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A cataract is a clouding, yellowing or discoloration of the natural lens inside the eye. Examples of common symptoms range from reduced vision (affecting reading, driving and general day to day activities), glare sensitivity, and a sense of just not seeing clearly. It can often be compared to looking through a dirty windscreen. Cataracts are a normal part of the aging process. By the age of 60 half of all people will have some cataract formation although it may be minor and not noticeable. Other causes of cataract include medical conditions such as diabetes, injury to the eye, other chronic eye diseases and rarely some people are born with cataracts. The rate of development of cataract varies, but it is usually a gradual process. Treatment of cataract involves surgery. It is usually performed under local monitored local anesthetic as a day case. It is a successful procedure in 98% of cases. The risks of the surgery will be discussed with your Ophthalmologist but they include infection, retinal problems such as tears or swelling to the retina.
How is the procedure performed?
Cataract surgery is performed with sedation and local anaesthetic. Surgery for the two eyes is done on separate days. A small (2.5mm) incision is made at the edge of the clear cornea and the lens is extracted through this incision using an advanced vibrating ultrasonic probe or laser. An intraocular lens is then implanted into a natural structure in the eye called the capsule (which is like a bag that holds the lens in position). The appropriate strength of the intraocular lens is determined pre-operatively by a series of precise measurements. The intraocular lenses are made of an acrylic material and are expected to outlast a patient’s lifetime. Generally no stitches are required during the procedure.
A short video below explains the essential steps in cataract surgery.
What to expect post-operatively?
Most patients notice a dramatic improvement to their vision within 24-48 hours of their surgery. However it may take up to several months for vision to maximally improve. The eye may be mildly gritty during this time. You are required to take eye drops for approximately one month following surgery and have checkups at one day and 2-4 weeks post-surgery. Strenuous activities such as vigorous exercise or moving heavy objects should be avoided for at least one week. Swimming, diving and other water sports can be resumed within one month. Contact sports should only be resumed following discussion with the surgeon. If you work outdoors in the dirt/dust or are an avid gardener, it is best to avoid these activities for at least one week. Cataracts do not grow back but in approx 10% of cases at thickening can occur on the capsule which may require some laser to spruce up the vision.
Improvement to visual potential
Cataract surgery can only help to improve vision that has been limited by the cataract. If a patient has other underlying problems for example diabetic retinopathy or macular degeneration cataract surgery may not yield as much of an improvement. Your doctor will be able to discuss the individual benefits of surgery with you.
Pregnancy and Breastfeeding
It is important to inform your doctor if you are pregnant or breastfeeding as the topical medications used postoperatively can potentially be harmful to the foetus or baby. This may require delaying surgery until breastfeeding is finished.
Expectations from cataract surgery
The goal of cataract surgery is to replace the cloudy natural focusing lens with a clear intraocular implant. The goal is not to eliminate glasses/or contact lenses altogether. Standard intraocular lens implants can only be selected in 0.50 to 1.0 dioptre steps usually and also do not correct for astigmatism. Hence after cataract surgery, glasses may still be required to give you the best possible general and reading vision.
There have been some recent technological advances in cataract surgery which means that we can now correct for astigmatism and even alleviate the need for reading glasses post-operatively with monovision and multifocal intraocular lenses.
It is important to discuss your options with your optometrist and surgeon to ensure that we meet you expectations with your surgical outcome.