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So you note symptoms of decreased vision and glare. Your ophthalmologist determines cataract surgery is required to improve your visual function. What additional information do you require to make an informed decision about your cataract surgery?

As our Hamilton eye doctors can attest, cataract surgery has improved drastically over the past 3 decades. Two advancements have been the vanguard of this revolution:  small incision surgery and the refinement of the intraocular lens (IOL).

Cataracts can now be removed using incisions less than one-tenth of an inch across. Surgical microscopes, a vibrating needle to break up the lens (phacoemulsification), and foldable intraocular lenses make this miracle a daily reality. These instruments in an experienced surgeon’s hands provide rapid, painless vision recovery.

The type of intraocular lens implanted at the time of your cataract surgery will determine how often you will require glasses to perform your daily tasks. The greater your understanding of these choices, the more productive your preoperative discussion with our Princeton-area ophthalmologists will be. The choice of lens implant will determine how frequently and under what circumstances you will require glasses following your surgery.

The lens in the eye sits behind the iris (i.e., the colored part) and along with the cornea, it is responsible for focusing the light on the retina.

Current IOLs are miracles of modern science; however, even the most advanced lens does not match the phenomenal capabilities of the natural crystalline lens that you were born with. Your native lens, in its youth, could effortlessly change power to bring whatever you chose to view into focus instantly.

As the lens becomes more rigid and inflexible with time, it can no longer change its focus easily, leading to the need for reading glasses or bifocals some time in the mid-forties. As the lens ages, it becomes cloudy — and when it begins to obscure the vision, then it is considered a cataract.

When this lens is removed during cataract surgery, a new lens must be implanted — much like if you removed a lens on a camera, you would have to put a new one on before you could expect to take a photo.

When deciding which lens is ideal for you, consider the following:

  1. How important is it for you to minimize your need to wear glasses?
  2. Is it more important to you to perform near tasks, like reading or distance tasks, such as driving and watching TV.

Current lens choices:

  1. Monofocal Lens: This is the most versatile and most widely implanted lens by far. It has a single refractive power. Measurements of your eye are taken to determine the power of the implant needed to give you the desired refractive result. A popular choice with the monofocal lens is monovision. With monovision, a monofocal lens is used to allow one eye to see distance and one eye to see near. This allows for most tasks to be done without spectacles. If better vision is required (for driving at night, for example) glasses can be used for those more demanding situations.
  2. Toric Lens: The toric lens addresses astigmatism. The astigmatic error due to the cornea is not alleviated with cataract surgery. A toric lens has different refractive power, along different portions of the lens. This lens has to be lined up with the axis of the patient’s corneal astigmatism. Correcting the astigmatism with the toric lens allows patients with corneal astigmatism to be more spectacle independent. This lens can also be used for monovision.
  3. Multifocal Lens: These implants use the optical principle of diffraction to divide the incoming light, providing both a distance and near focal point. Using this lens, both eyes can be set up in a similar fashion, and both eyes can function at both distance and near. Since the light is divided into two focal points, there is some degradation of the quality of the image, and this can decreased contrast sensitivity, a more sensitive measure of vision. These lenses also produce significantly more glare at night — so if night driving is an important task, these lenses are not ideal. The optical aberrations produced by these lenses cannot be corrected by simply wearing glasses. Recently, extended range of focus lenses have been introduced as variants of multifocal lenses that attempt to minimize the downsides of a multifocal lens.

Only you can determine when or if you would like to be spectacle independent after cataract surgery. The evaluation and discussion with your ophthalmologist will determine what is ideal for you.

Cataract surgery is indeed a modern miracle.  Choosing the correct implant for you will ensure you get the most out of your surgery.


Cataracts develop gradually, and it can be difficult to know when cataract surgery is needed. Our eye doctors in Hamilton, Princeton, and other central New Jersey communities see men and women daily who wonder if it’s time to undergo surgery to improve their blurred vision.

Cataracts are the most common cause of vision loss in people over age 40, and the condition currently affects more than 22 million Americans. And as our population grows older, more than 30 million Americans are expected to have cataracts by the year 2020. So, how do you know if you’re at risk? What are cataracts actually like? And how do you decide that it’s time for surgery?

Risk Factors

Anyone can develop cataracts, but there are certain risk factors that make it more likely for someone to develop a cataract:

  • Family history of cataracts
  • Diabetes
  • Smoking
  • Extensive exposure to sunlight
  • Suffering a serious eye injury
  • Prolonged use of steroids, especially combined use of oral and inhaled steroids

Wearing sunglasses that block the sun’s UVA and UVB rays can reduce your risk of developing cataracts, as can avoiding smoking (or quitting if you are a smoker). In an earlier blog post, we wrote about recent studies showing that women who undergo hormone replacement therapy have increased chances of needing cataract surgery in the future, as well. As we noted, the research suggests a cautious approach to hormone replacement therapy.

