What is a cataract?
A cataract is when your own lens inside the eye becomes cloudy. In a normal eye, the lens is clear, allowing light rays to be focused on the retina in the back of the eye. When a cataract develops, the lens opacifies and thus prevents the light rays from falling on the retina. This causes your vision to decrease and become dull and blurry, almost like looking through a dirty window. Images will appear hazy, fuzzy or less colourful than normal.
What causes a cataract?
Most cataracts develop gradually over time and is due to the normal process of ageing. This is called an age-related cataract. Other types of cataracts may include congenital cataracts (when it is present since birth), traumatic cataracts (which occurs after an eye injury) or drug induced cataracts (when using steroid drops over a prolonged period). Some risk factors that may increase your chance of developing a cataract includes sunlight exposure, smoking, diabetes, near-sightedness or previous eye infections.
How is it diagnosed?
A cataract can easily be seen with an eye examination at your ophthalmologist or optometrist’s office. Your ophthalmologist will use a special slit-lamp microscope to spot any abnormalities while doing a comprehensive eye examination. Your vision will also be tested to assess the sharpness and clarity and thereby determine the functional impact your cataracts have on your sight.
What is the treatment?
The only treatment for a cataract is surgery, which is mostly quick and very effective. Glasses, magnifiers and appropriate lighting conditions can improve your vision up to a point, but if those do not help anymore, surgery becomes a necessity. No eye drops, medications or laser can remove a cataract, and the only option is to have it removed with an operation.
When should I have the surgery?
You should consider having the surgery when the cataracts start interfering with your daily activities or lifestyle, for example when reading, watching TV or driving. However, if you do not feel that you have a problem with your vision and if you are managing with above mentioned visual aids, it is safe to delay surgery until your symptoms does bother you.
What can I expect during the surgery?
The operation is done as a day procedure at our hospital. The surgery is done in theatre using a microscope. It is done under local anaesthetic, which means that you will not sleep, instead the eye is numbed with a small injection next to the eye. Some patients may see light or movement during the procedure, but you will not feel any pain.
Your lens (which has developed into the cataract) is then removed through a very small incision in the eye, by breaking it up with ultrasound. This technique is called phacoemulsification. The cataract is then replaced by a clear artificial lens, called an intraocular lens (IOL). No stitches are needed as the wound is so small, it seals by itself.
The eye is then closed with an eye patch until the next morning, when your ophthalmologist will see you again in their consultation room to check that everything is fine.
Only one eye is operated at a time, the next eye will be done a couple of days later.
What are the possible complications?
In most cases, the operation is very safe and successful and your vision improves within a few days. However, because it is an operation, in a small number of cases complications can occur. Most complications are very rare and can usually be treated. But occasionally they are serious enough to cause permanent visual problems or even total blindness.
Some of the complications that may happen during surgery can include:
- Posterior capsule rupture: The cataract is normally removed from its own bag (the capsule) and the artificial lens is inserted in its place. But because this bag is extremely thin and fragile, it may tear and cause some of the jelly inside the eye (the vitreous) to come forward, or the lens itself may fall to the back. In this case it may be necessary for a second operation to remove the lens from the eye cavity.
- Suprachoroidal haemorrhage: This is sudden and severe bleeding into the eye, which is very difficult to control and can cause permanent blindness. This is a very rare complication.
- Damage to the cornea, iris or any other parts of the eye may occur.
Complications which can occur some time after the surgery includes:
- Problems with glare or halo’s around lights. This occurs quite commonly. Most patients become used to these reflections after a few weeks as the brain adapts and blocks out the symptoms.
- Dislocation of the artificial lens.
- Infection: This can be serious and if not treated promptly may lead to blindness.
- Glaucoma: Increased pressure inside the eye which can usually be managed with medication.
- Retinal detachment: This is also a serious complication and requires further surgery. You should contact your ophthalmologist immediately if you see the classic triad of symptoms; namely light flashes, floaters and a curtain spreading over the eye. This complication is more common in myopic (near-sighted) patients.
- Posterior capsule opacification: Your cataracts cannot return, but the bag that remains behind (the capsule) may become cloudy and cause your vision to become dull again. This is a very common occurrence, but is easily treated with laser in the ophthalmologist’s office. It is a quick and painless procedure, called a YAG-capsulotomy.
These are only some of the complications that may occur, but please be assured that cataract surgery is normally very safe and effective. If you have any questions or concerns, please do not hesitate to discuss it with your ophthalmologist.
What should I do after the surgery?
- It is very important to use your eye drops as prescribed after the surgery.
- Always keep the eye clean and wash your hands well before instilling your drops.
- You may bath and wash your hair, but avoid getting soap or water directly into the eye.
- Avoid rubbing / pressing on the eye.
- Wear a protective eye shield when sleeping for the first week following your surgery.
- You may continue with your normal daily activities including reading and watching TV.
Will I need to wear glasses afterwards?
Yes. The standard artificial lens that is inserted cannot change its focus to look at near and distant objects. Glasses are needed to fine-tune your vision and and help you focus at different distances. In some cases only reading glasses are required. Special multi-focal lenses can be considered in an attempt to render you spectacle free, but they are not suited for everyone. Please discuss your visual requirements beforehand with your ophthalmologist. A test for new glasses can be performed by your optometrist a month after the surgery.