Cataract is a disease which makes an eye lens to appear cloudy, thus reducing the eyesight. A normal eye lens assists in focusing light onto the retina for clear and undistorted image appearance. When a cataract forms in the eye, it makes images appear blurred and distorted. Although cataracts can sometimes develop quickly, in most cases, they form gradually as a person grows old. Most cataracts victims have both of their eyes affected by the disease, and the rate of development of the illness is equal in the two eyes. A cataract is a prominent disease, particularly in elderly people.
The exact cause of cataracts isn’t known. Nevertheless, the majority of cataracts cases seem to be a result of variation in the structures of proteins, causing the lens to appear cloudy. Although it happens in rare cases, people can develop cataracts upon birth or in their early childhood due to genetic diseases or inborn systemic infections. The development of cataracts can also be accelerated by serious eye trauma, surgical operation, or inflammation of the eye. Too much exposure to ultraviolet light or ionization radiation, diabetes, cigarette smoking, and particular drugs like steroids can make one develop cataracts at an early age. The use of statins, as well as phenothiazines, for a long period can also lead to cataracts.
By 2010, it was approximated that cataracts cases rose to 30 million. People with cataracts find it difficult to perform tasks which need clear eyesight, such as night driving, reading, and identifying people among others.
Candidates for Surgery
Not all cataract cases require surgical operation, since some people whose eyes are affected by the disease don’t have any significant issues with their vision. With the aid of a magnifying lens, brighter lighting, or prescribed spectacles, some people with cataracts have clear sight. However, with time as they develop, cataracts can lead to more issues.
Cataracts can cause a reduced, unclear, or yellow vision or simultaneous perception of two images while viewing a single object or scene.
Various types of cataract surgery
Being an outpatient case, cataract surgery is usually carried out in a hospital or ASC. Phacoemulsification is applied in the most popular cataract surgery method. A surgeon numbs the eye having a cataract by using drops or an injection and then slightly cuts the eye surface inside or beside the cornea. The surgeon inserts a tiny ultrasound probe into the affected eye and breaks up the clouded lens using ultrasonic vibrations. The ultrasound probe is again used to remove the small broken-up pieces of the lens. The vacant area previously occupied by a cataract is filled with a man-made lens. The artificial lens assists the eye to focus well after the operation.
The three standard cataract surgery methods include:
- Phacoemulsification: As per the above explanation, this is the most prominent cataract surgery method. It is a modern technique, which only requires less than an hour to remove the cataract, and only slight sedation is needed. The surgeon uses eye drops or an injection to numb the affected eye and doesn’t use stitches to close the incision. Additionally, a patient doesn’t need an eye patch after the operation.
- Extracapsular cataract surgical operation: This operation is mostly applicable when cataracts have become serious such that they can’t be emulsified due to high density. A larger cut is needed for the removal of the whole cataract without breaking it down in the eye. Just like the phacoemulsification method, an unnatural lens replaces the natural lens in the capsular bag. The wound is closed using multiple stitches, and patients take a longer time to regain their healthy eyesight. A numbing drug is administered into the eye using an injection. A patient needs to wear an eye patch after the operation.
- Intracapsular cataract surgery: This technique involves the removal of the affected eye lens together with the surrounding capsules simultaneously. Therefore, it requires a larger cut than that needed in an extracapsular operation. The intraocular lens is then put on a different area at the front area after the iris. Although its application is rare, intracapsular cataract surgery can be beneficial in certain cases.
Preparation for cataract surgery
To determine the most appropriate artificial lens for you, your doctor will measure your eye’s size and shape one or two weeks prior to your eye surgery day.
You may be required to abstain from eating or drinking anything for twelve hours prior to the operation.
During the operation
The operation takes less than an hour. The majority of patients feel a slight pain.
You will be conscious throughout the procedure, since the surgeon numbs only your eye. You may also be required to take some medication to make you relax.
The front part of your eye is slightly cut, and tiny equipment is inserted into your eye to fragment the cataract, and then the fragmented pieces are removed using the same tool. The surgeon then inserts an artificial lens (plastic, silicone, or acrylic) to replace your damaged lens. He will then close the cut, probably using stitches.
Although cataract surgery is an outpatient case, you will need a person to take you home. If cataracts affect both of your eyes, you may be required to have two separate operations scheduled at an interval of a few weeks. This will enable your first eye to recover before the next one is operated.
Probable problems and adverse effects of cataract surgery
Although cataract surgery is one of the most effective and safest surgical operations, it can cause rare problems, like endophthalmitis or bleeding. Before signing a consent form, your ophthalmologist will let you know some of the complications that you are likely to experience as a result of the procedure. The most prevalent complications that occur as a result of the operation are constant inflammation, glaucoma, endophthalmitis, cystoid macular edema, as well as the detachment of the retina. In a case where the bag which holds the lens is injured, the unnatural lens may be required to be put in a different area. The removal, exchange, or repositioning of the intraocular lens may be required if the lens moves. Although these problems are rare, they can make a patient lose significant eye sight. Therefore, you need regular followups with your surgeon after the operation. However, cataract surgeries aren’t a solution to degeneration of muscles, damage of the optic nerve, or the presence of floaters in your eyes.
For some months or years after the cataract surgery, you may have unclear eyesight. You may feel like your eyes have developed cataracts again. This is a process known as capsular opacification or a "secondary cataract." To help you regain your sight, your surgeon creates a hole on your thin lens capsule using a laser. The procedure is painless and takes a very short time in an office. You will regain your sight immediately after the procedure.
Briefly, the side effects comprise of:
- Infection or swelling of the eye
- Detachment of the retina
- Loosening of the artificial lens
- Cystoid macular edema
After the operation
Itching or soreness may be present in your eye for several days after the operation. You may notice some fluid discharge from your eyes, and you may also have sight problems in the presence of bright light.
You may be given eye drops to avoid infection. You’ll need to take it easy for a few days. Avoid driving, bending over, picking up heavy weight, or pressing your eye in any way for several days.
You may be required to sleep with an eye protector for one week after the surgery for faster recovery. Contact your doctor immediately in case you feel pain or take too long to recover.
Your eye should recover completely eight weeks after the surgery. Approximately 9 out of 10 people have improved eye sight after cataract surgery. However, don’t be a perfectionist in your expectations; you may be required to continue with wearing spectacles.
Overall, cataract surgery is very safe and effective. However, be sure you discuss any concerns with your ophthalmologist or surgeon.