Cataract

Cataract is a word derived from Latin and means ‘waterfall’. It refers to the clouding of the natural lens inside the eye. When cataracts are very advanced, the vision appears as if you are looking through a waterfall.

 

The development of cataracts occurs most commonly as an age-related change of the natural lens and is a process that eventually occurs in everyone. However, cataracts can progress at very different rates in different individuals. For most people, age-related cataracts start to develop around the mid-60s with some symptoms usually evident by 70 years of age. The average age to undergo cataract surgery in Australia is 76.

 

Advanced Cataract

Advanced Cataract

 

Cataracts can also occur at a younger age as a result of trauma to the eye, in association with metabolic diseases such as diabetes, or as a genetically inherited family trait. The treatment of different types of cataracts is the same.

 

Symptoms of cataract

Early symptoms of cataracts include an increased susceptibility to glare during the day or increasing glare from lights at night. Difficulty driving at night is usually the first practical problem associated with cataract development. Later, the clarity of both distance and near vision will start to decline. More light may be needed to read clearly. Eventually the vision will become hazy or dim and there may be loss of the normal perception of colours. Another important sign of cataract development is a failure to see an improvement in the vision with new prescription glasses.

 

Changes in vision due to cataracts develop slowly over a number of years and in the early stages, the eyes can gradually adapt, so symptoms are often overlooked. In about two-thirds of cases, cataracts develop in both eyes at the same time, and in about one-third of cases, in one eye before the other.

 

Posterior subcapsular cataract

Posterior subcapsular cataract

 

Cataract surgery

After consultation with your surgeon regarding your current visual status, your visual requirements and other medical conditions, a decision may be made to perform surgery to remove one or both of your cataracts. At Visionary Eye Specialists, we operate with the most modern and technically advanced small-incision cataract surgery.

 

Before any surgery, further testing will be performed to measure the eye in order to calculate the strength and design of the intraocular lens (IOL) that will be used in your surgery. Corneal topography (mapping) will be performed if you have any significant astigmatism that can be treated at the same time as removing the cataracts. After cataract removal, an intraocular lens (IOL) will be inserted; this has been a standard and routine part of cataract surgery since the early 1980s, and will normally result in you seeing much better then before the operation.

 

traumatic-cataract

Traumatic cataract

 

Cataract surgery is carried out as a day procedure and is associated with minimal discomfort. Intravenous sedation is given to reduce anxiety; in most cases there will be no memory that the surgery has taken place. The operation takes only 15–20 minutes to perform. You will go home with a patch over the operated eye and will return the following morning for your surgeon to review the results.

 

The timing of surgery on your second eye will depend on a number of factors including the strength of your glasses pre-operatively and how advanced the cataract in the second eye is. If you have a strong glasses script, your eyes will feel unbalanced with only one eye operated on, so the second eye may be operated on within 1–2 weeks. If the cataract in the second eye is less advanced, then it may be 6 months or more until the second eye requires surgery.

 

Mature Cataract

Mature Cataract

 

As a general rule, your eye will feel normal and the vision will be stabilised 2–3 weeks after the surgery. During that time you will be using eye drops to prevent infection and reduce inflammation. You will also be seen by your surgeon to ensure the surgery is settling as expected. It is normal to feel that your vision is much brighter after the surgery and sometimes too bright. This will become less noticeable over time. Recovery after the operation varies quite considerably and is dependent on many factors such as age, the density of the cataract, the presence of other general medical conditions such as diabetes, and associated eye diseases such as macular degeneration.

 

Complications of cataract surgery

As with any surgical procedure, there are small risks of complications that can occur during or after cataract surgery. Most of these can be treated and corrected with no loss of function of the eye. The risk of major complications that could result in sub-optimal vision following surgery is very low, less than 1 per 1000 cases, with infection in the eye being the most important cause. Antibiotic eye drops will be given before, during and after the surgery to prevent infection.

 

The sharpness of your vision following cataract surgery will depend on whether you have any co-existing eye conditions such as macular degeneration, glaucoma or diabetic retinopathy. Depending on the design of the intraocular lens used, you may need glasses for some activities, usually reading, but as a rule you will be able to see better without glasses than before the surgery.

 

Cataracts do not recur and, once settled, your eye will not require surgery again. In the years following surgery, however, you may require laser to the capsule that holds the IOL in place. This is sometimes referred to as  ‘secondary cataract’ and is a normal occurrence following the surgery.

 

Cortical cataract

Cortical cataract