Cataract

Cataract surgery through microscopic incision in topical anesthesia with drops

Cataract is one of the most common causes of vision blurring after a certain age. The cataract forms part of the eye ageing process. All people show blurring of the lens after a certain age. The procedure for cataract removal is the most common and successful surgery of Medical Science in general.

What is cataract? What causes cataract?

  • The cataract is a clouding of the lens of the eye. The normal lens of the eye is located behind the iris, it is the size of a lent and normally is transparent.
  • The cataract cannot be prevented nor treated pharmaceutically.
  • It is a very common disease that usually presents itself as people age.
  • Sometimes it can be caused by injury, certain diseases (eg. diabetes, infections of the eye etc.) or medicines, such as chronic use of cortisone.
  • In very few cases, an infant may be born with cataract (congenital cataract).

What are the cataract symptoms?

The main symptoms are:

  • Blurred vision both near and far, which progressively deteriorates. Vision becomes increasingly less distinct.
  • Glare and reflections around certain objects.
  • Weakened perception of colour.
  • The patient is intensely annoyed by sunlight.
  • There is no pain.

All of the above symptoms can affect everyday activities, such as:

  • Driving, especially at night or in strong daylight.
  • Reading or watching TV. In some cases, in the initial stages of certain types of cataract, the patient can read without glasses.
  • Sewing or other activities which involve detailed observation of objects.

When must cataract be treated?

One can decide to treat a cataract when it starts causing difficulty in vision quality, resulting in problems with the patient’s everyday activities (safe car driving, reading, television). Based on your symptoms, you and your ophthalmologist will jointly decide when to have the surgery.

It is no longer true that the cataract must be “mature” to be removed. With the new techniques ( phacoemulsification), this view is now considered outdated. On the contrary, removing an overmature cataract can make surgery more difficult.

Preoperative eye examination

Before surgery the patient’s eyes are examined to assess their general condition, the type of cataract the patient is suffering of and to make the necessary measurements which will point to the correct lens needed to be inserted in the eye. A thorough ophthalmological examination includes measurements of vision and the cornea’s curvature, measurement of the pressure of the eye and assessing how healthy the eye’s fundus is. Also, with the help of ultrasounds we measure the size of the eye and calculate the strength of the lens to be inserted during surgery.

How is surgery performed?

Nowadays the cataract is removed with ultrasound phacoemulsification. Through a small incision of 2-3 mm and with the help of a probe which emits ultrasound waves, the cataractic lens is emulsified and suctioned. In the end, an artificial lens is permanently placed in the eye (IOL-intraocular lens). The surgery ends with no sutures needed and the patient is able to see immediately.

 

The patient no longer needs to stay in hospital. He/she returns home immediately after surgery and can take up his/her usual activities the very next day. The patient can see better immediately after surgery and the vision improves further in a few days. Surgery is performed following the administration anesthetic drops and the patient leaves the operating room with no protective gauze.

 

The lens placed in the eye can correct myopia or hyperopia or astigmatism if there was any, prior to surgery, so the patient usually no longer needs glasses after surgery. A small number of patients may need a low grade correction with glasses for some activities (driving, watching television). In order to satisfy the patient’s needs and wishes, the surgeon discusses the options for postoperative correction with the patient.

State-of-the-art technologies for cataract removal

In our clinic we use the latest techniques for surgical removal of the cataract. Many of them were used, on a trial basis, in our clinic for the first time worldwide. They include bimanual cold phacoemulsification during which low energy ultrasound waves are used, smaller than 2mm incisions are made and healthy vision is restored more rapidly.

Newer intraocular lenses

In our clinic we use all intraocular lenses of the latest technology, depending on each patient’s needs. Multifocal intraocular lenses for correcting vision both near and far following cataract surgery. Toric intraocular lenses for the correction of corneal astigmatism.

On the day of the surgery

It is advised that the patient be escorted by a relative who will transport them to and from the clinic. The patient will stay in the clinic for 2-3 hours. The night before surgery the patient should have a light dinner, he should however skip breakfast on the day of surgery. The patient should not forget to take any medication he/she is taking (for blood pressure, heart conditions, diabetes) prior to surgery, but not aspirin.

After surgery

The patient will stay in the clinic for a short time to recover and can go home as soon he/she feels up to it. The eye surgeon will prescribe the necessary eye drops to be used at home following surgery and will give adequate instructions. It is important for the patient not to rub his/her eyes and not to let any water get in their eyes for one week.

What are the method’s advantages?

The technique of cataract removal through a tiny incision with drops offers several advantages. Using this technique the patient is able to resume his/her regular activities from the very next day. The patient’s stay in the operating room lasts a lot less and he/she doesn’t need to be hospitalized. The patient does not require general anesthesia or needle anesthesia. During surgery no sutures are made. Sutures may lead to astigmatism. The incision heals more quickly and naturally. All this results in fewer possible intraoperative and postoperative complications and the patient’s vision is restored more quickly.

Posterior capsule opacification or secondary cataract

In case of posterior capsule opacification, vision may diminish gradually. This is called also secondary cataract. In this case, we use a special laser beam (yag laser) that cleans the membrane opacificated behind the lens and restores the patient’s vision. This condition is registered in around 10% of patients operated for cataract. The procedure can be performed in the clinic and no hospitalization required.

 

Prevention - Advice

There is no special advice for preventing cataract. When surgery is indicated, we should do it at the right time to avoid difficulties during surgery for mature cataract removal.

However sunlight can be associated to the pathogenesis of cataract, we should protect our eyes from sunlight from an early age using the right sunglasses.

Finally, it should be reminded that cataract surgery is the most common, safe and successful surgical procedure in the whole field of medicine.