English
Ελληνικά Cataract
Cataract is the clouding of the lens in the eye. The lens is found behind the colored tissue which has a circular opening and is called the iris. In a normal eye, the lens is clear. It helps focus light rays on the retina (nerve sheath at the back of the eye), sending the light message to the brain and thus allowing us to see. When the lens becomes cloudy and cataract develops, light rays have difficulty passing through the retina and vision becomes blurred.
What symptoms does cataract cause?
Cataracts often develop slowly and cause a gradual decrease in vision that at some point cannot be corrected by changing glasses. In some people, vision can deteriorate relatively quickly. In addition, it causes discomfort from the sun or bright light, difficulty in driving at night and multiple images (e.g. double image-diplopia) that significantly reduce the quality of vision.
Are there different types of cataracts?
Yes. Most of the time the cataract appears with advancing age but in other cases it appears in newborns (congenital cataract), after taking drugs (e.g. cortisone) or after injuries to the eye (traumatic cataract).
Are cataracts related to diabetes?
Yes. Cataracts are more common in patients with diabetes mellitus.
Are cataracts a sign of aging?
Most often, cataracts develop late in adulthood. It can occur at any time after the age of 40. The normal aging process results in clouding of the lens. Cataracts do not always require treatment. It is usually operated on when it causes symptoms and reduces the quality of vision.
How do I know I have cataracts?
In the initial stages, the cataract is usually not noticed because it does not cause vision problems. In more advanced stages you may notice blurred vision. In most cases, the presence of a cataract does not alter the appearance of the eye. More rarely you may see the pupil have a yellowish, cloudy tint or appear white. Additionally, as cataracts progress your eyeglass prescription changes at a relatively rapid rate. In the more advanced stages, even changing the prescription of the glasses does not help to correct your vision, and the vision is still blurry even when you wear your glasses.
Eye examination for cataract detection
In the examination we first take a good history of the problems you have had with the eyes as well as any health problems you have and the medication you are currently taking. We then proceed to measuring vision without glasses as well as measuring vision corrected with glasses. We examine the eye in the slit lamp, measure the intraocular pressure, and most often use drops to open the pupil and examine in detail the lens (which is clouded) and the retina (the lining at the back of the eye). Because the drops that open the pupil cause temporary blurred vision we advise you not to drive when you come to the office for a cataract examination.
Treatment
When should I have cataract surgery?
In most cases, cataract does not harm your eye. It is usually safe not to have surgery if you feel that the blurred vision does not bother you. You need to have surgery when the cataract is advanced enough and the clouding it causes prevents you from doing your daily activities. The modern method of cataract removal has excellent results in the vast majority of patients. However, there can rarely be complications as with any other operation.
Is there anything I can do to slow the progression of cataract?
There is no proven method to stop the progression of cataract.
I have cataracts in both eyes. Can I operate on them at the same time?
Most people develop cataracts in both eyes but not necessarily at the same stage. After the appropriate clinical examination we can advise you on the benefits and risks of the operation in both eyes at the same time.
Instructions before surgery
We will explain in detail what you need to do before the surgery. It is important not to wear makeup on the day of surgery to reduce the risk of infection. You should also not wear makeup for at least a week after surgery.
Do I need special tests before surgery?
Yes. Special measurements are needed to calculate the power of the plastic intraocular lens that will replace your lens. These measurements are taken before the day of surgery, usually during the appointment at which you decide to proceed with the operation. If you wear contact lenses, you usually need to refrain from using them for 1 week for soft lenses and 2 weeks for hard lenses in order to optimize the reliability of the measurements. In addition, a general blood test and an electrocardiogram are required.
I had laser myopia/hyperopia correction. Can it affect cataract surgery?
In case you have had refractive surgery (laser surgery to get rid of your glasses) you must definitely inform us. Previous refractive surgery can affect the measurements we take to calculate the power of the intraocular lens. Sometimes after cataract surgery in eyes that have undergone laser refractive surgery, there may be more nearsightedness or farsightedness than originally anticipated. In this case, we can correct the refractive error by doing another laser and less often the surgical change of the intraocular lens is required.
