Comprehensive Ophthalmology

Comprehensive Ophthalmology and Cataract Consultation is the primary location for general eye care at the Infirmary. Each patient has an individual primary care ophthalmologist who provides comprehensive eye care including prescription of eye glasses, routine annual eye exams, and management of a variety of medical eye problems including cataracts, glaucoma, diabetic eye diseases and macular degeneration.

There are more than 23,000 patient visits each year to the newly renovated center, which is located on the first floor of the Infirmary. The ophthalmic surgeons of the Cataract Consultation and Comprehensive Ophthalmology Department perform a large number of state-of-the-art cataract surgeries, laser vision correction and other eye surgery as indicated.

General Information on Eyes and Cataracts

The eye is a complex organ. It receives images, converts them into chemical reactions, and transmits them through nerves to the brain, allowing us to see. Light enters the eye through the "cornea," a thin transparent membrane that covers a ring of colored tissue in the front of the eye called the iris.The iris automatically enlarges or contracts the pupil to regulate how much light can pass to the crystalline lens. This lens is a clear, disc-shaped structure that focuses images onto the retina. Finally, the optic nerve transforms these images into nerve impulses and transmits them to the brain.

Cataracts affect the crystalline lens. They cloud the normally clear lens as a result of aging, disease, or injury. The cloudy lens prevents light from proceeding to the retina, resulting in blurred or distorted images. Cataracts are among the most common and treatable eye problems. If untreated, however, a cataract will eventually cause seriously reduced vision.

Questions and Answers

• What is the difference between an ophthalmologist and an optometrist?
  An ophthalmologist is a medical doctor who has graduated from a medical school. He/she has undergone the medical and surgical training for the treatment of eye diseases. This includes 4 years of college, 4 years of medical school, 1 year of internship in a general medical or surgical field, 3-4 years of residency, and possibly up to 2 years or more of fellowship.
  An optometrist is an eye care provider who has attended 4 years of college and 4 years of optometry school. Optometrists primarily prescribe eyeglasses and contact lenses. However, in some states, optometrists are also allowed to diagnose certain eye conditions and prescribe a limited number of medications.
• How often should I have an eye examination?
  This is variable for different people. If you have no known eye diseases and no ocular complaints, then an annual exam is sufficient. If you are experiencing any eye problems, you should be examined by an ophthalmologist. The frequency of examinations will differ depending on the severity of the condition.
• If I wear my glasses, does this weaken my eyes and make me more dependent on them?
  No, this is a myth. Glasses will not "change" the eyes to make them weaker. However, this may not be true for the glasses prescribed for children. These glasses may be prescribed for a strabismus problem and, therefore, should be worn.

Questions and Answers on Cataracts

What is a cataract?

A cataract is a progressive malady of the natural crystalline lens inside the eye.

What kinds of cataracts are there?

There are several types of cataracts:

• The most common form of cataract is associated with normal aging, which can cause a lens to harden and turn cloudy. These are called "senile cataracts." They generally affect people 50 years or older.
• Traumatic cataracts may result from injuries: a sharp blow, an electrical or chemical burn, or a very high dose of radiation.
• Certain medications or eye diseases like diabetes can also cause the lens to cloud and form secondary cataracts.
• In rare cases, children can be born with cataracts either due to heredity or because the mother had a disease such as German measles during pregnancy.
• A person who develops a cataract in one eye will usually develop a cataract in the other eye as well, although the second cataract may not develop for several years.

What are the signs and symptoms of cataracts?

Depending on the size and location of the cloudy areas in the lens, a person may not realize a cataract is developing. Signs include:

• Objects beginning to appear blurry, hazy, or washed out.
• A reduction in night vision.
• A sensitivity to light and glare.
• A need for frequent changes in eyeglass prescription.
• Double vision.
• A visible lightening of the pupil.

How do doctors treat cataracts?

