What Is Cataract ?
Many people think that a cataract is a skin or a layer of tissue that grows over the eye. A cataract is the clouding of a part of the eye called the lens. Vision becomes blurred or dim because light cannot pass through the clouded lens. Over half of those over 60 have some cataract development and most cases can be treated successfully with surgery.
Where is the lens?
The lens is a transparent body that lies behind the iris, the coloured part of the eye. Its main function is to focus light onto the retina.
What causes a cataract?
In most cases, it is a degenerative change of the lens (an ageing process) as people get older. Until today, there is no medication or diet that effectively slows down or stops the development of cataract. The best solution to this problem is still surgery.
What are the symptoms?
- Blurred vision (glaring)
- Change of colour vision
- Double vision
- Increases in spectacle power
Cataract surgery involves the removal of the opaque lens surgically and replaces it with a clear artificial lens made of special material. Normally, cataract surgery is performed as day care surgery with local anaesthesia and some sedation.
Patient with pre-existing short sighted or farsighted refractive error may find that they do not need to wear thick glasses for best vision after cataract surgery. This is because the eye surgeon will normally choose an intraocular lens that will reduce the pre-existing refractive error. Thus, modern cataract surgery, especially phacoemulsification, can also be classified as a type of refractive surgery.
Cataract Removal : An ultrasonic probe is inserted through a tiny incision. The probe break the cloudy lens into pieces, then vacuums them away. This is called phacoemulsification.
Lens Implantation :
The cataractous lens is replaced with an artificial intraocular lens(IOL). The IOL is inserted in precisely the right spot, where the haptics, or "arms", gently unfold to keep it centered.
Vision Restored :
Once the Cataractous lens has been removed and replaced by the IOL, light once again passes through, focusing on the retina to provide a clear, sharp vision.
Phacoemulsification is the most advanced technique in cataract surgery. This technique involves using an ultrasound instrument to emulsify the lens and then aspirate the lens through a small incision.
There are a number of advantages from using a small incision:
- Earlier visual rehabilitation
- Minimal surgical induced astigmatism
- More predictable surgical outcome
However, due to the complexity of the surgery, the success of this surgery is highly dependent on the skills of the surgeon as well as good equipment. This is the surgery of choice recommended by our experienced eye surgeons. To complement the expertise of the eye surgeon, Centre for Sight uses modern equipment to provide a high quality eye surgery to our patients.
Day care surgery
Presently, most cataract surgery is being performed as a day care surgery. This means that the patient does not need to be hospitalised after surgery.
The INFINITI® Vision System combines unparalleled fluidics with unique energy delivery systems that provide you with options for efficient cataract lens removal: the OZil™ Torsional Handpiece. These patented technologies deliver enhanced fluidic stability and surgical control. You can customize to individual patients' anatomical variations and choose your fluidics and custom energy solutions according to your technique and individual patient needs. Increased surgical control delivers greater potential for obtaining better surgical outcomes and safety than with traditional phacoemulsification technologies. Torsional phaco improves efficiency and offers precise energy delivery with reduced repulsion that increases followability with an improved thermal safety profile.
The OZil™ Torsional Handpiece is a totally new approach to ultrasound lens removal offered on the INFINITI. Torsional phaco utilizes ultrasonic oscillatory movement that can benefit lens removal for all densities of lenses. The side-to-side movement of torsional phaco provides decreased repulsion while improving the thermal safety profile over traditional ultrasound.
There are multiple surgical benefits to decreased repulsion:
- Increased followability
- Reduced potential for turbulence
- Increased cutting efficiency
- Improved thermal safety profile
For more information visit www.infinitivision.com
Multifocal Lens Implant
Up to quite recently, the only option was to implant a monofocal lens which provides excellent vision after cataract surgery-but only at one set distance-usually predetermined for seeing things at a distance. Therefore, monofocal lenses will allow clear vision when at the movies or driving.
The downside to monofocal lens implants is that glasses will most likely be required for any type of near vision like reading, sewing or keeping your golf score.
