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What Is a Cataract?
A cataract is a clouding of
the normally transparent lens of the eye. Light rays entering the eye are
scattered and prevented from focusing sharply on the retina, the light
sensitive tissue lining the back of the eye. Symptoms include blurred vision,
sensitivity to light and glare, distortion, and colour changes.
Prevention
Avoid the insults to nutrition
such as smoking and excess alcohol consumption. Protect your eyes
from UV sunrays. A dietary supplement of Lutein and the
antioxidant vitamins A/C/E with
zinc is recommended. Very low dose aspirin may also help.
Types of Cataracts
There are mainly three types of
cataract.
Nuclear cataract
occurs in the center of the lens. This type is the most
common form of cataract and is associated with the natural aging process.
Cortical cataract
begins with spoke-like formation extending from the
outside of the lens into the center. When the spokes reach the center, blurring
and glare result in loss of vision.
Subcapsular cataract
develops very slowly and starts at the back of the lens.
Symptoms may not appear until the opacity is well developed. Subcapsular
cataracts are often found in patients with taking steroids for extended periods.
Small Incision (Phacoemulsification) Cataract Surgery
Indications
Cataract surgery should be considered when the vision has deteriorated to a
level which is causing problems with daily activities. Individual people have
different visual requirements and the level of vision at which cataract surgery
is indicated will differ between individuals. It is no longer necessary to wait
for a cataract to be “ripe” before surgery is carried out.
Anaesthetic
The operation is usually carried out under a local anesthetic to numb the eye
but in some cases a general anaesthetic may be indicated.
Procedure
The operation is performed using an operating microscope. A small incision
(2.5-3.5 mm) is made into the eye at the upper edge of the clear cornea (the
front window of the eye). A “porthole” is then made in the front surface of
the transparent membrane (capsular bag) surrounding the lens inside the eye. A
small probe is inserted through the opening of the capsule into the lens.
Ultrasound is used to gently break the cloudy lens into very small pieces which
are then sucked out of the eye through the tip of the probe leaving the
transparent capsular bag in place. A replacement artificial lens implant is then
usually placed within the capsular bag. Rarely an artificial lens is not
implanted because the eye is considered unsuitable, usually because of the
presence of other eye conditions.
In some cases the incision may be closed with one stitch. In many cases a tunneled
incision can be created which is self sealing at the end of the
operation and does not require stitches. The surgeon will test the wound at the
end of the operation to make the final decision as to whether or not a stitch is
required.
Length of the Operation
This varies depending on the complexity of the cataract but is usually between
15 and 30 minutes.
Time in Hospital
Cataract surgery is usually performed as a day case procedure but an overnight
stay may be required.
Post operatively
After surgery the eye may be uncomfortable with a sensation of grittiness but
there should be no severe pain. Standard pain killers are usually adequate for pain relief.
For the first 24 hours after the operation the pupil is dilated and the eye will
be light sensitive with some blurring of the vision. Some patients can
experience double vision during this period until the local anaesthetic, which
has been used to numb the eye, has worn off.
After small incision cataract surgery a patient may return to normal daily
activities the following day. This includes reading and watching TV and moderate
exercise. Patients are able to return to a light desk job after a few days.
Strenuous activity such as heavy lifting should be avoided for the first 2
weeks. Even with an artificial lens implant patients may still need a thin
spectacles lens to correct for astigmatism and any remaining spectacle error
(including reading spectacles). Spectacles are usually prescribed within 3 weeks
of small incision cataract surgery.
Time off Work
Clerical work can be resumed after 2 days. Manual work can be resumed after 2-4
weeks.
Risks and Complications
As with any surgical operation complications can occur.
The possible complications of cataract surgery include:
Serious problems however are very uncommon and the majority can be treated
successfully.
Following removal of the cataract (the cloudy lens) the transparent capsular bag
surrounding the lens is left in place. In between 10 and 20% of patients this
capsular bag will subsequently thicken in the months or years after cataract
surgery leading to a gradual blurring of the vision. In this case an outpatient
laser procedure taking only a few minutes can be used to make an opening in the
capsular bag and restore clear vision.
Outcome
Cataract surgery has a very high success rate
with over 90% of patients achieving a satisfactory improvement in vision
following the operation.
The improvement in vision after cataract surgery will depend on the health of
the rest of the eye.
Not every patient is suitable for small incision phacoemulsification cataract
surgery, usually because of their eye condition or other health factors. These
patients can have traditional cataract surgery and expect to do well.
Eyecare-Plus | 8 Rodney Street Edinburgh EH7 4EA | Tel.
0131 556 7836 | e-mail |
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