Cataract Symptoms

In its initial stages, a cataract is very small, and you may not even notice any change to your vision. As it develops over time, though, vision begins to blur. As the cataract grows, it becomes increasingly difficult to see. Someone with a cataract may notice light from a lamp or the sun seems glaring, or that oncoming headlights at night cause more glare than before the cataract developed. Different types of cataracts also have slightly different symptoms that may become noticeable at different times.

Timing of Cataract Surgery

Deciding whether to get cataract surgery is a conversation you’ll need to have while consulting with an ophthalmologist. It often depends on your lifestyle and daily activities. Getting annual vision tests after age 65 will help ensure the surgery is performed at the appropriate time, as well, because regular check-ups will tell you if cataracts are developing. The American Academy of Ophthalmology™ has an online consumer guide to cataract surgery with helpful information for men and women considering the procedure.

At Outlook Eyecare, we recommend a baseline eye exam for anyone older than 40, even people who aren’t considered at risk for developing cataracts. You can [cert] request a consultation [/cert] to meet with one of our eye doctors or call us at (609) 409-2777 in Monroe Township, (609) 419-1920 in Princeton, or (609) 587-4700 in Mercerville.


Steroids are a broad, versatile group of drugs that effectively reduce inflammation anywhere from the lungs to the skin. If you have asthma, COPD, or even seasonal allergies, you may rely on inhaled or oral steroids to keep you feeling your best. But a recent study links steroids to the development of cataracts, and it’s something that we want our cataract surgery patients here in New Jersey to be aware of.

What the Study Found

The study followed more than 3,600 adults over the course of a decade. The study found that the risk of cataract development was significantly elevated in people who met all of the following criteria at the beginning of the study:

  • Had ever used inhaled steroids
  • Had used oral steroids for at least 1 month
  • Had no pre-existing cataracts

Why You Shouldn’t Be (Too) Worried

Only 10 people involved in the study fit these criteria, but 7 of them had developed cataracts by the end of the study. That’s more than a chance relationship, and you would be right to conclude that using both inhaled and oral steroids has a significant.

Steroid use is more closely associated with a specific type of cataract called a subcapsular cataract. This type of cataract occurs farther toward the rear of the eye, as opposed to nuclear cataracts (the most common variety) that develop around the nucleus of the lens. Subcapsular cataracts do cause the same symptoms, including cloudy visual disturbances, increased nighttime glare, and less vibrant colors.

While these results are concerning, it’s also not yet safe to say that anyone who uses a combination of oral and inhaled steroids will eventually develop cataracts. That said, if you regularly use both oral and inhaled steroids, we recommend seeing your ophthalmologist to further evaluate your risk.

At that point, you’ll need to weigh the benefits of continuing to take the steroids against your chances of developing cataracts. This is not meant as a recommendation to stop taking them — we simply wanted to bring it to our patients’ attention. Do not stop taking any medications unless you’ve spoken with your doctor.



Cataract surgery is one of the safest and most effective procedures available today, thanks to advances in surgical techniques. But a new study confirms the findings of earlier research: Men using Flomax to treat symptoms caused by enlarged prostate are 2 times more likely to experience complications during and immediately after cataract surgery.

About 3 out of 4 men are diagnosed with an enlarged prostate or benign prostatic hyperplasia (BPH) by the time they reach age 70. Flomax is one of the most commonly prescribed medications used for treatment. Flomax works by relaxing the muscles in the prostate and the bladder. That’s the most common use, but physicians also prescribe Flomax for some women experiencing urinary problems, relying on the same principle of relaxing the muscles in the bladder.

Flomax is part of a class of medications called alpha-blocker drugs. In addition to their effects on the prostate and bladder muscles, alpha blockers also keep the hormone norepinephrine from tightening the muscles in the walls of smaller arteries and veins. This causes those smaller blood vessels to remain open and relaxed.

That’s also the source of the problem for cataract surgery patients. Blood vessels that remain opened even when the body needs to close them off to heal the areas of the eyes affected by cataract surgery can lead to complications. The American Society of Cataract and Refractive Surgery (ASCRS) and the American Academy of Ophthalmology (AAO) both recommend that it’s best to undergo cataract surgery before beginning treatment with Flomax.

A 2005 study also found that men taking Flomax or other alpha-blockers before cataract surgery were more likely to experience complications during and immediately after the procedure.

The new study showed that 7.5 percent of the men who had taken Flomax in the 2 weeks before cataract surgery had a serious complication, compared with 2.7 percent of those who had not taken the drug. That makes it a 2.3 times greater risk.

Studies like this also make it especially important to disclose your full medical history as accurately as possible. Knowing that a patient is taking Flomax (or any other alpha blocker) — or even if he or she used it in the past — is very important before an eye surgeon performs cataract surgery. Our experienced eye doctors in Princeton and Hamilton, New Jersey can prepare for alpha-blocker patients differently by adjusting our surgical techniques in those cases, which can lead to much lower complication rates and optimal results.

If you’re being treated with Flomax and are planning on having cataract surgery, discuss your condition with the physician who prescribed the medication. You should never simply stop taking an alpha-blocker without talking to your doctor.



