Cataract surgery

A cataract is a cloudiness that develops in the normally clear lens inside the eye.  It occurs as a part of the eye’s ageing process - it is not a growth, a white film, or a kind of cancer, nor is it caused by overuse of the eye.  An age-related cataract is not something that was absent one day and just appeared the next day -- it's actually the last phase of a series of gradual changes in the eye, starting in youth, that eventually have an impact on vision in later life. This is akin to other age-related changes in the human body, such as hair turning grey, and skin becoming wrinkled.

In modern societies, cataracts rarely cause blindness, but they do reduce the sharpness and quality of people’s vision, thus affecting their ability to do everyday work and leisure activities. When this occurs, surgery may provide the best solution.

There are numerous benefits from having the surgery -- it is not uncommon for patients to feel that their vision following this surgery is better than it has been since they were 40 years of age.

And now, thanks to remarkable advances in intra-ocular lens design, many people can have the added convenience of being able to greatly reduce or avoid the need to wear reading glasses or distance glasses (though sunglasses are still advisable).

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Am I a candidate?

People who have a cataract that may require surgery will generally notice one or more of the following symptoms:

• Hazy, cloudy, or filmy vision, for example, when watching TV, reading, driving, etc.
• Decreased quality of vision at night, particularly with oncoming headlights.
• Increased sensitivity to glare or bright sunlight.
• Colours don't seem normal or as bright as before (colours appear washed out).
• Double vision, even with one eye closed.

Cataracts generally start to become bothersome after age 60, although some people may not have problems until much later in life. Because cataracts develop gradually, sometimes people don't realise their vision is being affected until it has become quite blurred, and they have difficulty carrying out their everyday tasks. Furthermore, age is not a barrier to to having cataract surgery - people over the age of 100 years have had the surgery!  In fact, there is evidence that, in older people, an added benefit of the surgery is that it can reduce the likelihood of falls, hip fractures, and the need for admission to a nursing home.

If you are over 60 years of age and you have these symptoms, and you find that glasses do not correct the problem, then an eye examination is advisable in order to determine if a cataract has developed and if surgery is appropriate.

Revolutionary microsurgery

Cataract surgery is the procedure of removing the cloudy lens of the eye, and replacing it with an artificial clear lens. Results from cataract surgery have proved to be remarkably successful, and recovery time has been dramatically shortened.

At the initial consultation, numerous tests are done in order to determine the suitability of the eyes for surgery, and to determine the optical prescription that will be required for the lens implant. Additionally, the patient and their family can be taken to view the day-surgery facility in order familiarise them with the procedures and the environment.

Prior to surgery, patients are encouraged to continue the normal routine of their lives - they do not have to miss meals, and they can usually continue to take their regular medications.

On the day of surgery, patients do not have to change into a hospital gown, but can remain in their usual clothes. Patients are looked after by a team of staff who specialise in caring for patients undergoing a day-surgery procedure. Eyedrops are put into the eye to dilate the pupil. A mild sedative can be given, if preferred. A painless anaesthetic is then administered – either using eyedrops or a local anaesthetic injection, or on rare occasions using a general anaesthetic. The patient will be drowsy, but may still be aware of voices during the surgery.

The actual surgical procedure we use is called phacoemulsification, the most advanced technique in use today, which allows the cataract to be removed through a tiny, secure opening 3mm long.  An ultrasonic probe, which vibrates at 40,000 times a second, is inserted through the incision.  The ultrasonic action gently breaks the cataract up into tiny pieces, which are then suctioned out of the eye. The intraocular lens is then inserted, and it stays in position permanently. The illustration shows a foldable lens being inserted but, nowadays, injectable lenses are often used, which can be inserted through a very small incision in the cornea -- this type of procedure dramatically shortens the recovery period.

After surgery

After surgery the patient rests for a while in a reclining chair, with refreshments available. Most people are able to leave the clinic within an hour.

As with all surgery, post-operative care is essential. A protective eye shield may need to be used for a few nights, and eyedrops are prescribed. Sunglasses are helpful. It is quite safe to read or watch television. Bathing or showering, and hair washing, are quite safe, but pressure on the eye should be avoided. Physical activity may be resumed immediately, but strenuous exertion should be restricted for about one month -- moderate stooping is not harmful but straining should be avoided. Glasses may need to be altered three to four weeks after the operation. Initially, visual judgement may be unreliable, therefore, driving should not be resumed until the patient is fully confident, which may take a few days.

Risks of surgery

Cataract surgery is one of the most successful procedures in medicine. However, complications related to the surgical process or the anaesthesia can occur, and they can vary from mild to serious. Despite the best surgery and the best possible conditions, there is still about a 1 in 1,000 risk of a serious complication which could significantly harm the vision. At the time of consultation, the risks and benefits of the surgery are discussed in detail so that patients can make an informed decision about whether or not they wish to proceed. Provided the eyes are healthy, 99% achieve a very good result.

Secondary cataract

In the months or years after cataract surgery a small percentage of people develop a condition known as 'secondary cataract', which can reduce the vision. However, this is not a true cataract, but a thickening of the back of the lens capsule. Fortunately, this secondary cataract (more correctly called posterior capsular thickening) can be easily treated. A quick and painless laser treatment (YAG laser capsulotomy) makes a small opening in the back of the lens capsule, which restores vision within hours. When people remark that they know of someone who "had a cataract removed by laser", they are probably referring to this process.

All in a day

New and evolving surgical techniques and anaesthesia options, as well as the leading technology provided at Vision Eye Institute, have made cataract surgery a remarkably safe and effective procedure. And it all can be done as day-surgery, without involving a hospital stay.  Patients can resume normal activities, such as driving, walking, and sports, very quickly, usually within a few days.