White Cadillacs

Cataracts, the bread and butter of ophthalmic surgery, are often referred to by the old folks as "Cadillacs."  That's fine by me, because there are about as many types of cataracts as there are Cadillacs: white, black, brown, front-loaded, back-loaded, with spikes on the sides. . . Unlike Cadillacs, though, cataracts never went out of style.  Everyone gets cataracts at some point, if s/he lives long enough.

Cataracts are opacified lenses.  Like a camera, your eye has a lens that sits in a bag ("capsule") behind the iris.  All your life, it works hard, changing shape to focus near and far objects, allow color and light to come through, and filter UV rays.  When you turn forty, the lens gets a little rusty and starts having difficulty focusing at near (like an old tire, it looses its flexibility).  And then, sometime after that  -- there is a sixty year range -- the lens begins to cloud up and transmit vision poorly.  Color vision is diminished (blues and greens take on a yellow-orange tinge), objects appear fuzzier, and people experience more glare.  Chemically speaking, the proteins in the lens morph into water-insoluble molecules and the lens medium becomes opaque.  Time to take it to the shop and trade it in for a new one!

In cataract surgery, we use tiny instruments, some ultrasound power, and a little pump to remove the old cataract.  Then we replace it with a shiny new lens implant that we place in the same bag that once held the cataract.  Of course, there are different models.  The standard government issued lens implants give you good vision at one specified distance (near or far).  The suped-up ones ("premium lenses") give you good vision at near and far, decrease night glare, or correct for astigmatism.  They do not come with heated seats, but you can get ones with tinted windows (the SN series by Alcon) and others that decrease the blurry vision you may get at night.  Of course, you should read the small print (or if you can't see small print anymore, get a magnifier), and make sure you understand the side-effects associated with the premium lenses (glare, cost, decreased contrast).

Being the most commonly performed surgery in America today, cataract extraction is now perfected to an art-form.  It can be done suturelessly, painlessly, and rapidly.  And we throw in an oil change.