Understanding Cataracts with Dr. Kenneth Knudtson

Dr. Ken Knudtson, I'm an ophthalmologist, grew up in Sioux Falls, South Dakota. Well, I did my medical training at University of South Dakota in Vermillion and Sioux Falls, did my ophthalmology residency in Missouri, University of Missouri at Columbia, and then lucky enough to get back to my home state with my wife who's also a South Dakotan and ended up in Brookings here, which we love. It's been 23 years that we've been here in Brookings.

What is your specialty at Yorkshire Eye Clinic?

Well, I'm an ophthalmologist. There's the three O's we call it. One is ophthalmology, which is I'm a medical doctor and a surgeon, but we also have optometrists, which as some people know are eye doctors that specialize in prescribing glasses, contacts, but also can manage some medical things, but they're not surgeons. Then we also have opticians, which help fit and sell glasses and fill those prescriptions. All three of those we have at Yorkshire Eye Clinic, which is nice. We cover all the bases and total eye health care.

What are cataracts?

Well, cataracts, we all get some amount of it, and like you say, it comes with birthdays. It's just a natural process of the human lens in the eye starts to turn yellow and hazy with time. It's just due to the chemical nature. There again, I could get very specific about chemical bonds and stuff, but it basically turns yellow and cloudy over time, and that starts to degrade the vision.

Can you prevent cataracts?

Not really, however, you may increase the rate of cataract growth with harder living, if you will, smoking, drinking, or some people with medical conditions are going to progress with their cataracts faster than somebody else, but there's not really any magic pill at this time to prevent them.

What are the symptoms of cataracts?

Usually the symptoms begin with blurrier vision. People will complain of a little tougher to see the road signs, or some people it's glare at night from oncoming headlights they're noticing. Other people the reading might get more difficult and they use a stronger and stronger light to get to read. Other people, TV they'll say can't see the scores or the scroll on the bottom of the TV, so those are probably the main things. Other people might be not seeing the golf ball.

How can cataracts impact someone's life?

Everybody's different, so some people can tolerate more blurry vision than somebody else, but we may have a truck driver who during the day can kind of see the 20/20 line on our chart, but at night he's getting a lot of glare or dark rain, and so it starts to become a safety issue sometimes based on their occupation. Other people as I mentioned it could be golf or tennis or one of their recreation. Other people do near work like handiwork, sewing or art, and sometimes that's affected. We've had a couple artists and sculptors over the years who said yeah it's tougher or the colors don't seem the same as they used to, and because of that yellowness of the lens, sometimes we'll improve their ability to do their work by doing cataract surgery in that regard.

How do you diagnose cataracts?

Number one is what does the patient tell you? Are they having difficulties? And then of course we measure their vision in the clinic, and then we always examine them with ophthalmology and optometry. We have a special light called a slit lamp, and so if you've ever gone to the eye doctor and you put your head in that kind of thing that looks like binoculars, it helps us see into the eye and we can see the layers of the eye and specifically look at the lens to see how cloudy it is.

When is the right time to seek treatment?

Most people will start complaining about the things we talked about, just tougher to see, feel like they're struggling to read, and what is their vision on the chart? So there's three things that I go by. One is what is their vision on the chart? Two, how fuzzy or dense does that cataract look on exam? But three and most important, is it affecting the patient's daily activities? If it is, the other two are not as important as that. So sometimes somebody might see 20/30 and say, man, I'm struggling, I need to do cataract surgery. Another person might have 20/50 vision, that's not bothering me, doc, I'm able to see my TV, do my puzzles, and then we wait. So there's no hard and fast rule, but the main indication is how much is it affecting the patient.

How does cataract surgery work?

What exactly are we doing? We're removing that cloudy natural lens, and nowadays we do it through some really small corneal incisions. It's minimally invasive, the incisions that we use are very small, kind of a tunnel incision that are self-sealing. So nowadays the surgery goes rather quick, just about 10 minutes or so, and you don't have to put in stitches, that could be painful. So a lot of people have very little to zero pain, which is just amazing, the technology that we have nowadays. Once we have the natural lens removed, then we can put in our new man-made lens that's nice and clear. And the material of these new lenses are fantastic. The one we're currently using is a softer acrylic material. The lens actually rolls up inside an injector system. We inject that through the small incision, let it unroll, and then maneuver it right into place where their natural lens was. And that's basically it. That way you keep it with these small incisions that don't need any stitches, and so the recovery time is very quick.

How soon will patients notice results?

Usually fairly quickly, even the next day, sometimes right after surgery they may say, hey, this is really pretty good. But it can be a little blurry right after surgery for that first day, or kind of variable. So after surgery I come back to their room and kind of discuss what to expect. So first day can kind of be a little variable, but we see them the next day in clinic and test their eyes, and usually they're doing fairly well at that point. Some people are seeing 20/20 the next day. Others may be a little blurrier, but tends to get better over a few days. And then we also check them back at a one-week appointment, and a lot of times they're doing quite well by then, too.

Do you work with optometrists outside Yorkshire Eye Clinic & Optical?

Oh yes, we do that quite often. So we have great optometrists in this town, very well-seasoned, have been around for decades, just like me. And so they'll refer patients in for me to do the surgery, and then usually I'll do the one-day check, but then they'll go back for their one-week check with their local optometrist. We'll kind of take over the care and follow them through until their final check is usually a few weeks after surgery, and then would usually either check them for glasses if needed, or some people don't need glasses, but they always get checked over a few weeks.

How does cataract surgery improve your patient's lives?

Most people, it is a definite improvement in their vision, but also in their capabilities. As we mentioned before, we may have the truck driver or person that doesn't feel safe driving, now feels much more comfortable and confident. They're seeing the road signs, they're not getting as much glare. Other people are reading much better, they're seeing the TV well, or able to do their handiwork and hobbies, or golfing. Many patients seem to have improved color vision, and the colors are much more vibrant and more saturated. The lens is like a yellow filter they've been looking through. Once you remove that, there's more blues and greens and whites coming in. I've had a number of people say, gosh, I thought my walls were looking dingy, and I was going to have to paint them. I got my cataracts done, and now they're bright as heck.

Can you perform surgery on both eyes on the same day?

When we do cataract surgery and we're planning to do both eyes, at least at this time in this country, we don't do both on the same day for sterility reasons and some other reasons. We do one eye at a time, but usually nowadays we can do them a week apart. A person doesn't have to wait too long in between to get those both done, and they can heal up usually within a few weeks with both eyes done.

Why do you recommend Yorkshire Eye Clinic & Optical?

At Yorkshire Eye Clinic and Optical, we have the three O's, ophthalmology, optometry, and opticianary in the same building. You won't find nicer people who care about your outcome. We have people we've seen for decades and just love to see them back every year and get to know people. That's kind of our style. Everybody who works there really wants to help people and cares about people, so it's a great place to work. I think people, if you ask around, people will say, hey, yeah, you've got a good reputation. You seem to really care about helping people.