Cataract

Cataract surgery is the most common ophthalmic procedure in the world. According to scientific research, it is also the most effective treatment among all the surgical procedures. Cataract surgery, commonly referred to as “removal” or “extraction” of the cataract, involves removing the natural lens from the eye and replacing it with an artificial, plastic lens.

Everybody can develop a cataract. But it may occur at different age in different people. Cataract should be removed when it starts interfering with the daily and professional life of the patient. It is not necessarily the same moment for everyone. Patient should decide when to remove the cataract in consultation with a physician. In our Clinic, during cataract surgery, different types of intraocular lenses (monofocal, bifocal, diffractive, toric, etc.) are inserted into the eye, depending on the needs and demands of the patient. Dr Agnieszka Nowosielska has performed more than 5 000 primary cataract surgeries so far. She has also performed surgeries in more complicated clinical cases, such as: subluxated cataract, luxated cataract, very dense cataract, cataract after vitrectomy and after buckling surgery, cataract with pseudoexfoliation syndrome or in patients with high short-sightedness.

What is cataract?

Cataract refers to the clouding of the lens, which gradually loses its transparency and becomes as opaque as matt glass. Unfortunately, the clouding of the lens is a normal, age-related process. It is typically developed by elder people, especially over the age of 60. However, it can also occur in younger people as a consequence of other medical conditions, such as diabetes, or as a result of an eye trauma. Another type of cataract, a so called congenital cataract, can occur even in very young children. This kind of cataract must be removed immediately; otherwise, child’s vision will be hampered permanently. Cataract can develop slowly, leading to a progressive vision deterioration, or progress very quickly.

What is complicated cataract?

Complicated cataract refers to the clouding of the lens which is secondary to other eye diseases or changes. This type of cataract most frequently coexists with different types of glaucoma. If this is the case, an ophthalmologist has to decide whether to treat cataract and glaucoma at the same time or not. Complicated cataract frequently occurs in patients with far-sightedness. The bigger the lens is, the more difficult the surgery becomes. Another type of cataract is a subluxated cataract, in which suspensory ligaments of the lens (a mechanism that normally holds the lens in place inside the eye) do not work properly. In such cases, it may be not possible to insert a standard lens. If so, a special one, which can be attached to the eye, must be ordered.

How is cataract detected?

The most common symptoms of cataract include: cloudy or blurred vision, fading of colours, double vision, rapid deterioration of vision, seeing “halos” when looking at light or sun, difficulty with vision at night. Unfortunately, all these symptoms are also characteristic of other eye diseases. That is why, the patient should consult an ophthalmologist in order to learn what disease he or she is dealing with.

 

What causes cataract?

Developing a cataract is a normal, age-related process. Clouding of the lens can be compared to the appearance of wrinkles or grey hair – it concerns everybody, but it may occur at different ages. Clouding of the lens is a result of its “usage”, but it may also be due to eye trauma, harmful radiation or other eye diseases. Cataract can also be genetically predetermined, but it regards another type of cataract that occurs in children or in very young adults.

How is cataract treated? What does cataract surgery consists of?

The only available method of treatment for cataract is its surgical removal. The procedure involves removing the natural lens and inserting an artificial one inside the eye simultaneously, using a special ultrasound device.

Ultrasounds break a hard lens into small pieces, that are later removed from the eye with suction. This can be compared to the functioning of a little vacuum cleaner. After removing the lens, a new, artificial one is inserted in the same location. The whole surgery normally lasts about 20 minutes and the patient is allowed to return home an hour after the procedure is completed. Until now, no eye-drops or tablets have been proved to stop the process of cataract progression.

What types of intraocular lenses exist? What is the difference between them? How to choose the right type of intraocular lenses?

