COA Vision Blog

This June is Cataract Awareness Month. And, in honor of this month, we sat down with COA’s Director of Cataract Services, Dr. James McHale, to ask him everything you need to know about cataract treatment.

Do young patients get cataracts? If so, what are the causes?

Young people do get cataracts from time to time. The peak age or most common age of cataract surgery in America is 73. Younger patients oftentimes present with a cataract that is most likely in just one eye. This can be due to previous trauma, infection, or inflammation of that eye. Steroids are the most common medication that causes cataracts in younger patients and are often related to underlying diseases such as arthritis and lupus or linked to those who take chronic steroids due to an organ transplant. There are also some genetic or metabolic diseases that can also lead to the early development of cataracts. It’s quite rare, but sometimes even newborn children are born with cataracts and require surgery shortly after birth to prevent a permanent loss of vision.

Once a cataract has been discovered, what types of tests are necessary to conduct before surgery? Why are these important?

Before cataract surgery, a comprehensive, dilated examination of the eye is required. Notes are made regarding a variety of things, including ocular dominance, pupil size, and visual acuity. Other more high-tech measurements are taken like the length of the eye, the curvature of the cornea, the positioning of the cataract inside the eye, and scans of the retina. All of these factors will then help a surgeon determine the most appropriate treatment option. 

If I had LASIK when I was younger, can I still have cataract surgery?

Absolutely. Everyone develops cataracts if they live long enough. Having LASIK will not prevent cataracts and does not change the way we perform cataract operations. However, having had LASIK previously can impact your focus following surgery and will be a vital factor in determining which type of lens implant your surgeon recommends for you. 

What type of lens implants will provide me with the greatest freedom from glasses?

In reality, all of the lens implants that we use for cataract surgery will reduce your dependence on glasses to some degree. In most patients, we give them freedom from glasses for distance vision. We have lens implants that correct both nearsightedness, farsightedness, and astigmatism to accomplish this task. There are also more advanced lens implants that can help people see up close and far away, which delivers the greatest freedom from glasses. Some of these even come in a form that corrects astigmatism at the same time. These continue to improve with each generation of lens implants and about 35% of our patients choose these lenses.

This June is Cataract Awareness Month. And, in honor of the month, we sat down with Dr. Charles Hickey, our talented ophthalmologist who has been performing cataract surgery for over 30 years.

Dr. Hickey, what are some of the biggest changes in cataract surgery that have helped improve outcomes?

The two most important changes in cataract procedures have been the elimination of sutures and the ability to fine-tune refractive outcomes. Pre-operative testing of the anatomical shape and length of the eye allows us to completely eliminate distance glasses in many of our patients. We also have the option of correcting astigmatism as well as improving near vision along with good distance correction similar to what you have when wearing a pair of bifocal glasses.  These are the result of improvements in the design of the small plastic lenses we place in the eye at the time of surgery. 

What are some of the symptoms patients complain about with cataracts—besides a general blurring of vision?

Symptoms of cataracts can include difficulty distinguishing color, especially the color blue. Some cataracts act like yellow sunglasses, and people cannot distinguish navy blue from black. Having trouble with glare from bright lights is also common and can cause problems both with driving and reading. As cataracts worsen, the blur increases, making it difficult to see in all lighting conditions. It can also increase the risk of falling as patients may not see a step or curb in dim light. 

While it may vary from one person to another, when is the best time to have a cataract removed?

The time to have cataract surgery is when a person is having difficulty seeing and enjoying any activity that is important to them. This varies greatly from person to person. Some cataracts blur distance vision but not reading vision. Some of these patients do not realize they have any problems at all until they flunk their vision test when renewing their driver’s license. Other cataracts cause glare and blur with reading, and these patients will often seek surgery early. It is usually an individual and personal decision made in consultation with their ophthalmologist. 

Briefly, what should a patient expect on the day of surgery?

The day of surgery now starts with a COVID screening upon entering the surgical center. If all is well in this regard, patients recline on a cart, retaining their street clothes and shoes. An intravenous is started, a sedative is infused, and the area around the eye is blocked with injection medicine that the patient neither feels nor remembers receiving. They then move into the operating room on the same cart, and the surgery takes about fifteen minutes. The gentle sedative is continued, and Mozart and Beethoven play softly on WOSU radio (at least in my operating room!). The patient returns to the front area for a beverage and a snack and then leaves for home. We expect little to no pain, but some people can feel a bit of scratchiness as the eye begins to heal.

If I have had astigmatism all my life, can cataract surgery help improve that?

Patients who have lifelong astigmatism have the choice of a toric lens implant that not only corrects their distance vision but also corrects their astigmatism. This correction works much better than astigmatic glasses as the implant moves with eye movement, and patients are always using the optical center of the correction. Some of our happiest patients are those who opt to correct their astigmatism in this fashion.

