by Dr Paul Zhao Cataract is the clouding of the lens of the eye which causes blurring of vision. This occurs with increasing age in general though younger age groups may also develop cataracts as well. When the blurring of vision from cataract is severe enough to affect your daily life, then surgery can be performed to restore vision. In this guide, we'll cover everything you need to know about cataract surgery, including:
Symptoms of cataracts:
Patients most commonly experience slowly progressive, painless blurring of vision. One eye may be more affected than the other. Some individuals may also experience increased glare, poorer vision at night, and loss of color vibrancy.
Indication for cataract surgery:
Cataract surgery is recommended when visual impairment affects one’s usual daily activities. This can vary from person to person depending on what the individual’s visual requirements are. For example, a person who needs to drive at night has higher visual demands and will likely require cataract surgery earlier than another person who is home bound with limited mobility and has lower visual requirements. There is no absolute cut-off age for cataract surgery.
Types of Cataract Surgery:
Cataract surgery involves removing your existing lens and replacing it with an artificial lens that can correct the refractive power of the eye. For example, a patient who is short-sighted can have this corrected by placing the appropriate powered lens in the eye with cataract surgery.
There are two main types of cataract surgery: phacoemulsification and extracapsular cataract extraction (ECCE).
Phacoemulsification is the most common type of cataract surgery and involves using a small ultrasound probe to break up the cloudy lens into smaller fragments and remove it through a small incision.
ECCE is an older procedure that involves removing the lens in one piece through a larger incision and is now done only for very advanced cataracts.
Laser-assisted cataract surgery
Femtosecond laser-assisted cataract surgery is where a precise laser replaces some, but not all, steps of standard phacoemulsification. It aims to reduce damage to the inner surface of the cornea and increase the precision of intraocular lens placement.
The laser would first be performed at a separate machine, before the patient is transferred to the surgical bed for completion of the cataract surgery. Your surgeon will need to evaluate your suitability for this procedure and advise whether it is necessary.
Who should consider Laser assisted cataract surgery?
Laser assisted cataract surgery is beneficial for patients with less healthy corneas. It is currently not done routinely for all cataract surgeries. The decision for using laser should be discussed with your eye doctor.
Benefits of Cataract Surgery:
Cataract surgery can significantly improve your vision and quality of life. Benefits of the surgery may include:
• Improved vision: Cataract surgery can help you see more clearly and vividly.
• Better color vision: Many people report that colors appear more vibrant after cataract surgery.
• Improved night vision: Cataracts can make it difficult to see in low light conditions, but cataract surgery can improve your night vision.
• Reduced glare: Cataracts can cause glare and halos around lights, but cataract surgery can reduce these symptoms.
• Special lenses are also available to improve reading vision for selected patients who are suitable for such lenses.
Risks of Cataract Surgery:
While cataract surgery is generally safe and effective, there are some risks associated with the procedure. These risks may include:
• Infection: The risk of infection with cataract surgery is less than 0.1%
• Massive Bleeding: This is an extremely rare complication which occurs in 1 in 30000
• Cornea Swelling: This may occur in the initial period after surgery especially for more advanced cataracts and can take a few days to a few weeks to fully resolve. The vision will be foggy and blur but slowly improve as the cornea swelling subsides.
• Retinal detachment: This may occur in less than 1-2 percent of patients after routine uncomplicated cataract surgery.
Preparing for Cataract Surgery:
It is important to inform your surgeon if you had laser refractive surgery performed (e.g. LASIK, PRK, epi-LASIK, SMILE) previously. This information is very important in ensuring accurate calculation of the intraocular lens power.
You will need to stop wearing contact lens (at least one week for soft lens and at least two weeks for hard lens) prior to undergoing the assessment in order to accurately calculate the lens power.
On the day of your surgery, you should avoid wearing contact lenses and eye makeup. You should also arrange for someone to drive you to and from the surgery, as you will not be able to drive immediately following the procedure.
During Cataract Surgery:
Cataract surgery is typically performed on an outpatient basis and takes less than 20 minutes to complete. Eyedrops are instilled to numb the eye and ensure the procedure is painless and sedation is often also given to calm the patient. Some patients even fall asleep under the sedation during surgery.
During the surgery, your eye doctor will make a small incision in your eye and use an ultrasound probe to break up the cloudy lens. The lens fragments will be removed, and a new artificial lens will be implanted in its place.
Types of Intraocular Lens:
Monofocal IOL - For patients who don’t mind wearing spectacles, the choice of a monofocal IOL is commonly preferred. It offers the best image quality, but for only one distance. Standard monofocal lens aim to correct for distance vision. However, reading glasses will still be required for near vision.
Monovision is a form of presbyopic correction whereby one eye is corrected for distance and the fellow eye is left slightly short-sighted after cataract surgery to enable some degree of near vision. However, depth perception may be compromised and some patients may also not be able to tolerate this imbalance between both eyes.
Multifocal IOL - There are 2 broad categories of such lenses.
1. Trifocal lenses
Such lens reduces spectacle dependence by correcting for both distance, intermediate and near vision. However, these IOLs may be associated with increased glare and haloes and reduction in contrast resulting in poorer night vision than a monofocal lens. Multifocal lenses are generally not recommended if you have had previous refractive surgery.
2. Extended Depth of Field lens (EDoF) correct for distance and intermediate vison with less glare and haloes. Night vision is also not compromised as much compared to the trifocal lenses
Toric IOLs are available for both monofocal and multifocal lenses. Some patients may have high corneal astigmatism that requires correction. Standard IOLs do not correct for astigmatism. Although this can be corrected with the use of glasses post-operatively, toric lenses can be used with the aim to reduce the residual astigmatism.
After Cataract Surgery:
Following your cataract surgery, you will be given eye drops to prevent infection and reduce inflammation.
It is common to experience some discomfort, swelling, and sensitivity to light in the days following your surgery. You should avoid rubbing your eye, and also avoid tap water from entering the eyes for at least 3 weeks after surgery. Frequently Asked Questions (FAQ)
- What can I do to prevent cataract?
- There is no known prevention for cataract. However, standard precautions such as wearing sunglasses to reduce ultraviolet ray exposure form the sun may slow down its progression.
- What happens if I leave my cataract(s) untreated?
- Cataract(s) cause progressive loss of vision and eventually if blindness if left untreated. In uncommon circumstances, it may lead to acute glaucoma where there is a sudden spike in the eye pressure causing eye pain, headache and blurring of vision.
- Will the Cataracts grow back?
The lens capsule may become cloudy over time. This is not the Cataract coming back. If you notice this happening, visit your eye doctor for a painless laser treatment which can be done by the doctor at the clinic.
- How long with the lens implants last?
The lens implants last a lifetime.
- Do I need to avoid seafood after the procedure?
There is no food restriction.
- How soon can we return to work after surgery? Depending on the healing process, you will normally be given 2 weeks to 1 month of medical leave.
In summary, cataract surgery is a safe and effective procedure that can significantly improve vision and quality of life. It is essential to consult with an eye doctor to determine if cataract surgery is the right option for you and to follow post-operative instructions to ensure proper healing.