Something that the vast majority of us take for granted is our eyesight, yet when the public is surveyed the majority mention losing their vision as their number one fear. As we age, we typically notice some changes in our ability to see. One of the most common ocular conditions that arises in late adulthood that affects our ability to see is cataracts. The diagnosis and prognosis of cataracts doesn’t have the same connotations it once did. With technological advancements in medicine, cataracts can be treated with often better uncorrected vision than many of us have experienced our adult life. Millions of cataract surgeries are performed worldwide each year, the result being that many people not only enjoy restored vision, but even improved vision from what they had before the cataracts developed.
What are cataracts?
Cataracts are a common condition than normally present in the sixth decade of life, whereby the eye’s intraocular lens becomes clouded, losing some of the transparency that is vital to clear vision. Not all cataracts cause blurred or cloudy vision, it is only when they impair vision to the point that even the most accurate and up-to-date vision prescription impedes a person’s ability to function comfortably that cataract surgery should be considered. Cataracts can be slow to progress, but sometimes develop in the matter of a just a few days. Cataracts can occur due to ocular trauma, diabetes, steroid use, and sun exposure, to name a few. An infant can be born with cataracts, deemed congenital. Congenital cataracts can be severely detrimental to the development of normal vision in an infant or toddler (a condition called amblyopia) and this is one important reason infants should have an eye examination by the age of 6 months. Fortunately, congenital cataracts are often non-progressive and visually inconsequential or benign.
What will happen before surgery?
A comprehensive eye exam is recommended for healthy adults every 2 years, and yearly for those over 60. Part of a complete eye exam includes a refraction to determine your spectacle prescription and what is known as your best corrected visual acuity. Should you be diagnosed with a cataract and deemed a good candidate for cataract surgery, your corneal curvature (keratometry), axial length and anterior chamber depth will be measured. An IOL Master is a device used to determine some of these measurements. The data gleaned from these measurements aid in the calculation of the lens implant’s power most suitable for you. The implanted lens is commonly referred to as an intraocular lens, or IOL, in the medical community.
What happens during cataract surgery?
During your surgery, the clouded eye lens will be removed using small incisions, eye drops to numb the eye for the procedure, topical medications to the eye and eyelids to prevent contamination and pain, and a high frequency ultrasound device to dissolve and remove the cloudy lens. The use of this device, which breaks the clouded lens into tiny little pieces before it is removed from the eye, means that cataract removal can be done using only miniscule incisions. Due to the fact only small incisions are required to enter the eye, the healing time of today’s modern cataract surgery is far faster than it once was, and the risks associated with cataract removal surgery have been greatly reduced. The incisions are so thin and small, they actually self-close without the need for stitches. The risk of blindness with today’s cataract techniques is about 1 in 5000. The two major risks associated with cataract surgery are endophthalmitis and retinal detachment. Endophthalmitis describes an intraocular infection, that usually presents as clouded vision, red eye and discomfort about 4-7 days following surgery. Once the clouded lens has been removed, a new man-made lens will be put into place, this helps restore the refractive power of the original lens, in exactly the same spot that your natural lens was positioned, which is just posterior to the iris and pupil. The entire outpatient procedure takes about 15 minutes to perform, and in most cases you remain conscious throughout. Following surgery, you will be advised to sleep wearing a protective shield for about a week. You will be instructed to take (both in the days leading up to and following your surgery) medicated eye drops to prevent infection, minimize inflammation and to promote healing and eye comfort. Follow-up visits with the ophthalmologist or optometrist are scheduled for 1 to 2 days following surgery, 1 week and then again 4 to 6 weeks after your surgery date to monitor healing and measure your visual progress. In about 30% of cases, a second procedure is required (called a Yag-capsulotomy) to remove secondary opacification of the posterior lens capsule. This is part of the original lens that was intentionally left behind during the original surgery to help keep your new lens implant in place and so as not to disturb the posterior contents of the eye.
A modification of modern cataract surgery involves the use of lasers. Lasers, rather than blades and ultrasonic lens disintegration, are used to allow more precise incisions and to reduce the amount of trauma sustained to the eye intraoperatively. Faster healing and less damage to the corneal endothelium are benefits of using laser-assisted cataract surgery.
Browse through our full list to understand more about common eye conditions, including cataracts, glaucoma, and more.
Watch these short videos on cataracts and cataract surgery. BEGIN