What is a Cataract?
What are the Symptoms of Cataract?
Cataracts may cause you to have reduced vision which may be foggy or blurred. You may find it more difficult to see things. Cataracts can also cause symptoms of glare which may effect you particularly if driving at night.
What can be done about it?
A cataract operation will remove the cataract and replace it with a new clear lens. This is is usually very effective at improving your vision and reducing the symptoms caused by the cataract.
What does a cataract operation involve?
Cataract surgery is usually done as a daycase under local anaesthetic. You would usually spend a few hours in hospital in total. The procedure would be performed in the operating theatre.
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Will I need glasses after cataract surgery?
We can calculate what strength of the artificial lens we put in to replace the cataract lens to reduce your dependency on glasses after the surgery.
The various options should be discussed with your cataract surgeon before the surgery is performed.
Monofocal lenses: Most commonly patients receive a monofocal lens which will give them good distance vision after the surgery. You would require glasses for reading and other near activities. You may choose to wear bifocal or varifocal glasses to avoid putting glasses on and off for near and distance even though your distance prescription would be small.
What is a premium IOL?
The new lens we insert into the eye to do the job of the natural lens which has become cloud is called an IntraocularLens (IOL). A standard IOL is a monofocal, non-toric lens. It will usually aim to focus you for good distance vision and it will not-correct astigmatism. These are the most commonly inserted lenses. For most people they are the ideal choice.
Premium lenses include toric lenses or multifocal lenses of combined toric multifocal lenses. There is an additional cost to these lenses. Most health insurance plans do not cover this extra cost so a supplemental payment is required.
Multifocal Lenses: A multifocal lens is a premium lens designed to give you good distance vision and good near vision. If you decide that being free of glasses for all activity is important to you then a multifocal lens is a good option. The main downside to multifocal lenses is that you may see glare or haloes around lights. This typically would effect people most when driving in dim light. Some people find this bothersome while others perceive it but aren't very bothered by it.
Extended Depth of Focus Lenses (EDOF). These are premium lenses which are designed to give you better near vision than a monofocal lens. They are not designed to give as good near vision as a multifocal but they are less likely to give the symptoms of glare or haloes that a multifocal can cause.
The decision largely comes down to patient preference and patient personality. Some people prioritise being glasses free while others prioritise vision quality.
Toric IOLs: If you have significant astigmatism, you may be offered a toric IOL. This is a premium lens which corrects astigmatism. You can select a toric monofocal or multifocal lens.
Are there any risks with Cataract Surgery?
Generally Cataract Surgery is very safe and most patients have no complications at all. However like any surgery there are risks.
Common side-effects of cataract surgery would include some discomfort in the initial 12 hours following surgery. Over the counter analgesics such as Paracetamol, Ibuprofen or Solpadeine are usually advised for this.
Some people can have a foreign body sensation (like there is an eyelash in their eye) initially. This resolves quite quickly. A gel lubricant such as Vidisic Gel or Gel Tears can help with this.
People can feel like the eyes are gritty or dry for a period after cataract surgery. The use of artificial tears such as Hylo Tear, Hyabak, Systane, Celluvisc or Artelac SDU drops can help with this. Any dryness due to the surgery will resolve within weeks of the surgery.
On the day of the surgery the vision in the eye can be very blurred. People might experience some double vision until the local anaesthetic has worn off. By the following day you should be seeing out of the eye. Some people have excellent vision the day after cataract surgery. Many people have foggy or misty vision for several days after cataract surgery. This usually resolves within a few weeks.
Thankfully the risk of a serious complication such as bleeding inside the eye, infection or retinal detachment which would result in very poor vision is very low. This would affect less than one in a thousand patients.
In less than one percent of patients there is a problem which may require a second operation before the vision is restored. This may happen a number of weeks following the first surgery. This may occur when there is a lack of support for the new lens due to a defect in the natural capsular bag which we usually use to hold the new lens in place. This may mean that a new lens need to be inserted at a later date. Rarely a piece of lens can go to the back part of the eye and needs to be removed as a second operation called a vitrectomy.
In a small percentage of people some fluid in the retina can develop in the weeks following the surgery. This is called Cystoid Macula Oedema. It is usually managed initially with a prolonged course of eye drops. This usually causes the fluid to resolve and the vision to recover. In a percentage of these patients a local steroid injection may be required. This is rarely a persistant problem. Patients with Diabetes Mellitus are more likely to experience this.
Rarely the cornea can remain foggy for a prolonged period after cataract surgery. This is more common in patients with very advanced cataracts or in patients who have a pre-existing disorder of the cornea. If it doesn't clear within months of the surgery sometimes a corneal operation is required. We must remember that cloudiness in the first few weeks is quite common and resolves spontaneously in the vast majority.
It is common that some time after the cataract surgery (ranging for months to many years after the surgery), the natural bag that we have put the new lens into can itself become cloudy. You may feel like the cataract is coming back. Thankfully, this capsule pacification can be cleared quite easily and safely with a quick laser procedure called a YAG capsulotomy. This is usually as once off procedure.
Removing a visually significant cataract improves the quality of vision and reduces glare. However some patients do notice some changes in their vision called dysphotopsias. This is caused by different visual effects caused by the artificial lens. People can notice a different type of glare or duller areas in their vision. Modern artificial lenses have made great progress to eliminate these visual disturbances but they can still occur in a minority of patients. Most patients adapt to these and after a period of time are not troubled by them.
Before your operation you will plan with your surgeon what you are likely to need glasses for after surgery. Even with the most advanced technology to perform the calculations to predict your prescription after the operation, there can be some variability in the final prescription. This may mean that you do not get the expected outcome and would need to wear glasses to correct this. .
Having discussed all the possible problems, it is worth pointing out that the vast majority of patients undergoing cataract surgery have an excellent outcome and are very happy with their improved vision.
We all have a natural lens inside our eye which focuses the light which enters the eye. This natural lens should be clear. If this natural lens becomes cloudy we call it a cataract. Cataracts most commonly occur later in life but they can in fact occur in any age. Sometimes we can identify a reason why someone developed a cataract such as an injury or the use of a lot of steroid medication. Often it occurs for no identifiable reason at all.