Weathering eye surgery

Open any newspaper or magazine and you can find information regarding LASIK surgery to improve vision. The operation has become so common in recent years that doctors now advertise their low prices.
Cataract surgery, on the other hand, affects far more people but attracts practically no attention. According to Dr. Gerald Sevachko, 3 million Americans have cataract surgery every year.
"It's the most frequently reimbursed procedure by Medicare, way above hip surgery or coronary bypass surgery," he said.
Cataract surgery is done to correct clouding of the lens of the eye, a condition that becomes more prevalent with age. The lens becomes opaque and is surgically replaced with an artificial lens.
There has been an increase in the number of cataract surgeries over the years because of lifestyle changes, said Dr. Sevachko.
People are living longer and remaining active longer than they did a generation ago. Therefore they need clearer vision longer. Also, more young people are opting to have the surgery because of advances in the procedure.
"Years ago, only when the patient was almost blind in both eyes was the procedure done. Then there was a long rehabilitation period," said Dr. Sevachko. "And the optical correction afterward was with real thick glasses or contact lenses. It left a lot to be desired."
Cataract surgery is now a fairly simple procedure. Local anesthetic is used, and the patient can return to normal activities quickly.
One patient's story
Cathy Coppola, 53, of Struthers was surprised when a doctor told her four years ago that she had cataracts. She said she wasn't having any problems at the time, but her eyesight worsened quickly. She elected to have the surgery about six months later.
"[The doctor] told me they used to have to wait until the cataracts matured, but you don't have to wait for that anymore," she said.
Dr. Sevachko said that years ago a cataract had to be in a particular stage of development before it could be safely removed, but that is no longer the case. He said patients now decide when they need the surgery.
Most of the time, cataracts cannot harm the eye, no matter how long you wait.
"The time to have it done, I think it's important to emphasize, is not when somebody tells you, but when your lifestyle is affected. When the quality of your vision reaches the point when you can no longer comfortably do the things you have to do and want to do, that's the time to consider having surgery done," he said.
Coppola began having trouble seeing at work, describing her vision as "very blurred and like looking at the brownish-amber haze of an antique picture."
She had one cataract removed by Dr. Sevachko in February 1999 and the other removed about 18 months later.
Dr. Sevachko said cataract surgery isn't done on both eyes at the same time to prevent the risk of both eyes' getting infected at the same time.
How it went
Coppola said the procedure took about a half-hour and was painless. The doctor gave her an injection near the eye to numb the area and minimal sedation to relax her.
"I felt nothing, I saw nothing. When he did the second eye, I felt a slight pinching. I told him I felt something, and he gave me a little more medication and then I felt nothing," she said.
During the procedure, a small incision is made in the eye, the cataract is removed, and the implant, a small plastic lens about 6 mm across, is put in position. In the past, Dr. Sevachko said, before the implant was available, very thick "Coke bottle" glasses were used to correct vision after the cataract was removed.
"A lot has been done with the technique, but the implants have made the biggest difference," he said.
After the surgery, Coppola had to wear a protective patch to avoid bumping the eye. She noticed a difference in her vision when the doctor removed the patch the next day.
"When he took the bandage off, I could see. What I noticed right away was everything was bright. I wasn't seeing 'antique' anymore. It was still a little blurry for a couple days, and then things got clearer," she said.
Coppola said she "basically got back to normal the next day." She had to wear the patch for about a week.
"I was able to go back to work in the next day or two," she reported. "I had no problems. I felt fine. Once in a while I felt a little tenderness, like a muscular twitch, but no pain. And that went away."
What happened next
About four months after the surgery, Coppola noticed milky-looking spots and a haze on her eye. The doctor said she had developed what is commonly referred to as a secondary cataract.
During cataract surgery, a portion of the lens capsule is left in place to support the lens implant, explained Dr. Sevachko. This capsule can get clouded and cause blurring similar to that caused by a cataract. This is remedied by using a laser to open this membrane.
"When the quality of your vision, again, gets to the point that it interferes with your daily activities, then we open that membrane up with a laser," Dr. Sevachko said. He said lasers are used only for the secondary cataract procedure.
Secondary cataracts occur in 20 percent to 50 percent of patients, said Dr. Sevachko.
"That also is way up there on the Medicare reimbursement list. It's done fairly frequently," he said.
Coppola underwent the laser procedure and hasn't had any problems since. Despite initial nervousness, she said she's glad she had the surgeries.
"I would tell anyone who's having it done not to worry at all. It's really nothing," she said.
Dr. Sevachko said that recent claims about ways to prevent cataracts, such as taking lutein supplements or eating antioxidant-rich foods, have yet to be proved.
"What accelerates [cataract formation] in some individuals as compared to others is difficult to say. A lot has been made about being deficient in certain dietary things, minerals and vitamins, but nothing has really been proven," he said.
Dr. Sevachko said cataracts are part of the natural aging process of the eye, and in most cases there's nothing that can be done to prevent it. Some people believe a cataract is a film that can be scraped off the eye, he said, but it is actually part of the lens.
"Most of the cataract surgery today is done on people whose cataracts are a result of the lens of the eye becoming opaque -- that's what a cataract is -- and that's generally due to aging," said Dr. Sevachko.

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