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When Should You Consider Cataract Surgery?
Nicholas Donas, MD shares important information about Cataracts and questions to ask if you are considering cataract surgery.
Featured Speaker:
Dr. Donas puts his patients at ease, so they feel comfortable talking to him. “I make a point to speak in terms everyone can understand, and I am always honest with my patients. It is important to me that I am available and that I give each the time they need to have their questions answered.”
Nicholas Donas, MD
Nicholas Donas, MD, is board-certified by the American Board of Ophthalmology. Dr. Donas knew he wanted to be a doctor early in life. He attended NYU and Mount Sinai Medical School. His father struggled with Glaucoma and blindness in one eye, which was his inspiration in choosing his specialty. Dr. Donas has been in private practice in Dobbs Ferry since 2003 and has performed over 3500 cataract surgeries. He is affiliated with St. John’s Riverside Hospital as well as Mt. Sinai Hospital and New York Ear and Eye Hospital.Dr. Donas puts his patients at ease, so they feel comfortable talking to him. “I make a point to speak in terms everyone can understand, and I am always honest with my patients. It is important to me that I am available and that I give each the time they need to have their questions answered.”
Transcription:
When Should You Consider Cataract Surgery?
Melanie Cole, MS: Cataracts are the most common cause of vision loss in people over 40 and is the principle cause of blindness in the world. That’s quite a statement to make. Here to tell us what cataracts are is my guest, Dr. Nicholas Donas. He’s a board-certified ophthalmologist at St. Johns Riverside Hospital. Welcome to the show. Doctor explain a little bit about cataracts. People hear that word. They're not sure what they really are and how they affect your vision.
Nicholas Donas, MD: Sure Melanie. So, cataracts are the lens in the eye. We all have a lens in the eye that helps us focus on things. It’s that lens that as we get older will get cloudy or we say gets dense. It causes changes in the way we see things. Sometimes those aren’t always perceivable to us, but over the years, especially on the eye exam, we can pick up changes in the vision. That’s when we tell the patient that they're developing a cataract. At that point, we either address it or tell them we will continue to observe it.
Melanie: So, what will people notice, first of all, and what age will they start to—I mentioned in the intro that it was over 40, but what age typically do you see people coming to you with cataracts, and what is it that they come to you and complain about?
Dr. Donas: So, most people, I would say in my experience and in general, I think the average age when you start to develop a cataract is probably sometimes in your mid-50s. It usually doesn’t become a problem where it needs to be addressed with surgery until about your early 70s. That’s just an average. There’s plenty of people and I've had plenty of patients who are in their 50s who have cataracts that are significant. I have patients who are in their mid-90s who haven’t needed cataract surgery. In other words, their vision is still very good. So, the age varies, but the average I would say of forming a significant cataract is sometimes in your early 70s.
Melanie: Then what? People come to you, they have complaints about their vision.
Dr. Donas: Yeah so one very common complaint is… You know one of the earliest complaints that people will have is they’ll say they have some glare driving at night. So, glare driving at night seems to be one of the most common complaints people will have. Sometimes it will just be very subtle. I’ll ask well how much does that glare bother you? They’ll say it’s just something I notice, but it doesn’t seem to bother me too much. In that case, we’ll just continue following the patient usually on an annual basis. There’s some patients where the cataracts develops a little bit quicker. They’ll say they’ve noticed a significant change in their vision over the past year. Obviously, that’s something that if it happens quickly, it’s easier for the patient to perceive the difference. People will often complain that their prescription isn’t working, their glasses aren’t working, they just can't see the way they want to see. Reading is difficult, especially under low light. Those are some of the common complaints people will have.
Melanie: Is there a genetic component to cataracts? If you know both your parents had them and they had cataract surgery, are you more likely to need that as well?
Dr. Donas: I find that if your parents had cataract surgery or had a significant cataract when they were young, meaning in their 40s or 50s, that seems to be something that will be inherited. If you're 50 years old and you have a significant cataract, it’s likely that you have a family member that also had cataract surgery when they were quite young.
Melanie: So that would seem to be pretty common then and run in families. Tell us what treatments are available if you determine… Well first of all, how do you even diagnose cataracts? And then if you do determine someone has them, how do you discuss treatment and when does cataract surgery become the discussion?
Dr. Donas: So, at every eye exam we look at the lens, we look at the clarity of the lens. Sometimes the color of the lens can change. The lens initially starts out clear. As we get older, it develops a kind of a yellow appearance to it. Sometimes it gets cloudy. Those cloudy cataracts tend to interfere with the vision more than just a yellowing of the lens. When we see that on the exam, we’ll mention it to the patient. If it kind of goes along with the complaints that they're having, and their vision has diminished, we discuss the options of what they would do with that to take care of the cataract. Really the only option for significant cataract, a cataract that is interfering with the patient’s vision and interfering with their daily activity is to remove the cataract. So, the cataract has to be physically removed. It’s the lens of the eye, like I mentioned previously. It needs to be removed and then replaced with a new interocular lens.
