Cataract
When asked, many people wrongly believe that a cataract is a “film” or “cloudiness” that grows on the outside of the eye. This is incorrect. A cataract is actually a problem that develops within the lens inside the eye.
The lens of the eye lies behind the coloured part (the iris) of our eye. This lens functions like the lens of a camera, allowing the eye to focus on objects at different distances in front of it. When we are young, this lens is clear. As we age, the protein within the lens degenerates, resulting in clouding of the lens. The cloudy lens is called a cataract.
Most cataracts are simply the product of natural aging of the lens of the eye. Therefore, everyone’s eyes will form cataract over a certain age. Cataracts are commonly seen over the age of 50 years old, and most commonly cause symptoms over the age of 60 years old.
Some conditions may cause specific types of cataract, or accelerate the formation of cataract. These include:
- Prolonged exposure to sunlight, or radiation
- Certain medications, particularly oral steroids
- Diabetes
- Eye trauma
- Eye inflammation
- Congenital (present at birth)
- Hereditary (strong family history of cataracts)
Cataracts will cause a disturbance in your vision. These visual problems will usually come on quite gradually, but often reach a “tipping point” where they will quickly bother you and interfere with important activities in your life, such as reading, driving or working.
You may experience one or more of the following symptoms with cataracts:
- Blurred vision or hazy vision
- Doubling or “ghosting” of the edge of objects
- Glare or sensitivity to bright lights during the day
- Reduced night vision, and haloes around headlights or streetlights
- Wearing your usual prescription glasses no longer gives clear vision
You may have initially thought that your blurred vision was simply due to a need for a new pair of glasses, or that your glasses need a good clean! However, once a cataract forms inside your eye, glasses outside of the eye will not improve your vision. This is not the fault of the glasses, but rather a sign that your cataract may now need to be treated.
There is only one treatment for cataract, and that is surgery. In cataract surgery, the cloudy lens is removed from your eye and replaced with a new artificial lens implant (intraocular lens implant). This restores clear and optimal vision to your eye.
There is no right or wrong time for cataract surgery. As every patient has different visual needs for their activities and lifestyles, they will differ as to the optimal time for their cataract surgery.
However, it is important to know that we do not have to wait for your vision to become very blurry, or for the cataract to become very “hard”, before recommending surgery. As the safety and outcomes from modern cataract surgery have improved to such remarkable levels, we are proactive about fixing your cataracts. We will generally recommend surgery as soon as you experience symptoms, or if your reduced vision is beginning to restrict important activities such as reading, driving or working.
Dr Then will help guide you as to the safest and most appropriate time for your cataract surgery.
Cataracts are currently treated with surgery, not with laser alone.
However, a recent development is that of Femtosecond Laser-Assisted Cataract Surgery (FLACS), in which femtosecond lasers are used to assist in various steps of the traditional cataract operation, but not to do the entire operation itself.
Currently FLACS does not offer significant benefits to most patients undergoing routine cataract surgery. Dr Then can discuss your suitability for this if you wish.
Cataract surgery
Cataract surgery is performed as day surgery, and involves the removal of the cloudy lens from the eye, and insertion of an artificial lens implant (intraocular lens) in its place. Here’s how cataract surgery works at Peel Vision.
Cataract surgery
Cataract surgery is performed as day surgery, and involves the removal of the cloudy lens from the eye, and insertion of an artificial lens implant (intraocular lens) in its place. Here’s how cataract surgery works at Peel Vision.
Cataract surgery is the removal of the cloudy lens (cataract) from the eye and insertion of an artificial lens implant (the intraocular lens implant) in its place.
The main aim of cataract surgery is to improve the visual disturbance caused by cataracts. This usually means clearer sharper vision for most patients after cataract surgery.
However, it is important to remember that aging and other problems in the eye can also reduce vision. Some of these eye problems may have already been present before the cataract formed or may have been diagnosed at the same time as the cataract. If these eye problems are present, they may limit the final visual outcome after cataract surgery.
