Gimbel Eye Centre | Cataracts and Other Conditions

Sight is our most precious sense, enabling us to enjoy the beauty of the world, to see the faces of the people we love, to drive a car, to read — indeed to enjoy the world in which we live. For centuries, developing cataracts doomed a person to blindness. Today, modern microsurgical techniques allow people to enjoy good, clear vision after their cataracts have been removed. Giving up favourite activities and suffering through years of poor vision due to cataracts is no longer an inevitable part of the aging process.

The Gimbel Eye Centre specializes in restoring sight to people whose vision has been impaired by cataracts. Since 1964, over 75,000 cataract surgeries have been performed by our surgeons, using the most advanced surgical techniques and equipment. The techniques developed at the Gimbel Eye Centre have set international standards of excellence and have attracted patients from across Canada, the United States and from 50 countries around the world. This technical excellence is combined with warm, personal care, making the cataract surgery experience at the Gimbel Eye Centre truly unique.

A cataract is a cloudiness that develops in the normally clear lens of the eye. For the sake of easy reference, a natural lens is referred to as a cataract when it has turned cloudy. A cataract is not a growth, a white film or a kind of cancer.

The lens is a transparent fine focusing element suspended behind the pupil (the opening in the centre of the coloured portion of the eye controlling the amount of light entering the eye). The lens is about the size of an ordinary pill and consists of a strong, transparent out capsule filled with a transparent flexible gel. As the lens varies its thickness, it enables the eye to focus on near and distant objects.
When light enters the eye, it passes through the cornea (the eye's clear front window) and then through the pupil and the lens, which fine focuses the light rays onto the retina at the back of the eye. The retina changes the light images into electrical impulses and sends them to the brain via the optic nerve. When the lens has become clouded from the development of a cataract, light rays become distorted and are not focused clearly on the retina, which reduces vision and can eventually result in blindness.

Almost everyone who lives a long life will develop cataracts. The cloudiness does not spread from one eye to the other; though, cataracts tend to develop in both eyes at some time. Some cataracts mature over a period of years, whereas others can form rapidly within a few months.

Typically, cataracts develop as part of the normal aging processes that takes place in the natural lens. Throughout a person's life, new optical fibres are slowly and continuously produced on the inside of the lens capsule, which causes the gel to become increasingly compressed and hardened over time. This natural hardening of the lens diminishes its ability to alter its shape for focusing on near objects, making corrective lenses necessary in mid-life. At a certain point in each eye, an associated cloudiness begins to develop as well. This hardening and clouding process continues until the lens is completely opaque and light can no longer pass through the lens and focus on the retina. A cataract, which forms in this way as part of the natural aging process, is known as an age-related cataract. Heredity seems to play a part in determining when a person will develop cataracts, just as it determines other factors such as the time hair begins to turn grey.

Sometimes, a serious injury to the eye can cause a traumatic cataract to develop. When the eye is pierced or receives a strong blow, the lens is disturbed and initiate the clouding reaction to occur. Besides injuries, there are other disruptive factors that can contribute to earlier than normal cataract development — such as exposure to ultraviolet (UV) rays, harmful chemicals or radiation; use of some medications; disease or infection prior to birth.

Some babies are born with congenital cataracts. In these cases, prenatal factors interrupted the normal development of a clear lens. Fortunately, modern microsurgery can usually give these infants the same clear vision that is enjoyed by adults after cataract surgery.

Cataracts vary in their development and symptoms from person to person. Some common cataract symptoms are as follows:

A gradual loss of colour vision, objects may appear yellowed or less intense
in colour;
Increasing haziness causing blurred or distorted vision;
The appearance of dark spots or shadows that seem to move when the
eye moves;
An increasing need for more light to see clearly;
Glare at night — haloes or coloured rings around lights;
A tendency to become more nearsighted because of the increasing density of the natural lens;
A stage where it is easier to see without glasses than with them — second sight;
Double vision, which persists even if only one eye is open;
In advanced stages, a change in the appearance of the pupil may occur — it may appear white or yellow.

Most people with developing cataracts experience only some of these symptoms because they are related to the different ways cataracts form. Noticing these symptoms does not necessarily indicate the presence of a cataract, as some of these changes can also be symptoms of other problems. A person experiencing these visual problems should have a thorough eye exam so the underlying condition can be diagnosed. People who think they may have a cataract are welcome to contact Gimbel Eye Centre to discuss their symptoms and/or to arrange an appointment; however, we prefer these individuals contact their primary eye care provider who will:

Perform a comprehensive eye examination to detect the presence of a cataract or any other condition, which may affect vision and influence the outcome of cataract surgery — and if necessary,
Provide a referral.

There is no known way to prevent cataracts from developing or make the cloudy lens clear after a cataract has developed. However, recent studies have shown that the development of cataracts may be delayed by following certain lifestyle practices — such as giving up smoking, protecting the eyes from UV rays, lowering blood sugar levels, eating fruits and vegetables frequently and wearing protective eye wear when engaged in activities that may cause injury to the eyes.