Melanie: What’s going on in the world of cataract surgery Dr. Donas? Is it advancing pretty rapidly? People used to be a little bit afraid of it, someone going near their eye. What’s going on and exciting in the world of cataract surgery?
Dr. Donas: Well, cataract surgery has evolved quite a bit over the past 20 or 30 years. It’s certainly not your parents or your grandparent’s surgery. It’s changed quite a bit. I have patients who might remember a grandparent or a parent having to be admitted to the hospital. There was a time where they had to stay for several days under observation. They would also immobilize their heads. So, it was quite a different experience than it is now. Cataract surgery over the past several years has evolved quite a bit. It has become a lot less invasive. It has trended towards smaller incisions, a quicker surgery time. That has led to just a quicker recovery for patients overall and better outcomes, of course.
Patients these days also have many more options when it comes to choosing the interocular lens that we use to replace the cataract with. That, of course, is something that we discuss with the patients at length and we have a long discuss to try and figure out what the best fit would be for the patient. So, patients have an option of how they want their vision to be after the surgery. Many patients often achieve independence from glasses after having cataract surgery. That can be achieved with lens that can give you both distance vision and near vision, which are called multi-focal lenses. There’s patients with astigmatism who have the option of choosing an astigmatism correcting lens. So overall there’s just a lot more options for patients. It’s a much quicker and safer procedure than it used to be. It’s very well tolerated. Invariably I have patients come to me after the surgery and tell me how quick of a procedure it was, and it wasn’t at all what they had expected it to be.
Melanie: So, as you wrap it up, Dr. Donas, tell us. Can cataracts come back, even after surgery? Is there a way to prevent them? Give your best advice. What you would like the listeners to know about cataract surgery and cataracts in general. And as an ophthalmologist, what you want them to know about today’s cataract treatment?
Dr. Donas: Yeah. So, in general, also touching on preventing cataracts, I think it’s always a good practice for patients to wear sunglasses to protect their eyes from UV damage, just the way you’d protect your skin. The most likely cause of a cataract is probably exposure to sunlight. So, we do tell patients to protect their eyes with sunglasses. Also, after the cataract is removed, there is something called a secondary cataract that can occur. That’s something that’s typically taken care of in the office with a quick laser procedure that’s minimally invasive and very well tolerated by most patients. It’s something that often times can occur after cataract surgery but doesn’t really affect the result of the surgery itself.
Melanie: So interesting. What a fascinating topic. Thank you so much for being with us today and sharing your expertise and explaining how cataracts have changed, the treatment has changed over the years. It’s so interesting. Thank you again for joining us. You're listening to Riverside Radio Healthcast. For more information, please visit riversidehealth.org. That’s riversidehealth.org. This is Melanie Cole. Thanks so much for listening.
When Should You Consider Cataract Surgery?
Melanie Cole, MS: Cataracts are the most common cause of vision loss in people over 40 and is the principle cause of blindness in the world. That’s quite a statement to make. Here to tell us what cataracts are is my guest, Dr. Nicholas Donas. He’s a board-certified ophthalmologist at St. Johns Riverside Hospital. Welcome to the show. Doctor explain a little bit about cataracts. People hear that word. They're not sure what they really are and how they affect your vision.
Nicholas Donas, MD: Sure Melanie. So, cataracts are the lens in the eye. We all have a lens in the eye that helps us focus on things. It’s that lens that as we get older will get cloudy or we say gets dense. It causes changes in the way we see things. Sometimes those aren’t always perceivable to us, but over the years, especially on the eye exam, we can pick up changes in the vision. That’s when we tell the patient that they're developing a cataract. At that point, we either address it or tell them we will continue to observe it.
Melanie: So, what will people notice, first of all, and what age will they start to—I mentioned in the intro that it was over 40, but what age typically do you see people coming to you with cataracts, and what is it that they come to you and complain about?
Dr. Donas: So, most people, I would say in my experience and in general, I think the average age when you start to develop a cataract is probably sometimes in your mid-50s. It usually doesn’t become a problem where it needs to be addressed with surgery until about your early 70s. That’s just an average. There’s plenty of people and I've had plenty of patients who are in their 50s who have cataracts that are significant. I have patients who are in their mid-90s who haven’t needed cataract surgery. In other words, their vision is still very good. So, the age varies, but the average I would say of forming a significant cataract is sometimes in your early 70s.
Melanie: Then what? People come to you, they have complaints about their vision.