We always advise that cataract surgery will only fix the cataract, not the “whole eye”, but it will usually give patients back their best possible vision.
Depending on the type of intraocular lens that is implanted in each eye during cataract surgery, patients may enjoy some freedom from spectacles after cataract surgery.
Generally, most patients will have problems from cataracts in both eyes and will therefore need cataract surgery to both eyes to give them their best vision. Cataract surgery is usually performed on one eye at a time, two weeks apart. This is to ensure that one eye is safe and fully heals before the other eye is operated on.
Cataract surgery is performed as day surgery in hospital and generally is a quick operation, taking on average 10 mins to complete.
As cataract surgery is so quick, it is usually performed under local anaesthetic with light sedation.
The eye is numbed with anaesthetic eye drops as well as an anaesthetic injection placed into the lower eyelid (not the eye itself). The anaesthetic will take all pain and vision away, so that patients do not feel or see anything during their eye surgery. Having a local anaesthetic also means that patients can return home fully alert, without any of the grogginess or side effects of a deeper general anaesthetic.
Occasionally a general anaesthetic will be recommended. For example, patients who are extremely claustrophobic, anxious, or unable to lie flat and still for the duration of the operation, may require a general anaesthetic. They should still be able to return home the same day.
Cataract surgery is performed as day surgery, meaning that patients will return home the same day. Patients will usually be admitted to hospital at least 2 hours prior to surgery as the preparation process is intensive, mostly involving the instillation of frequent eye drops to prepare the eye for surgery.
Once the cataract surgery is complete, an eye pad is placed on the eye. Patients are observed on the ward for 1-2 hours after surgery before being discharged home with their carer. Patients are not allowed to take a taxi or drive themselves home.
Patients (and their carers) should allow the entire half-day for the cataract surgery process to be complete (the entire morning or afternoon, depending on when their surgery is).
Patients are instructed to remove their eye pad on waking the next day and begin applying their prescribed postoperative eye drops. These eye drops will be supplied to them at the end of their surgery.
Patients will have an appointment to attend Peel Vision within the first few days after each cataract surgery for a review and to ensure that they are not having any problems.
The final postoperative check-up is usually 6 weeks after surgery. At that visit Dr Then will ensure that the eye has fully recovered and that the patient is fully satisfied with their visual result.
Most patients will have blurred vision for at least the first few days after cataract surgery, as the eye recovers. It will take time for the eye to heal and adapt to the new intraocular lens implant in the eye. Generally, most patients will start to recover clear sharp vision within the first week after surgery, and most patients will have vision good enough to drive and work within 1-2 weeks.
If patients require glasses after their cataract surgery, Dr Then will advise them which glasses are most appropriate and how best to obtain them. New glasses should be obtained no earlier than 6 weeks after surgery, to ensure that the eye and vision are fully recovered and stable.
All surgery carries risk and cataract surgery is no different. For most patients, the risks are manageable and predictable. It is generally rare to experience serious complications during or after cataract surgery. However, each patient will be thoroughly counselled as to their individual risks.
- Increased glare or light sensitivity
- Dry eye symptoms
- Haloes or starburst around night lights
- Floaters more apparent in vision
- Rupture of the capsule holding the lens during surgery
- Severe infection
- Severe or permanent swelling of the cornea
- Retinal tears or retinal detachment
Even though these complications may occur, it is very rare for them to result in severe or permanent visual loss, particularly if they are detected and treated appropriately.
DO:
- Complete the full prescribed course of postoperative eye drops provided
- Keep the eye clean and safe
- Wear dark glasses when outdoors, and use additional eye drops for dry eye
- Drive when your vision feels clear
- Return to work when your vision feels clear
- Return to recreational activities when you feel comfortable to do so
- Resume any contact lens wear on the advice of Dr Then
DON’T:
- Drive within 24 hours of surgery
- Swim within the first 4 weeks after surgery
The cost of surgery is variable depending on whether or not you have private health insurance that covers for cataract surgery.