In general, patients who choose to have monofocal lens implants will be dependent on glasses either some or most of the time in about 70% of cases. Patients who choose to have multifocal lens implants will only be dependent on glasses either some or most of the time in about 15% of cases. So, patients choosing multifocal lens implants typically experience greater overall freedom from glasses allowing them to participate in most everyday activities without dependence on, or the hassle of glasses.
While the goal of multifocal lens is to decrease a patient's dependence upon eyeglasses, there are some tradeoffs with the lens. The design and technology utilized by these lenses will create some degree of haloes around lights at nighttime. This halo effect is not problematic during the daytime because of the smaller size of everyone's pupil in daylight. The more the patient's pupil normally dilates in the dark, the more evident this phenomenon will be at nighttime.
Fortunately, this is more of a distraction rather than something that interferes with vision, and the human brain is excellent at adapting to such images over time. The overwhelming majority of patients are able to get used to this, such that it becomes much less bothersome or noticeable over time. Having the multifocal lens in both eyes seems to facilitate this process of adaptation. However, like many other visual symptoms, some individuals have more difficulty adapting than others do.
The multifocal lens is not an appropriate option for many patients. Reducing the frequency of wearing glasses is not a priority for everyone, and the individual patient's lifestyle and activities should be considered. For various reasons, the multifocal lens will not work as well in certain eyes. This is generally true if there are other ocular health problems, poorer visual potential, small pupils, and significant astigmatism.
Both multifocal and standard monofocal lens can provide excellent vision following cataract surgery. If the surgeon identifies a patient to be a good candidate for the multifocal IOL, then this is an option to consider if one wishes to try to reduce their dependence on glasses.
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Cataract Frequently Asked Questions
When should I go for surgery?
If there is significant visual impairment affecting one's daily activities such as driving, reading, working or things one enjoy, then it is the right time to consider surgery. Cataract surgery only becomes necessary if you are not happy with your vision and want to see better. Consult our doctor if you have any questions or concerns about your vision.
What if cataract is not removed?
Complications of mature cataract may happen, such as lens-induced glaucoma and lens-induced inflammation of the eye.
Does cataract surgery hurt?
Thanks to anesthetic drops and medications to help you relax, this procedure involves only minimal discomfort. During the procedure, the patient is awake.
I have cataracts in both eyes. Will the surgeon treat both eyes at the same time?
Typically, the surgeon will perform cataract surgery in the second eye two or three weeks after the first eye. All patients are different, so it is best to consult the surgeon about special circumstances.
How long will I be in the centre for the surgery?
Patients commonly spend only a few hours at the centre and can enjoy the comforts of their home after the procedure.
How long before I can return to normal activities?
Most patients can resume normal basic activities like reading and watching TV by the next day, and return to work within two to seven days. Doctors typically recommend against any strenuous activity for two or more weeks. However, results vary for different patients, so you should ask our doctor what is best for you.
Will I need glasses after cataract surgery?
It depends on what type of intraocular lens you choose to have implanted. Most patients do not need glasses or contacts for distance vision following cataract surgery with a traditional monofocal lenses , but may require reading glasses for near vision. However, should the patient choose multifocal lens implant, four out of five AcrySof® ReSTOR® IOL patients reported never wearing glasses for distance, intermediate or near tasks after their surgery.
Can my cataract recur?
No. Once a cataract has been removed it cannot recur. However, over time, some patients may complain that their vision has deteriorated. This well documented condition which may occur following cataract surgery is known as a secondary cataract or "PCO" (Posterior Capsular Opacity). This is not a true cataract but rather an opacification of a membrane behind the implanted lens. Secondary cataracts can be easily treated by a simple laser procedure performed in the clinic.
Any precautions after surgery?
Every patient is different, so be sure to ask our doctor for advice on eye care after the procedure. The surgeon may ask you to refrain from rubbing your eye or engaging in any strenuous activity for a few weeks after surgery.
Who do I call if I have a problem?
Consult our doctor immediately if you have any problems, especially if you experience decreased vision or pain.