Most women approaching menopause begin thinking about hormone therapy to mitigate the most common symptoms that accompany “the change,” which can range from uncomfortable hot flashes to more serious conditions like osteoporosis. When women begin to look into hormone therapy, though, questions about the treatment’s potential risks emerge, which a clinical trial identified several years ago. Those health risks include heart disease, stroke, and even breast cancer.

Our eye doctors in the Hamilton Township and Princeton, N.J. areas say you can add cataracts to that list.

A study of more than 30,000 postmenopausal women in Sweden found that using hormone replacement therapy (HRT) may make it significantly more likely for women to need cataract surgery in the future, compared to women who never undergo HRT. A cataract is the thickening and clouding of the eye’s natural lens that can occur as men and women age.

There’s reason to be cautious about HRT. The essence of the study’s findings boils down to 2 important points:

1. The longer a woman used HRT, the greater her chances of developing cataracts.

2. Women who consumed more than 1 alcoholic drink per day while taking HRT had nearly double the risk of having cataracts, compared to women who didn’t drink or use HRT.

This is the first large study to reach these conclusions. Earlier studies exploring the potential link between HRT and cataracts performed in the U.S., Australia, and Europe yielded mixed results. There are some shortcomings to the Swedish study’s conclusion, though: The study didn’t identify the type of hormone replacement treatment being used (there are different types of HRT), offer details on the type of cataract the study’s subjects developed, or consider their exposure to sunlight (which is itself a risk factor for cataracts.)

Additionally, the Swedish participants nearly all had the same ethnic background, which could influence the outcome. As we mentioned in an earlier blog post about cataracts, certain ethnicities appear to have a higher risk for developing cataracts than the general population. If you have Scandinavian heritage, the findings may prove more relevant to you, but it’s hard to say because the study didn’t prove (or disprove) that the homogeneity of its participants was a factor.

In that same blog post, we outlined that there are simple things you can do to actually lower your risk of developing cataracts, such as wearing sunglasses that block UV rays and eating more foods rich in vitamin C. It’s also clear that women and men who don’t smoke are less likely to develop cataracts at a younger age. Those little changes to your habits and lifestyle can add up to healthier eyes.

Hormone replacement therapy is no longer routinely prescribed for menopausal women, as doctors learned about the potential risks associated with the treatment, but it may still be beneficial for some women. Certain types of HRT remain the most effective treatment for postmenopausal symptoms, and the decision of whether to have HRT is one you should discuss thoroughly with your doctor.


June is Cataract Awareness Month, an observance created by the American Academy of Ophthalmology to raise awareness of this important eye health issue. At Outlook Eyecare, we see this as an opportune time to educate you about this very common condition. Our eye doctors in Princeton treat patients from surrounding cities like Hamilton Township and other central New Jersey communities, but because it is such a widespread concern, we feel everyone can benefit from learning more about cataracts.

Cataracts occur as we age and the eye’s natural lens thickens and becomes cloudy. They are the main cause of vision loss for men and women older than 55 and, according to the American Academy of Ophthalmology, about 25 million Americans have cataracts. Here are 3 important facts about cataracts that many people might not know.

  • Lifestyle’s role as risk factor: Lifestyle and behavior can influence how early or late in life you develop cataracts, and how the condition will progress. Age is the most common risk factor associated with cataracts, but recent studies indicate that other factors play a role in the timing and severity of developing cataracts. For example, diabetes, extensive exposure to the sun, smoking, and obesity can all contribute to an increased risk of cataracts. High blood pressure and certain ethnicities have also been linked to having a higher risk of having cataracts than the general population. Eye injuries, previous eye surgery, and using steroid medication over a long period can also result in cataracts.
  • You can lower your risk: Cataracts cannot be prevented, but you can take steps to decrease the risk of developing cataracts. Protecting yourself from sun exposure by wearing sunglasses with lenses that block UV rays and using wide-brimmed hats can help. Several studies concluded that people who eat more foods rich in vitamin C lower their risk of developing cataracts at younger ages. Women and men who don’t smoke cigarettes are also less likely to develop cataracts until much later in life.
  • Improved vision is just one benefit of surgery: During cataract surgery, your eye surgeon replaces the natural, clouded lens with an intraocular lens, an artificial lens made of plastic, silicone, or acrylic. There are a range of lenses to choose from, and each provides unique benefits. More than just improving your vision, cataract surgery has been shown to improve patients’ quality of life and reduce the risk of falling.

If you’ve noticed your vision becoming less clear, cataracts could be the cause. Cataract Awareness Month is a good time to request a consultation at one of Outlook Eyecare’s 3 locations. Or call one of the offices at (609)409-2777 (Monroe Township), (609) 419-1920 (Princeton), or (609) 587-4700 (Mercerville), to schedule an appointment.

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Outlook Eyecare
5 Centre Drive #1B
Monroe Township, NJ 08831
Phone: (609) 409-2777

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Outlook Eyecare
100 Canal Pointe Boulevard #100
Princeton, NJ 08540
Phone: (609) 419-1920

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