Cataracts

What is a cataract?

The lens is the primary focusing mechanism of the eye. As we age, this crystal clear lens becomes cloudy and yellow and looses its elasticity, or ability to change focus. When this occurs, it is called a cataract.

Who is at risk of having a Cataract?

Symptoms of cataracts

  • Clouded, blurred or dim vision
  • Increasing difficulty with vision at night
  • Sensitivity to light and glare
  • Seeing “halos” around lights
  • Frequent changes in eyeglass or contact lens prescription
  • Fading or yellowing of colors
  • Double vision in a single eye
Vision Before Cataract
Vision With Cataract

When should I have the surgery?

Cataracts should be removed when they begin to affect your daily lifestyle. When glare and blur interfere with driving, or you give up your favourite hobby, it is time to consider having surgery.

The surgery

Small Incision

A tunneled incision is made in the sclera one to three millimeters above the iris. Through this tiny incision, the surgeon will remove the cataract and implant a foldable lens. Due to the architecture of the incision, the surrounding tissues overlap to make the incision self sealing. Your surgeon may decide to use a stitch when needed.

Phacoemulsification

The most modern method of removing a cataract is through the use of phacoemulsification. The phacoemulsifier is an ultrasonic probe which vibrates 40 000 times per second. It breaks a cataract up into tiny microscopic pieces which are emulsified and gently aspirated out of the eye. This method of cataract removal is considered the least traumatic to the eye.

Insertion of the lens

A specially designed injector, much like a syringe, is used to implant a foldable replacement for the human lens, needed to restore focus to the eye. This implant is called an intraocular lenses. The injector is inserted through the scleral tunnel incision, over the iris, into the centre of the pupil. There, the lens is slowly injected where it expands and unfolds into position.

 

What will my vision be like after the op?

Before surgery, you and your doctor will determine which intraocular lens is best suited for you.
The current choices are :

  1. Monofocal Implants
    (a) Both eyes are corrected for distance and you need reading glasses after the surgery
    (b) Some people prefer to see near after surgery and choose a “near” lens
    (b) Monovision : a slight undercorrection for distance in the non-dominant eye to give some reading vision and distance vision in the dominant eye.
  2. Bifocal or multifocal implants are available but not routinely used.
    These have elements for both far and near. However, many patients complain of glare when driving at night with these implants.
  3. Toric implants are available in both obove options to correct astigmatism.
  4. Accomodating IOL eg: Crystalens by Bausch & Lomb
    Crystalens® has a hinge on either side of the implant that allows the lens to bend and it is said to actually mechanically shift focus between near and far.
In Far Position
In Near Position

What can I expect after the op?

Vision

People vary in how quickly they see clearly following the operation. You may suffer from droopy eye lid/double vision. The vision may be out of focus for a while.

Arcs of Light

It is common for people to see arcs of light especially at night and reflection in their vision after the surgery. This is due to internal reflection of light from the implant and is normal. It will settle after a few weeks.

spots

Most patients see some new spots floating in their vision for a few weeks following surgery. If there are a large number of spots associated with flashes of light please let us know.

Watery eyes

It is common post-operatively for your eyes to water, particularly if you ever had a tendency to watery eyes before the surgery. This can sometimes be annoying and there is not much that can be done about it and we normally just have to wait for it to stop spontaneously.

Dry Eye

Some people develop a dry eye after surgery. In most people it gets better after 3 or 4 months. Sometimes however in some people who were predisposed to dry eye it becomes permanent.

Will I still need spectacles after the op?

Everyone is different and how your eyes respond to surgery will vary. While a lot of people will not need specs after surgery, most people will need specs for either distance or reading purposes, depending on your choice of the implant.

Temporary reading glasses maybe used while waiting for the final spectacles. You may start using these from the first post op day, as they will do NO harm.

At approximately three to four weeks after surgery you will need to be tested for final spectacles(if required) by your local optometrist.

Can a Cataract grow back?

Once a cataract is removed, it cannot grow back. The thin posterior capsule that is left behind to act as a platform for the implant can opacify over a period of 3 months to 10 years. When this happens you will notice your vision starting to blur or get misty as though you are looking through a dirty window. Many people call this an “after cataract”.
Please book an appointment when this happens and I will advise you if I need to “polish” the implant. This requires puncturing a small hole in the posterior capsule(through which you will see more clearly) using a.Yag laser.