1. If you have Private Health Insurance:
We recommend contacting your health fund to check if you are covered, before proceeding with any bookings.
You will be quoted for any out-of-pocket expense (gap) for your surgical fee, prior to making any booking for surgery. Dr Then is committed to capped gap agreements to minimise patient costs. Your health fund will advise you if you have any hospital excess to pay for your admission, and our anaesthetists kindly do not charge an out-of-pocket expense for cataract surgery.
Using your private health insurance gives you the choice of hospital for surgery and allows you to book surgery at your convenience.
2. If you don’t have Private Health Insurance:
a) Public
Public surgery is available at Peel Health Campus for Medicare card holders. There is no cost involved with public surgery however there is a wait list. The length of time waiting for surgery is unpredictable and can vary with government restrictions. Multifocal lenses are not available as a public patient and some restrictions for surgery may apply depending on your locality.
b) Self-funded surgery
Self-funding surgery is an option for patients who do not have private health insurance, do not want to wait (or do not qualify) for public surgery or who want multifocal lenses not available in the public system. Cost is variable depending on lens type, Concession and Medicare eligibility.
Feel free to contact our team for further details.
The intraocular lens implant
The IOL is an artificial lens that is placed into your eye after the cataract is removed.
The IOL is made of acrylic and is designed with a set prescription in it to match the prescription of your eye. It therefore functions much like an “internal pair of glasses”.
We now have an amazing array of artificial lens implants to choose from when performing cataract surgery. However, there is no such thing as the “perfect lens” and each lens has its pros and cons.
Deciding on the correct lens implant for each patient is critical and does take time and care. Dr Then will thoroughly assess each patient and counsel them as to the safest and most appropriate lens for them. This decision will depend on multiple factors including but not limited to:
- Patient age
- The prescription of the eye
- If any other eye conditions or eye disease are present
- Patient occupation or recreational activities
Ocular biometry (the measurement of the shape and power of the eye) is also critical in ensuring that the correct lens implant is chosen for the cataract surgery.
Click here for a link to Measuring the eye for cataract surgery (ocular biometry).
Many patients are keen to be rid of their glasses after cataract surgery. Whilst the lens implant placed in the eye can certainly reduce a patient’s dependance on their existing glasses, it is not always possible to completely free patients from glasses for all activities.
We may achieve the following visual results for patients following cataract surgery:
Distance vision without glasses
The most common lens implant that we use is known as a MONOFOCAL lens. This will focus the vision of the eye into the distance, meaning that patients may not have to wear glasses for distance activities such as driving, watching TV and playing sport. However, they will still need glasses for near activities such as reading and computer.
Distance Intermediate and Near vision without glasses
Some lens implants or lens combinations will also allow patients to perform both distance and near activities such as reading and computer without glasses. These include:
1.MULTIFOCAL lens implants
2.EXTENDED DEPTH OF FOCUS lens implants.
3.MONOVISION (one eye focused for distance, and one eye focused for near with a MONOFOCAL lens)
Not all patients will be suitable or eligible for these lens implants and lens combinations. Dr Then will discuss the pros and cons of these lenses where appropriate.
The lens implant is designed to last forever within the eye. It does not need to be removed or changed.
However, whilst the lens never changes, the eye does age and change around the lens so some patients will find that their vision may change over time, and their glasses may also change prescription over time.
It is rare to have to remove the lens implant because patients do not tolerate or like them.
However, if cataract surgery does not achieve the visual result that we expect, and it is due to an unexpected inaccuracy from the lens implant, then the lens implant may be exchanged. This is a rare event and does carry some risk which will be discussed with you.
The cataract will never “grow back” in the eye. It has been permanently removed, and the lens implant permanently replaces it within the eye.
However, a small proportion of patients may develop a clouding of the bag that holds the intraocular lens in the eye. We call this Posterior Capsular Opacification (PCO). It occurs in approximately 20% of patients after cataract surgery, usually within the first 5 years. PCO is effectively treated with laser.
Click here to learn more about Laser treatment for haze after cataract surgery.
