Surgeons offer glimpse of cataracts

 Paulette Brooks sees clearly now.

The 64-year-old Edinburg woman underwent surgery four years ago to remove a cataract from her left eye. The effect of the procedure was immediate — in the operating room itself.

"There was a clock, and I was watching the clock and could see as soon as they put in the new lens," she said.

The cataract makes a person’s vision cloudy, almost like looking through sheer fabric.

"My vision was very impaired," Brooks said. "I couldn’t see the food (on) my plate, and I couldn’t see distance, like in the sky, the stars at night.

"So once I had that done, that was all restored."

Brooks also developed a cataract on her right eye and decided to have surgery again after she failed a vision test by the Texas Department of Public Safety.

Brooks is not alone, said Dr. Carlos Manrique, an ophthalmologist who does about 20 cataract surgeries a week in the Rio Grande Valley.

People wait until they can’t see well to take care of their cataracts, which can make the procedure more complicated, he said. The bigger the cataract is, the higher the risk in getting it out.

Cataracts are an age-related ailment, but in the Valley there are particular risk factors — like diabetes — that can trigger it at an earlier age, said Dr. Parul Desai, an ophthalmologist in Edinburg.

Cataracts are the leading cause of blindness in the world, according to Prevent Blindness Texas, a nonprofit organization. There are more cases of cataracts than there are of glaucoma, macular degeneration and diabetic retinopathy combined, the organization said.

"People can’t see as well as before," said Dr. Raul Peña, an ophthalmologist who does 30 surgeries per week.

Today, cataracts affect more than 22 million Americans aged 40 and older. By age 75, some 70 percent of people have cataracts. And as the U.S. population ages, more than 30.1 million Americans are projected to have cataracts by the year 2020, according to Prevent Blindness Texas.

A cataract is a clouding of the eye’s lens that blocks or changes the passage of light into the eye. The lens of the eye is located behind the pupil and the colored iris and is normally transparent. The lens helps to focus images onto the retina, which transmits the images to the brain. Vision may become blurry or dim because the cataract stops light from properly passing through to the retina.

Risk factors for developing cataracts include a family history of cataracts, diabetes, smoking, extended exposure to UV rays, serious eye injury and the use of steroids, Desai said.

The surgery to fix the cataract is non-invasive, and no anesthesia is required. The surgery is ambulatory, meaning the patient isn’t confined to a bed. Most patients see better almost immediately and return to their normal lives the next day. Patients do not need to wear a patch afterward, just sunglasses.

"We numb the eye with drops, then we use the special machine that sends an ultrasonic wave that breaks that cataract into tiny little pieces and then suctions it out," Manrique said.

Then, the doctor inserts a lens implant, which comes in multiple varieties. The most common is the restore lens because cataract surgery has caught up with Lasik, he said.

"With the restore lens, (in) 80 percent of the cases, they do not need glasses for reading or distance. So we have come a long way with cataract surgery nowadays and that is why you are so amazed it is still the leading cause of blindness. How can that be possible?" Manrique said.

The surgery is done in four minutes, although more time is required to prepare the patient for surgery at the hospital.

The surgeons rely on a microscope for the procedure, and because their movements are so tiny and precise, their hands seem to barely move.

Cataract surgery is covered by Medicare and most insurance policies. The only implant that generally isn’t covered is the farsightedness-correction intraocular lens (IOL), which can be implanted in the eye. With that, patients up to 100 years old do not even need glasses, Desai said.

Those with insurance have to come up with $4,000 to $5,000 to have correcting IOLs implanted in both eyes, or half of that to have one corrected.

Some doctors have finance plans with no interest with $200 monthly payments or lower payments of $120 with little interest.

Insurance also does not cover the test to determine which lens is suitable, she said.

"But you can imagine that for the rest of your life, you will not need glasses to read and to see distance, which is (the) biggest advantage," Desai said.

Cataract surgery is not covered by vision plans, Peña said.

"It is your medical insurance … that covers the procedure, because the eye is part of your body," Peña said.

Some insurance will require a referral, others just let you pick up the phone and get an appointment with an ophthalmologist as soon as you detect a problem in your eyes, Peña said.

After the cataract surgery, some patients may need glasses for things like reading and needlework but are able to do 99 percent of their work without them, Manrique said.

"What we are trying to do is keep everybody functioning, and keep everybody able to do what they love to do, whether it is to go play golf, go play bingo," Manrique said.

By the end of the year, Doctors Hospital at Renaissance will replace its ultrasound machine, with a LenSx Laser. Doctors Hospital, which is the busiest cataract surgery center in South Texas and the third-busiest in the state, will get one of the first 30 LenSx Lasers in the United States, Manrique said.

"That technology has been approved (by the) FDA," Manrique said. "It makes the surgery even safer, more precise, and the reason is because now we are talking about blade-free surgery — just with the laser machine, that breaks the cataract and creates the tunnel where we introduce the implant prop."

Doctors recommend getting your eyes checked every year after age 60. They say not to wait until you fail the DPS vision test. Optometrists can detect cataracts, but only an ophthalmologist can treat them.

Texas House Bill 84, known as Katie’s Law, requires drivers 85 years of age and older to pass a vision test to renew their licenses. Licenses then are valid for two years instead of six. The law was enacted after 16-year-old Katie Bolka was struck by an elderly neighbor. Under the law, drivers ages 79 and older are not allowed to renew their driver licenses electronically.

Manrique said the majority of patients wait until they fail the vision test to have the cataract removed.

"When we are monitoring (the patients) once a year … we are able to find out earlier if their vision is going down," Manrique said.

The youngest person Manrique has treated for cataracts was a 6-year-old boy who developed the ailment after chemotherapy. The oldest was 102.

Brooks’ surgery was a success. And even though she had been anxious, she said the results were worth it.

"It’s good to get your sight back," Brooks said.

And in just one morning.