cataract

Matthew Marano, Chief of Opthalmology at Barnabas Health in Livingston examines the eyes of his patient Manuel Cruz, 60, a Newark resident and Roman Catholic Bishop, who had successful cataract surgery last year.

(Robert Sciarrino | NJ Advance Media)

By Susan Bloom

Though the prospect of eye surgery made him apprehensive, Manuel Cruz, Auxiliary Bishop of the Archdiocese of Newark, knew something needed to be done last fall to address his faltering vision.

“I remember being in the car on my way to a meeting and the lights and glare bothered me; when I said mass, the lights in the church began bothering me too,” the 60-year-old Newark resident shared.

“It was a gradual thing and I wasn’t able to pinpoint exactly what was going on,” he admitted, until a physician friend of his delivered the likely prognosis. “He told me, “it sounds like you’re getting cataracts.”

According to the American Academy of Ophthalmology, cataracts are a clouding of the lens of the eye which leads to a decrease in vision. It is a common condition affecting nearly 22 million Americans over 40; by the age of 80, more than half of all Americans will have them.

A function of the aging process, “there’s almost no dodging this bullet -- nearly everyone will develop cataracts if they live long enough,” confirmed surgeon Matthew Marano, M.D., Section Chief of Ophthalmology at Saint Barnabas Medical Center and the Barnabas Health Ambulatory Care Center in Livingston and Director of Marano Eye Care in Livingston and Newark.

Cataracts represent a denaturing of the protein in the eye’s lens over time due to exposure to UV light, conditions such as diabetes and glaucoma, medications like steroids administered to treat autoimmune disorders, hobbies or occupation, or simply a genetic predisposition, he added.

“Beginning in one’s 20s, the lens of the eye starts hardening and becoming less stable,” Marano explained. “Over the next 20 years or more, patients suffering from cataracts may experience a slight decrease in vision, especially at night, a glare or halo around streetlights, the need for more light when reading, or may complain of headaches, a decreased ability to focus or distinguish colors, or a sensation similar in appearance to ‘frosting on a window.’”

According to Marano, the profile of the average cataract patient has changed over time. “Years ago, patients used to have to wait for the cataract to be ‘ripe’ to have it removed, which was typically around 75-85, but over the past decade we’ve been seeing younger and younger patients, the result of a combined increase in visual demands at the hands of technology and a growing awareness of the degradation in the quality of their vision by active professionals, who are less apt to accept it,” he said.

“The volume of cataract surgeries in America has subsequently tripled in the past 15 years, from roughly 1 million performed in 2000 to over 3.5 million performed annually today, with even greater growth expected by 2020.”

“The volume of cataract surgeries will definitely grow based on increasing awareness and other social and demographic factors,” agreed Rosa Braga-Mele, M.D., Professor of Ophthalmology at the University of Toronto and Chair of the Cataract Clinical Committee at the American Society of Cataract and Refractive Surgery in Fairfax, VA.

According to Braga-Mele, “the baby boomer generation is highly motivated and educated, is working longer, and is far less tolerant of visual changes.” As a result, “while 20 years ago the average age of our cataract patients was 80, they’re more often in their mid 60s-70 now” and can be as young as their 50s, she said.

Braga-Mele and Marano agreed that cataract surgery -- the process by which a cloudy lens is replaced with a new synthetic one -- has evolved by leaps and bounds in the past several decades.

Forty years ago, “we used to freeze the lens to remove it, which could be an uncomfortable procedure, until we progressed to phacoemulsification in the 1970s-1980s, through which we’d dissolve the lens using ultrasound and essentially vacuum it up,” Marano said.

“By the 1980s-1990s, better intraocular lenses made of higher-quality materials such as acrylic, along with improved visualization through the use of more advanced microscopes, enabled the procedure to be done successfully right in the doctor’s office.”

According to Marano, the subsequent rise in and evolution of laser vision correction procedures, which reshape the cornea, have been a boon to the field of cataract surgery in that they can address a patient's other vision deficiencies at the same time.

"High-tech intraocular lenses can now correct for astigmatism in cataract patients, while presbyopic lenses, which provide both distance and near perception, can fully eliminate the need for glasses in cataract patients up to 80% of the time," he said.

And the field has continued to advance. “In the past 1-2 years,” Marano said, “the use of cutting-edge femtosecond laser technology for cataract surgery has enabled smaller incisions, greater stability and more precise placement of the intraocular lens, and better and more predictable patient outcomes with less irritation to the eye.”

Done as a two-stage outpatient procedure using a sedative, "the process is painless and quick -- less than 10 minutes." Typically waiting 1-2 weeks between doing both eyes "so that we can hit a prescription perfectly," he said, "patients can see well right in the recovery room as they wake up and we can ultimately eliminate what were once pretty significant prescriptions."



"As soon as I woke up, I could see the clock on the wall and I couldn't wait to get my second eye done the following week," said a grateful Cruz, whose successful cataract surgeries last December eliminated the need for the bifocals he'd relied on for distance and reading for the past decade.

"Now I have very good eyesight – I see, read, watch tv, and drive without a problem and I'm not affected by cataracts anymore. Vision issues can be frightening, but I hope I can help take fear out of the conversation," Cruz said. "The intersection of today's technology with compassion and experience make this procedure such a blessing."



"Cataracts are a very common condition, particularly in an aging population, but there's nothing to be afraid of," Braga-Mele concurred. "Femtosecond laser-assisted cataract surgery allows increased precision and smaller incisions, which translate to faster recovery and better patient outcomes with respect to vision.

It’s healthy to be apprehensive about any surgery,” she said, “but this procedure is very easy and user-friendly for patients.”