Cataract surgery normally involves inserting into the eye a monofocal lens that is designed to provide clear vision at a single focal point (far or near). Depending on the visual impairment from which the patient suffered before the surgery, he or she may need to wear glasses in some situations, for example, for reading or for distant vision. Cataract surgery allows not only to replace a clouded lens with a transparent one, thus removing the cataract, but also to choose the right lens in order to correct the pre-existing visual impairment. Therefore, it is possible not only to remove the cataract, but also to remove the necessity of wearing glasses for reading as well as to correct astigmatism, short-sightedness or far-sightedness. Patients who, for a variety of reasons, do not want to use glasses, not even for reading, can decide to have inserted a special diffractive or multifocal lens during the surgery. This type of lenses is very advanced and technologically developed. Even though they work almost as well as young people’s natural lenses, it should be remembered that even the best lenses do not guarantee the perfect vision. Despite the changes, the eye is not new. Learning how to look through new lenses is usually very fast, but some patients may perceive the changes in the quality of vision differently. It is slightly more complicated to choose the right lens for patients with astigmatism. Astigmatism needs to be corrected with one pair of glasses for reading and another one for daily use. However, there are cataract surgery options that can eliminate the need for glasses. Vision gets even better than when wearing glasses, as the lens is placed inside the eye, in its natural location. Toric lenses can be adjusted so that using glasses is necessary only for reading or not necessary at all.

What glasses will I need after the cataract surgery, depending on the visual impairment before the surgery, if a standard, that is a monofocal, lens is inserted?

What type of lens should I choose, depending on the visual impairment before the surgery and expectations concerning the need for glasses afterwards?

It should be noted that choosing the right lens is an individual matter. What is good for one person may not necessarily be the best option for another patient. When choosing a type of lens, it is essential to consider all the diseases which the patient suffers from, both ophthalmic and general. On occasions, it is the patient’s health that determinates the choice of lens. The final decision should be taken in consultation with a doctor.

Does cataract surgery hurt?

Cataract surgery is absolutely painless. Before the surgery, local anaesthesia in the form of eye-drops is administrated together with analgesics and sedatives administrated intravenously. During the surgery, patients feel nothing but the touch.

Is my vision going to improve after the surgery? Am I going to restore normal vision after the surgery?

After the cataract surgery, vision always improves. However, the degree of improvement depends on whether the eye is healthy or affected by any other disease. If, apart from cataract, the patient suffers from other eye diseases, such as glaucoma, AMD or diabetes, vision will improve only as much the eye condition allows it to.

It is not possible to answer the question whether the patient will restore normal vision after the surgery. Vision after the cataract surgery will not be the same as in times of youth. Artificial lens, that corrects the vision after the surgery, is a prosthesis. Every prosthesis, even the most expensive and advanced, has its limitations. Cataract surgery does not consists of replacing the eye with a new one, young and healthy, but of improving the condition of the eye considering its circumstances. However, it should be noted that lenses that guarantee the greatest possible improvement are available on the market. The lens can be adjusted so that there is no need for glasses. The decision about what lens to choose should be taken according to the individual situation of the patient and in consultation with the ophthalmologist carrying out the surgery.

What are the possible complications after the cataract surgery? Is cataract surgery safe?

Cataract surgery is a safe procedure. According to the statistics, it is the procedure burdened with least postoperative complications. However, it should be remembered that every eye is different and has different circumstances. More complications may arise in the case of complicated cataract. On occasions, it is not possible to insert the lens and an additional procedure has to be performed. Nevertheless, current technical and surgical capacities lead to vision improvement in almost every case.

Does cataract surgery need to be repeated? Can cataract recur?

Cataract surgery does not need to be repeated. The lens, once removed, does not regrow, so it does not need to be removed again. However, the posterior lens capsule, in which an artificial lens in inserted, can sometimes become cloudy, leading to the development of a secondary cataract.

What is secondary cataract?

Secondary cataract does not refer to the re-growing or recurring cataract. It is due to the clouding of the posterior lens capsule, that is a special bag in which an artificial lens is placed during the surgery. The posterior lens capsule is the residue of the lens, which can become less transparent over time. The problem may be solved by performing a laser procedure. It is quick and painless and the vision is restored, as just after the surgery.

Are there any contraindications for cataract surgery?

There are no particular contraindications for performing a cataract surgery. Every cataract can be removed.

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