What are the lenses you put in the eye during surgery made of?

Lens implant materials have been greatly refined over the last thirty years and currently include synthetic materials such as acrylic and silicone. These lenses are foldable and can be inserted through very tiny surgical incisions, most under 3 mm. The lenses are permanent and should last fifty years or longer.

How successful is cataract surgery for most patients?

Cataract surgery is the most common procedure funded by Medicare, and it is the most successful. Infections and hemorrhage can be an issue, but they are quite rare. If any problem is noted during or after a procedure, prompt treatment will still result in good outcomes in most cases. It is very important however to use all pre- and post-operative eye drop medications to ensure the best results.

Can you do cataract surgery if I have macular degeneration?

Cataract surgery is commonly performed in the setting of macular degeneration. Removing the cataract will help vision but to no better than the condition that the macula allows. There are continued new improvements and medications for wet macular degeneration, and much work is being done to help dry macular degeneration as well. In time, there is hope that both types of macular degeneration can be more successfully treated.

During this unprecedented time with COVID-19, Columbus Ophthalmology Associates is proud to be a leader in our community. As a practice, we take safety and excellence in eye care seriously. We recently sat down with COA President, Dr. Robert Derick, to talk to him about COA’s newest safety measures and what phase 2 of reopening entails.

An Interview with Dr. Derick

Dr. Derick, this recent “Stay at Home” order has affected health care in ways few people understand.  How has the shutdown affected your patients? Specifically, are you seeing issues that are a result of delayed treatment? 

Even though we were open during the 5-week shutdown and saw emergency patients, we definitely have seen patients who have put off treatments that are potentially vision-threatening—specifically delaying glaucoma and retina surgery that has resulted in significant vision loss.

You opened in a slow but deliberate manner to allow your staff, doctors, and patients time to get used to this new way of providing care.  What have you learned from this method that has allowed you to set the bar high for other practices? 

We put our patients’ and staff members’ safety as our top priorities. That allowed us to develop protocols that were consistent with those goals. Our Academy of Ophthalmology and the CDC were good resources, and our staff was instrumental in putting in place the new manner that we are able to safely treat our patients. We intentionally started with a reduced schedule to make sure our protocols were working, adjusted staffing as we slowly increased patient numbers and tweaked our clinic flow. One example of the tweaking was to have a patient stay in one exam room as much as possible. This reduced patients in our waiting area.

 What specific changes have you made to ensure the safety of the staff and patients? 

Patients are asked to wear masks and not have visitors with them unless they need assistance. We screen patients on arrival with both a questionnaire as well as a temperature check. All of our staff also have a daily temperature check. There are shields in place where there is close patient contact. We are meticulous in wiping down surfaces and encouraging both patients and staff to frequently wash their hands and use sanitizer.

How have your first few weeks of surgery gone? Are you now ready to increase the number of procedures and patients you can care for? 

We continue to learn better ways to make our clinic efficient and safe, however, we have found that the time we took to thoughtfully develop the protocols prior to reopening has made our return very uneventful and smooth. Surgery has been uneventful, and we are now back to normal flow.

What changes have been made to your optical department, something that is especially important to your elderly population who love the convenience of having all their eye care needs met in one location? 

Similar to the clinic, every surface is wiped down frequently, and every frame that is touched gets sanitized.

What percentage of patients have continued to postpone surgery just due to the fact they are uneasy being out in public yet? 

I would estimate a small number—perhaps 5%—and we make every effort to reschedule them at their convenience.

What would you tell them to help them be more comfortable coming into the clinic or the surgery center? 

We have received excellent feedback from the patients that have come in about the professional manner in which our staff members conduct themselves. Patients can see the emphasis on safety that we place on our entire clinic. I feel that the patients can help share with their friends and contacts on their comfort level. In short, I would tell patients who are hesitant that we are making every effort to ensure their safety, and so far, the experience at COA has been excellent.

Have you talked to other practices on how they are dealing with this reopening? 

We are fortunate to be a leader in the community and also have great relationships with most practices in town. As a result of these relationships, we have been in contact with other practices throughout the shutdown as well as during the reopening. It is reassuring to know that almost all of the protocols that we have instituted are being used throughout the city.

Your initial effort was to get patients who had surgery canceled back in for their procedures. Now that you have accomplished that, what will phase two be about?  

Most of our optometric colleagues have opened their practices, and as they get busier, our referrals will naturally increase. We are also seeing many patients we had to reschedule during the shutdown in addition to patients that were already on the schedule. Phase 2 will be to slowly reduce the backlog of people that need our help to restore their vision.