It is not usually necessary to treat cataracts unless they interfere with daily life. The most common forms of cataracts can take up to 15 to 20 years to reach a stage where they seriously impair vision. As a first step, an ophthalmologist (a doctor who specializes in the medical and surgical treatment of the eye) conducts a thorough examination to detect cataracts. Then, the patient and the ophthalmologist decide together whether removal is necessary.

Cataract removal involves surgery to remove the clouded lens. The doctor prescribes medicine along with performing the surgery, but no pill, eye drop, or ointment alone can prevent or cure cataracts. Similarly, lasers cannot remove cataracts, although doctors sometimes perform laser therapy if the membrane that holds the lens becomes cloudy in the weeks following surgery.

What's involved in cataract surgery?

Surgery for cataracts is a brief and relatively simple procedure. It usually takes 45 minutes to an hour to complete. In the past, most cataract surgery patients remained in the hospital following the operation. But with improvements in techniques and equipment, doctors can perform most cataract procedures as ambulatory surgery, and the patient can return home the same day. Today, more than 95 percent of cataract surgeries are successful. It is one of the safest forms of surgery

Just before the operation begins, patients receive eye drops. Most patients also receive a sedative and an an injection of local anesthetic. Sometimes, the ophthalmologist recommends general anesthesia to put the patient to sleep. Although using local anesthetic is far more common, both approaches are acceptable.

During surgery, the surgeon makes a small incision on the surface of the eye. This incision becomes a passageway through which the surgeon removes the lens.

In most patients, the surgeon leaves a portion of the lens capsule (the thin membrane that holds the lens in place) in the eye. This technique is called an "extracapsular procedure." Occasionally, the surgeon removes the lens capsule along with the lens. This technique is an "intracapsular procedure." Both procedures are safe and both improve vision.

What replaces my lens?

Most cataract surgery patients receive an "intraocular lens implant" to replace the natural lens. This plastic implant resembles a small contact lens. The doctor inserts it in the front part of the eye during surgery. The implanted lens is a permanent replacement for the natural lens; except in rare cases, it will never be taken out. Some patients (such as those suffering from certain types of eye disease in addition to cataracts) should not receive an implanted lens. Options for these patients include special cataract glasses or contact lenses.

What can I expect after surgery?

In the days immediately following surgery, get plenty of rest and avoid heavy lifting or other types of strenuous activity. For several days following surgery, you may experience some discomfort in or around the eye. Your doctor will usually remove your bandage within a day or two after the operation, but your eye will take several weeks to heal completely.

To protect the eye and encourage healing, you should follow all instructions for using eye drops and other prescribed medications. If you wear glasses, you may resume wearing them as a protective measure. The prescription may no longer be correct, but this will not harm your eye and your vision should still be acceptable. In fact, all patients should wear some form of eye protection (such as sunglasses) during the days following surgery. Your doctor will also give you an eye protector to wear at night for two to three weeks.

How will cataract surgery improve my vision?

Patients who have received an intraocular lens implant may notice some improvement as soon as the doctor removes the eye bandage. At some point after the operation, usually six to eight weeks, patients will receive a new eyeglass prescription that should also improve vision significantly. As the eye heals and adjusts to the lens implant, more changes in prescription may be needed.

Patients who do not receive a lens implant usually do not experience significant improvements in vision until they begin wearing contact lenses or cataract glasses, about six to twelve weeks following surgery.

Improvement in vision and individual lifestyle determine how quickly patients can resume normal activities. For example, if you have good vision in your untreated eye and do not engage in many activities that require acute vision or excessive straining, you might resume many normal activities within a few days of the operation.

Are there after-effects I should know about?

A common occurrence following extracapsular cataract surgery is a clouding of the thin membrane that holds the lens in place. A doctor can readily treat this problem with laser surgery. During laser treatment, the ophthalmologist makes tiny holes in the clouded membrane to allow light to pass. This painless procedure takes only a few minutes and has a very high rate of success.

For additional information about cataracts:

Contact Information

If you would like to make an appointment with an Infirmary ophthalmologist, please call Comprehensive Ophthalmology at 617-573-3202. The service is open Monday through Friday.

Medical Staff

page updated: 2/01/08