Dr. Donas: Yeah so one very common complaint is… You know one of the earliest complaints that people will have is they’ll say they have some glare driving at night. So, glare driving at night seems to be one of the most common complaints people will have. Sometimes it will just be very subtle. I’ll ask well how much does that glare bother you? They’ll say it’s just something I notice, but it doesn’t seem to bother me too much. In that case, we’ll just continue following the patient usually on an annual basis. There’s some patients where the cataracts develops a little bit quicker. They’ll say they’ve noticed a significant change in their vision over the past year. Obviously, that’s something that if it happens quickly, it’s easier for the patient to perceive the difference. People will often complain that their prescription isn’t working, their glasses aren’t working, they just can't see the way they want to see. Reading is difficult, especially under low light. Those are some of the common complaints people will have.
Melanie: Is there a genetic component to cataracts? If you know both your parents had them and they had cataract surgery, are you more likely to need that as well?
Dr. Donas: I find that if your parents had cataract surgery or had a significant cataract when they were young, meaning in their 40s or 50s, that seems to be something that will be inherited. If you're 50 years old and you have a significant cataract, it’s likely that you have a family member that also had cataract surgery when they were quite young.
Melanie: So that would seem to be pretty common then and run in families. Tell us what treatments are available if you determine… Well first of all, how do you even diagnose cataracts? And then if you do determine someone has them, how do you discuss treatment and when does cataract surgery become the discussion?
Dr. Donas: So, at every eye exam we look at the lens, we look at the clarity of the lens. Sometimes the color of the lens can change. The lens initially starts out clear. As we get older, it develops a kind of a yellow appearance to it. Sometimes it gets cloudy. Those cloudy cataracts tend to interfere with the vision more than just a yellowing of the lens. When we see that on the exam, we’ll mention it to the patient. If it kind of goes along with the complaints that they're having, and their vision has diminished, we discuss the options of what they would do with that to take care of the cataract. Really the only option for significant cataract, a cataract that is interfering with the patient’s vision and interfering with their daily activity is to remove the cataract. So, the cataract has to be physically removed. It’s the lens of the eye, like I mentioned previously. It needs to be removed and then replaced with a new interocular lens.
Melanie: What’s going on in the world of cataract surgery Dr. Donas? Is it advancing pretty rapidly? People used to be a little bit afraid of it, someone going near their eye. What’s going on and exciting in the world of cataract surgery?
Dr. Donas: Well, cataract surgery has evolved quite a bit over the past 20 or 30 years. It’s certainly not your parents or your grandparent’s surgery. It’s changed quite a bit. I have patients who might remember a grandparent or a parent having to be admitted to the hospital. There was a time where they had to stay for several days under observation. They would also immobilize their heads. So, it was quite a different experience than it is now. Cataract surgery over the past several years has evolved quite a bit. It has become a lot less invasive. It has trended towards smaller incisions, a quicker surgery time. That has led to just a quicker recovery for patients overall and better outcomes, of course.
Patients these days also have many more options when it comes to choosing the interocular lens that we use to replace the cataract with. That, of course, is something that we discuss with the patients at length and we have a long discuss to try and figure out what the best fit would be for the patient. So, patients have an option of how they want their vision to be after the surgery. Many patients often achieve independence from glasses after having cataract surgery. That can be achieved with lens that can give you both distance vision and near vision, which are called multi-focal lenses. There’s patients with astigmatism who have the option of choosing an astigmatism correcting lens. So overall there’s just a lot more options for patients. It’s a much quicker and safer procedure than it used to be. It’s very well tolerated. Invariably I have patients come to me after the surgery and tell me how quick of a procedure it was, and it wasn’t at all what they had expected it to be.
Melanie: So, as you wrap it up, Dr. Donas, tell us. Can cataracts come back, even after surgery? Is there a way to prevent them? Give your best advice. What you would like the listeners to know about cataract surgery and cataracts in general. And as an ophthalmologist, what you want them to know about today’s cataract treatment?
Dr. Donas: Yeah. So, in general, also touching on preventing cataracts, I think it’s always a good practice for patients to wear sunglasses to protect their eyes from UV damage, just the way you’d protect your skin. The most likely cause of a cataract is probably exposure to sunlight. So, we do tell patients to protect their eyes with sunglasses. Also, after the cataract is removed, there is something called a secondary cataract that can occur. That’s something that’s typically taken care of in the office with a quick laser procedure that’s minimally invasive and very well tolerated by most patients. It’s something that often times can occur after cataract surgery but doesn’t really affect the result of the surgery itself.
Melanie: So interesting. What a fascinating topic. Thank you so much for being with us today and sharing your expertise and explaining how cataracts have changed, the treatment has changed over the years. It’s so interesting. Thank you again for joining us. You're listening to Riverside Radio Healthcast. For more information, please visit riversidehealth.org. That’s riversidehealth.org. This is Melanie Cole. Thanks so much for listening.