What exactly does cataract surgery involve?
The modern method of cataract removal involves a tiny incision in the cornea (the clear window of the eye) and then a procedure known as phacoemulsification. During phacoemulsification, the lens is crushed using ultrasound and removed via a special pump. A clear-transparent artificial lens ( intraocular lens ) made of plastic material is placed in the eye. The back of the original lens capsule is held in place to provide support for the intraocular lens. The corneal wound is extremely small and most often closes without the use of sutures. Sometimes we may need to use sutures that are absorbed or removed in the office.
Can cataract be removed using a laser?
In recent years, a special type of laser has been developed that can be used for the initial steps of the operation. Phacoemulsification as previously described is still necessary. Nowadays, cataract surgery cannot be completed only with the use of a laser.
What exactly do I feel during the operation?
During the operation you lie down and your face is covered by a special sterile cover. If for any reason you cannot lie on your back or if you are claustrophobic, you must tell us before the operation so that we can do our best to make you comfortable during the operation. During the operation the surgeon uses a microscope with a bright light. The sterile drape covering your face and the bright light prevent you from seeing the operation or the tools we use. Some patients report seeing shadows or colors during surgery. You may sometimes feel the surgeon’s hands on your forehead or cheek. As the phacoemulsion machine uses quite a bit of liquid during the procedure, you may feel liquid running down your cheek, ear or throat.
What kind of anesthesia is needed?
The operation is performed under local anesthesia which means that you are not asleep during the operation but the eye is anaesthetised. To anesthetize the eye we use drops or an injection with anesthetic around the eye. In some cases, sedation and very rarely general anesthesia may be used.
Should I be hospitalized?
No, cataract surgery is performed on an outpatient basis and you go home on the same day.
Are there different types of intraocular lenses? Do I need glasses after surgery?
There are different types of intraocular lenses that may be used during cataract surgery.
Monofocal lenses
These lenses allow you to see clearly either far or near. In most cases, we prefer to correct distance vision (so you can see well far without glasses) and use glasses for near vision, e.g. to read a book. During the pre-operative examination we can properly advise you on the advantages and disadvantages of correcting for far or near distance using a monofocal intraocular lens. Usually correction to make the eye see well near is recommended for patients who are used to removing their glasses to read. If the eye is corrected to see well near, then glasses are needed for distant vision.
There is also the possibility to correct distant vision in the dominant eye and near vision in the non-dominant eye. This allows the patient to do most things in their daily life without the use of glasses which are usually only necessary for reading small letters at a very close distance. To make sure that this option is to the patient’s liking, we usually do a simulation using contact lenses before the cataract surgery.
Multifocal Lenses
These lenses correct vision for both distance and near distance. They are not suitable for all patients and can sometimes affect the quality of vision. We can give you more information during your pre-operative examination.
Toric Lenses
These lenses are similar to monofocal intraocular lenses and have the ability to correct astigmatism. If you have enough astigmatism, using a toric intraocular lens reduces the chance of needing glasses for long distance after cataract surgery. You will need glasses for the near distance as in the case of a monofocal intraocular lens. They are not suitable for all patients and a special corneal examination is needed before their safe use.
Some issues that can arise with the use of a toric intraocular lens are the following:
- The toric lens may not correct all astigmatism, so long distance glasses may be required after surgery.
- If complications arise during surgery, the use of a toric intraocular lens may not be possible.
- As the toric lens must be placed with its axis in a specific position within the eye, in case of deviation from this position, a second corrective surgery may be necessary to ensure good and clear vision for the long distance.
Color perception
The cataract causes light scattering and selectively absorbs blue light. After surgery, the new lens ( intraocular lens ) is very clear and usually the colors look much brighter than before. The lenses we use have UV filters but we advise you to wear sunglasses when outdoors in strong sunlight to prevent UV rays from reaching the retina.
Are there any possible complications from cataract surgery?
The possibility of vision loss after cataract surgery is very rare. Serious complications after cataract surgery are generally rare.
