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What is a Cataract?

 

 

Age-related cataract is the most common cause of blindness. Cataract formations occur when the natural crystalline lens inside your eye becomes cloudy, misty and it feels as though you are looking through a dirty camera. This is a part of the natural ageing process along with presbyopia, the loss of close-up vision. Age-related cataracts normally occur in those over the age of around 60, it can happen in one eye or both your eyes, and tends to get progressively worse with time.


Traumatic cataract
can appear when the natural crystalline lens is damaged as a result of an eye injury. This can impede the vision in the same way and would be removed through surgery.


Congenital cataracts
has the
 potential to lead to blindness and an irreversible damage to the visual system if not operated within 6-8 weeks of birth. Cataract in new-borns is rare and affects 3-4 per 100,000 children in the UK. It accounts for 5% to 20% of blindness in children worldwide.

 

Cataract is responsible for 51% of world blindness, which represents about 20 million people (WHO, 2010)

The back of your eye is the retina, this works like the film in a camera, when light is focused and hits the retina an image is taken and sent to the brain. The front part of your eye, your cornea, works like the lens; when a cataract begins to form it can make the lens misty and cloudy.


Can I have Cataract Surgery?

People of any age that show a significant lens clouding may be suitable for cataract surgery, a thorough eye examination and comprehensive diagnostic tests can confirm the suitability of surgery.


Signs and Symptoms of a Cataract

  • Difficulty seeing in dim lighting or darker conditions like night time driving
  • Colours appear dim and faded
  • Your vision will get progressively worse, you may find your glasses are no longer useful
  • Bright lights may be dazzling and halos or rings may appear around them
  • You may feel as if you are looking through a misty window with a yellow or brown tinge


Can I have the new laser cataract surgery/ blade-less cataract surgery?
The use of femtosecond lasers within cataract surgery is becoming more common. Femtosecond lasers are used to minimise the use of surgical blades and needles providing precision and micron accuracy. The femtosecond laser constructs the wound and then breaks up the cataract in approximately 50 seconds allowing the surgeon to extract the broken up cataract and introduce the artificial lens. Laser cataract surgery (or, more accurately, laser-assisted cataract surgery) is fairly new and significantly increases cataract surgery cost, primarily because the laser machine is very expensive. While studies have shown that lasers can improve accuracy during the procedure, they may not necessarily improve cataract surgery safety, recovery time and visual outcomes in every case.


How to Prepare for Cataract Surgery
Prior to cataract surgery it is important to have a thorough consultation with your optometrist or ophthalmologist who will perform a comprehensive eye exam to check the overall health of your eyes and evaluate whether there are reasons why you should not have surgery and identify any risk factors you might have. They will identify your occupation, hobbies and lifestyle to ensure expectations are attainable.

A number of tests and scans will be performed including a refraction similar to what you have done at an optician. This will accurately determine the amount of near-sightedness, farsightedness and/or astigmatism you have prior to surgery. Additional measurements such as the curvature of your cornea and the length of your eye will be taken to help your surgeon decide upon the appropriate power of IOL to place inside your eye to gain the best possible outcome for you.


What kind of Intraocular Lens/ Implant (IOL) should I have?
Today you have many types of IOLs to choose from for your cataract surgery depending on your specific needs. In addition to IOLs being able to correct near-sightedness and farsightedness there are now Toric IOLs used correct astigmatism. Astigmatism is when your cornea is shaped similar to a rugby ball rather than a round football, if astigmatism is left uncorrected, it can distort your vision and you will not be entirely satisfied with cataract surgery results.


Monofocal IOL
A Monofocal IOL will correct either your distance or your near vision. In most cases, people wish to correct their distance vision and are happy to remain wearing reading glasses. Alternatively you can have two slightly different powered lenses to give you some distance correction and some reading correction, this is called Monovision.


Monovision
can be simulated through contact lenses and a quick trial is required to see if you can tolerate the difference.

Some people may have certain conditions whereby a Monofocal IOL is better suited, i.e. due to occupation, previous eye surgery or certain eye or medical conditions.


Multifocal IOL
A Multifocal IOL is designed to provide an increased range of vision after cataract surgery than standard Monofocal IOL. This works by splitting light enabling you to have multifocal functionality and can eliminate or reduce the use of glasses completely. Multifocal IOLs tend to be a popular choice for those with presbyopia. Eye Clinic London’s preference of Multifocal IOL are the Trifocal lenses and the extended range of vision lenses. Both have proven safety and efficacy but your surgeon will discuss with you which one will suite your eyes, your particular needs and lifestyle.


Toric IOL
Both of the above IOLs are available in a Toric type. Toric IOLs can be used to correct moderate to high levels of astigmatism, they work by being placed in a specific position to counter the astigmatism.


The Day of Surgery
You can expect to be at the surgical centre for 90 minutes or longer. To begin with, the nurses will prepare your eye using drops to dilate your pupil and numbing the surface of the eye. Thereafter you will be taken into the surgery room where surgery typically takes 15 minutes. A clear eye shield is placed over the eye to protect it in the early stages of your recovery, you will be advised to keep the plastic shield over the operated eye every night for one week. Thereafter, you will be taken into recovery where your post-op drops and medications will be explained. You must have someone drive you home after cataract surgery; do not attempt to drive until you have visited your eye doctor/optometrist the day after surgery and he or she has tested your vision and confirmed that you are safe to drive.


Recovery
You also must wear your protective eye shield while sleeping or napping for about a week after surgery. While your eye heals you might experience some eye redness and blurred vision during the first few days or even weeks following the procedure.

During at least the first week of your recovery it is essential that you avoid strenuous activity and heavy lifting, bending, exercising and similar activities that might stress your eye while it is healing, and water that might splash into your eye and cause infection.

Keep your eye closed while showering or bathing. Also, avoid swimming or hot tubs for at least four weeks and any activity that would expose your healing eye to dust, grime or other infection-causing contaminants.


Questions, Worries or Concerns?
If you have any questions or concerns about cataract surgery be sure to discuss them with your eye doctor and cataract surgeon prior to signing “informed consent” documents authorising surgery. Be sure to advise your surgeon of all medications you are taking, including non-prescription (“over-the-counter”) formulations and nutritional supplements. Some medications and supplements can increase your risk of cataract surgery complications and might need to be discontinued prior to surgery.

Your cataract surgeon may give you other instructions and recommendations for your cataract surgery recovery depending on your specific needs and the outcome of your procedure. If you have any questions at any time after cataract surgery your surgeon will be happy to answer these.

N.B. This information, which may be presented orally, in writing, via a video presentation or a combination of all three, is meant to help you make an informed decision about whether to proceed with surgery.