuss your surgery in more detail. We will discuss the type of lens that is most appropriate for you. Once you decide to have surgery, we will arrange for your eyes to be measured, either on the same day or close to the date of your surgery.

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If you need to talk with me after your visit or procedure, please call my office. You can also e-mail me with nonurgent issues from this website whenever it is convenient for you.

If you have urgent concerns or issues while my office is closed, or need general medical advice, you can call the Appointment and Advice line, available 24 hours a day, 7 days a week. You will be connected with a nurse who can give you immediate advice.

If you are experiencing a serious problem or an emergency, call 911 or go to the nearest Emergency Room when the clinic is not open.

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Coordinating Your Care

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Having all of our Kaiser Permanente departments located together or nearby, including pharmacy, laboratory, radiology, and health education, makes getting your care easier for you.

Another major benefit is our comprehensive electronic medical record system, which allows all of the doctors and clinicians involved in your care to stay connected on your health status and collaborate with each other as appropriate.

When every member of the health care team is aware of all aspects of your condition, care is safer and more effective.

If you come to an office visit

• At the beginning of your visit, you will receive information about when you are due for your next test, screening, or immunization. We can discuss and schedule any preventive tests that you need. 
• At the end of your visit, you may receive a document called the "After Visit Summary" that will summarize the issues we discussed during your visit. You can refer to it if you forget what we discussed. You can also view it online under Past Visits.
• To help you prepare for your visit, please see additional details under Office Visit. 

If I prescribe medications

We will work together to monitor and assess how your medications are working and make adjustments over time. Prescriptions can be filled at any Kaiser Permanente pharmacy. Just let me know which pharmacy works best for you, and I will send the prescription electronically in advance of your arrival at the pharmacy.

• Order them online or by phone. Order future refills from my home page or by phone using the pharmacy refill number on your prescription label.
• Have them delivered to you by mail at no extra cost. Or you can pick up your medications at the pharmacy. If no refills remain when you place your order, the pharmacy will contact me regarding your prescription.

If lab testing or imaging is needed

For lab tests, I will use our electronic medical record system to send the requisition to the Kaiser Permanente laboratory of your choice. For imaging procedures, we will schedule an appointment with the Radiology department. When the results are ready, I will contact you with your results by letter, secure e-mail message, or phone. In addition, you can view most of your laboratory results online, along with any comments that I have attached to explain them.

If I refer you to another specialty colleague

If we decide together that your condition would also benefit from the care of other types of specialists, our staff will help arrange the appointment(s) with one or more of my specialty colleagues.

If surgery or a procedure is a treatment option

I will recommend you review educational information and tools to help you prepare for your procedure or surgery. The information will often help you decide whether surgery is right for you. If you decide to have a surgery or procedure, the information will provide details about how to prepare and what to expect.

If we proceed with surgery, I will have my Surgery Scheduler contact you to determine a surgery date and provide you with additional instructions regarding your procedure. Once your surgery is scheduled, a medical colleague of mine will contact you to conduct a preoperative medical evaluation that will assure that you are properly prepared for your surgery.

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Convenient Resources for You

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As your specialist, I have a goal to provide high-quality care and to offer you choices that make your health care convenient. I recommend that you become familiar with the many resources we offer so that you can choose the services that work best for you.

My Doctor Online is available at any time that is most convenient for you. From my home page you can:

Manage your care securely

• View and compose secure e-mail messages.
• Manage your prescriptions.
• View your past visits and test results.
• View your preventive services to see whether you are due for a routine screening or updated immunization.

Learn more about your condition

• Read about causes, symptoms, treatments and procedures.
• Find interactive health tools, videos, and podcasts to help you manage your condition.
• View programs to help you decide on or prepare for a surgery or procedure.

Stay healthy

• Locate health education classes and support groups offered at every medical center.
• Explore interactive programs, videos, and podcasts that focus on helping you stay healthy.
• View your Preventive Services to see whether you are due for a routine screening or updated immunization.

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