- There is a 1:1000 chance of severe and permanent vision loss due to infection or bleeding in the back of the eye.
- There is a 1:100 chance that you will need a second corrective surgery
- There is a 1:20 chance of a minor complication that may need appropriate treatment during or after surgery
- 1:10 patients need laser treatment some months or some years after surgery to treat the clouding of the posterior lens capsule that occurs over time.
What should I watch out for after cataract surgery?
If you have any of the following symptoms, you should let us know immediately.
- Swelling of the eyelids, intense redness inside the eye, blurred vision, purulent discharge. These can be symptoms of a serious infection that occurs 2 to 6 days after surgery.
- Blurred central vision. It usually happens a few weeks after the surgery and is due to swelling in the macula (i.e. fluid that collects in the area of sharp vision at the back of the eye)
- Red eye and pain when you stop treatment with the drops we give after surgery. This is usually due to a reactive inflammation and needs treatment with anti-inflammatory drops.
- Distortion of vision. It rarely happens if the intraocular lens is displaced and usually requires corrective surgery to reinsert the intraocular lens into the correct position.
- Shadows, flashes or small black spots. You may see a sort of shadow or a bright crescent at the edge of your field of vision for some time after surgery. This happens because of the different way light passes through the new lens (the intraocular lens) and reaches the retina. Within a short time the eye adjusts and the shadow or crescent disappears. More rarely, these symptoms may be related to a retinal tear or retinal detachment. If you notice flashes, many small red or black spots, or a “black curtain” that blocks your vision, you should see us immediately for a proper retinal check.
Care after surgery
What will my eye look like immediately after surgery?
The eye after surgery is covered with an eye pad and a plastic transparent shield. The eye is usually left with the eye pad and the plastic cover until the next day. We remove it when you come in for your post-op exam. You need to wear the plastic cover for 7 to 10 days when you sleep so that you do not press on the operated eye without realizing it.
On the day of surgery, you may feel pain in the eye or a sensation of a foreign body (as if there is a piece of trash in the eye). For pain you can take pain reliever such as paracetamol or ibuprofen. The foreign body sensation is due to the tiny incisions we make on the surface of the eye and improves with time and the use of artificial tears. The eye usually fully recovers 2 to 4 weeks after surgery, but sometimes this time can be a little longer.
How should I put the drops?
We will show you the correct technique for putting in your drops after surgery. The procedure is as follows:
- Tilt your head back
- Gently pull the lower eyelid down with one hand
- You look up and with the other hand squeeze the bottle so that a drop falls into the lower eyelid. Don’t worry if more drops fall – the amount the eye can hold is specific and the excess is removed in the form of tears.
- Do not touch the eyelids with the plastic tip from the dropper bottle.
How can I wash my face or my eye after surgery?
We advise not to pour tap water into your eye for a week after surgery. You can clean the eye with sterile gauze and saline. If you want to wash your hair, we recommend tilting your head back to prevent water from getting into your eyes for the first 7 days.
What else should I watch out for after surgery?
You should not touch or rub your eye for the first 7 days after surgery. It’s a good idea to wear sunglasses when you’re outdoors in the sun because the bright light can bother you. You can usually resume your activities or go to work 2 to 3 days after surgery. If you do manual work or work that requires a lot of time in front of a computer screen, you usually need more days to safely return.
When can I get new glasses?
We usually check for the need to use glasses and give a new prescription 6 weeks after the operation. In this period or between the operation of the first and the second eye you may face a little difficulty if there is a significant difference between the refractive error of the 2 eyes. In this case you can wear your old glasses and we advise that you see your optician to remove the old lens in the operated eye until you can get your new glasses fitted.
Can the cataract return?
No. Cataract surgery is done only once. Sometimes the posterior capsule can become cloudy behind the new lens (the intraocular lens) that we put in the eye. This happens in about 1 in 10 patients. It’s called a posterior peripheral opacification, and it’s treated with a laser—an easy procedure called YAG laser capsulotomy (see YAG laser capsulotomy).