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Cataract Surgery

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What are Cataracts?

The eye is like a round camera, the front of the eye being like the lenses and the back of the eye (the retina) like the film in a camera. Just behind the blue or brown part of the eye (the iris) or the black circle in the middle (the pupil) is the lens of the eye (also called the crystalline lens). A cataract is a natural opacification or haze that develops with age in the lens.

As we age this clear lens becomes cloudy and can also hardens. With hardening we lose the ability to focus close up and often require reading glasses. As the lens becomes increasingly cloudy the vision out of the affected eye is reduced. In the early stages new spectacles can often help, but eventually they will not.

Cataracts do not cause blindness and it is extremely rare for them to get worse fast.

Who is at Risk of Cataracts?

Patients are at an increased

  • The natural ageing process; often, patients are in their 70’s or 80’s when cataract becomes a problem
  • Some eye surgeries like vitrectomy will result in rapid cataract formation
  • A result of an injury or trauma to the eye
  • A complication of other diseases such as glaucoma and diabetes
  • Prolonged use of corticosteroid

What Are the Symptoms of Cataracts?

  • Clouded, blurred or dim vision
  • Increasing difficulty with vision at night
  • Sensitivity to light and glare
  • Need for brighter light for reading and other activities
  • Seeing “halos” around lights
  • Frequent changes in eyeglass or contact lens prescription
  • Fading or yellowing of colours

At first, the cloudiness in your vision caused by a cataract may affect only a small part of the eye’s lens and you may be unaware of any vision loss. As the cataract develops, it clouds more of your lens and distorts the light passing through the lens. This may lead to more noticeable symptoms.

Types of Cataracts

Cataracts may be classified based on their location within the lens:

  • Nuclear cataracts – These form in the middle of the lens and cause the centre to gradually become more densely yellow, further clouding the vision.
  • Cortical -These are white wedge shaped spokes that form around the edges of the lens.
  • Posterior sub capsular – This occurs at the back of the lens capsule, which is like a shell of the lens. This type of cataract tends to develop quicker than the other types of Cataracts and it is more commonly seen in patients with diabetes or on long-term steroid treatment as well as younger patients.

Treatment of Cataracts

Surgery is the only treatment option for cataracts, it is usually recommended when the severity impairs vision sufficiently.

Cataract Surgery
Cataract surgery involves removing the clouded lens and replacing it with a clear artificial lens called an Intraocular Lens (IOL) or Lens Implant, it is positioned in the same place as your natural lens. It remains a permanent part of your eye.

This surgery is generally safe and has a high success rate.

Types of IOL
Your ophthalmologist will help you to choose the most suitable lens implant based on your needs and lifestyle. It is essential to appreciate that spectacles may still be required to provide the sharpest focus in certain conditions despite the most suitable implants chosen.

Surgery Procedure
The procedure is quick, pain-free, and performed in a day surgery (hospital) on an outpatient basis. You will always need to be driven and picked up from the hospital and will be in the hospital for a number of hours. It is important to have someone at home when you get home.

Cataract Surgery is performed in five stages, these are:

  1. The operated eye will be completely anaesthetized by an anesthetic specialist
  2. A small incision in the cornea is made to allow access and removal of the opaque lens
  3. The cataract will be broken into small pieces with an ultrasonic probe (phacoemulsification) and removed.
  4. After the cataract is removed, a foldable intraocular lens is then implanted into the eye for focusing light
  5. Finally, the eye will be patched and the incision is then allowed to seal with the eye’s natural mechanisms and you may return home. There are no stitches involved.

Post-Surgery
Recovery is rapid and patients usually do not report any discomfort during or after surgery.

You will not be able to drive after the procedure, you should have someone ready to take you home. You may also have to arrange for temporary home assistance.
Post-operative eye care and wound-healing are important factors in your cataract surgery’s success.

Once home from the hospital you should take things quietly and rest.
You may watch TV or read on your first night if you feel comfortable to do so.
Please cover the operated eye with the plastic shield given to avoid unintended trauma to eye during sleep.
It is very common to have an increase in watering and a gritty feeling in the operated eye. Please use preservative free lubricating drops if this occurs. This can be purchased over the counter from your pharmacist.

Your ophthalmologist will check your eye the day after your surgery.

  • You will be given instructions on how to use your post-operative drops.
  • Depending on the severity of your cataract, your vision will clear in a couple of days or may take a few weeks.
  • It is essential to understand that even if visual recovery is slower, the final visual outcome will still be the same.

Risks of Cataract Surgery

  • Some complications can include
  • Persistent Ocular Inflammation,
  • Glaucoma – changes in eye pressure
  • Macular Oedema – swelling of the retina at the back of the eye (cystoid macular oedema)
  • Retinal Detachment
  • Rare complications such as infection (endophthalmitis) or bleeding Vitreous Haemorrhage can also arise.

All of these complications are rare but, can lead to significant vision loss. Thus, close follow-up is required after surgery.

If you have pre-existing Macular Degeneration, optic nerve damage or Floaters, these will not be made better by Cataract Surgery.

What Cataracts are left Untreated?
Cataracts only affect the quality of vision. They are not a disease but rather an ageing change. Under almost no circumstances can they cause problems other than poor vision if left untreated.

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