Fortunately, modern microsurgery offers a very real solution to the cataract problem. If there are no other serious problems with the eye, cataract surgery performed by a skilled surgeon can provide excellent vision in more than 99% of cases. NOTE: Degenerative problems with the retina or optic nerve may limit the potential for clear vision in some cases, even when the cataract surgery has been successful.

In the past, people with cataracts were told to wait until their cataracts had "ripened" or "matured," meaning that they had to live through many months or even years of gradually deteriorating vision. This frustrating wait is no longer necessary — people may have their cataracts removed as soon as they start to interfere with
their lifestyles.

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As a result of modern medical developments and surgical techniques, some of which were pioneered at Gimbel Eye Centre, cataract surgery is now a highly successful operation with very few associated complications and very little or no discomfort. In fact, over 75,000 cataract surgeries have been performed at Gimbel Eye Centre with excellent results.

The first part of a modern cataract procedure involves removing the cloudy portion of the natural lens. The surgeon begins by making a very small incision, less than 1/8" wide, at the edge of the cornea. The location of the incision depends largely upon whether or not the person has astigmatism (when the curvature of the cornea is greater in one plane than another — causing light rays entering the eye to bend unequally, preventing the formation of a sharp point focus on the retina), since incision location may be able to correct or reduce astigmatism. A special kind of incision, known as the no-stitch incision, is used because it can seal itself after cataract surgery without stitches, which allows the eye to heal more naturally and with greater symmetry.

In the past, cataract surgery often caused or intensified astigmatism, but the use of a no-stitch incision makes this much less common. In fact, the no-stitch incision often reduces pre-existing astigmatism, leading to excellent vision after surgery. For more than just a small amount of astigmatism, additional corneal incisions, laser refractive surgery or prescription corrective lenses (spectacles or contact lenses) may be utilized to reduce or eliminate the focusing problem. If you have more than a small amount of astigmatism, Gimbel Eye Centre welcomes you to discuss your options with your primary eye care provider or with one of our Patient Counsellors at your convenience.

Once the incision has been made, the surgeon inserts a small instrument into the front part of the eye and makes a smooth round opening in the front of the lens capsule called a continuous curvilinear capsulorhexis — a technique developed by Dr. Howard Gimbel in 1984. This neat opening keeps the capsule strong and intact so the artificial lens implant will be able to rest securely within it after the cataract has been removed. Next, the surgeon inserts an ultrasonic probe through the opening in the lens capsule. The ultrasonic probe vibrates ~40,000 times per second with high frequency sound waves. These controlled vibrations gently break up the cataract into tiny pieces, which are then suctioned out of the eye. This part of the procedure is known as phacoemulsification and it has the advantage of causing much less trauma to the eye than other methods of cataract removal. NOTE: Instruments are also available to utilize laser energy to break up the cataract; however, lasers are not as efficient as ultrasound for cataract removal.

Once the cataract has been removed, the surgeon moves on to the next portion of the surgery — replacing the focusing power of the natural lens. Before a cataract developed in the eye, the lens provided the eye's fine-focusing ability. After the lens has been removed, the eye is unable to focus unless that ability is replaced. Today, ophthalmologists use the intraocular lens (IOL — also known as a lens implant) device as the most typical method of restoring optical power after natural lens removal. The recent development and refinement of IOLs has provided the solution to this focusing problem. Lens implants are tiny lenses designed to fit inside the eye where they do not need any care. For many years, polymethylmethacrylate, a pure form of Plexiglas, was the standard material for IOLs. Now, most IOLs used are made of acrylic, copolymer or silicone, which are materials that allow the lens to be folded in order to fit through the tiny no-stitch incision.

The best location to place the IOL is inside the lens capsule. The surgeon uses a supporting ring if the patient's capsule support is weak. If capsule support is practically non-existent, the IOL can be placed in front of the iris (the coloured portion of the eye) or if required, it can be supported by sutures behind the iris. After the cataract has been removed, the surgeon inserts the IOL into the eye and carefully positions it. Most IOLs have tiny spring-like arms, known as haptics, which hold them securely in place. Usually, when an IOL is implanted during cataract surgery, clear vision can be achieved almost immediately. The surgeon chooses the power (strength) of the IOL to provide the best possible focusing power for each eye. In fact, pre-existing focusing problems, such as nearsightedness or farsightedness, can be compensated for by the IOL — meaning that people have greater freedom from corrective lenses (spectacles or contact lenses) after surgery.

As with any surgery, there are risks involved in the cataract procedure; though, serious problems resulting in permanently decreased vision are very rare. There is a very slight chance of infection or other complications, but most problems that occur can be solved so vision is not permanently lost. Generally, while under the care of a skilled surgeon, there is very little reason for concern.

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